Pre-diabetes

Have you been told that you're pre-diabetic? Were you told to change your diet and exercise more frequently? Do you understand what 'pre-diabetic' means? Let's dig in!

Pre-diabetes, hyperglycemia, and high blood sugar are synonymous. A normal, fasting glucose, or blood sugar, for a non-diabetic is usually between 70-110 (results may vary by lab and provider). Do not confuse this test with a hemoglobin A1c, or A1c for short. The A1c is an average of your sugar for the past 3 months. The finger-stick test is what your sugar is right now. A normal A1c for non-diabetics will be below 5.7%.

If your fasting glucose is above 120 and you have an A1c of 5.7%-6.4%, you are pre-diabetic.

If you have two abnormal fasting glucose levels on two different days and an A1c of 6.5% or higher, you are diabetic.

Typically, 2 hours after eating a meal your blood sugar should go back down into the normal range.

If you ate before you had your A1c drawn and the number was high (6.8%), it still means you have diabetes. Again, the A1c is an average of your blood sugar over the past 3 months. One meal before the lab test will not affect this result. It will affect your random blood sugar finger-stick, but not the A1c.

The A1c number increases as your average sugar levels increase.
As the blood sugar number increases, so does the A1c. As a reference, oral medications are usually started first, however, once the A1c reaches 10, insulin is the recommended treatment.

So, now what? What can you do? Take your 'pre-diabetes' diagnosis as a wake up call. Now is the time to change. Now is the time to start the diet and exercise regimen.

Remember a few weeks ago when we discussed fruit, vegetables, meat? This is the new diet. The new norm. Make the changes now so we can delay diabetes as long as possible!

Routine Screenings

Have you had your mammogram? What about a prostate exam? A colonoscopy? When do you need these tests? I'm so glad you asked!

The US Preventative Services Task Force has reviewed multiple screenings and decided when and what should be done and how frequently. Let me share the most common with you broken down by gender. This is not exhaustive by any means, but it will be the most common, most basic tests that should be completed routinely. Obviously check with your PCP and see if you need these or any other tests.

WOMEN

• Pap smears
• Generally begin at age 21
• If normal, only need testing every 2-3 years.
• Breast exams
• Annually beginning at age 21
• Mammograms
• Annually beginning at age 40
• Earlier if necessary (personal or family history of breast cancer, etc).
• Colonoscopies
• Stool test first beginning at age 50
• If positive, then colonoscopy.
• If negative, repeat annually.
• Personal/family hx may change these recommendations.
• DEXA scan
• Osteoporosis screening at age 65

MEN

• Prostate exams
• Typically with blood work first beginning at age 55
• Colonoscopies
• Stool test first beginning at age 50
• If positive, then colonoscopy.
• If negative, repeat annually.
• Personal/family hx may change these recommendations.

EVERYONE

• Labs should occur based on your personal history.
• If you have diabetes, every 3-6 months typically.
• If young/healthy, every 1-2 years.
• Should include checks for anemia (CBC), liver/kidneys (CMP), cholesterol, HIV, Hep C (if you were born between 1945 and 1965).

New NP advice

I'm almost 5 years into my practice and have only recently felt like I'm no longer a novice. This does not mean I am now an expert, not by a long shot, but it means I'm not running to a resource every time a patient comes in with a complaint!

Looking back to the beginning, what would I tell myself? What would I have spent more time on in school? Let me share with you!

1. Spend a lot of time on pathophysiology. The patho, the way the body works specifically in a diseased state, is so important. You can spend an entire lifetime learning about cells, the way they respond during times of disease and stress, the end-organ results, etc. When you then add medications to the disease process, it changes a lot of things-kidneys, liver, other disease processes. The more you continue to work on your pathophysiology, the better off you'll be.

2. Mind your own business. In the age of social media and being 'friends' with everyone it is easy to blur the lines of friends and colleagues. The party from last weekend may have unintended consequences during the work week. If you're friends with one person and not another it can cause unnecessary drama at work.

3. Practice what you preach. People are watching you. Patients, coworkers, administration. There are eyes (and ears) everywhere. Being impeccable with your word, minding your own business, and doing what is required (and expected) of you will go a long way.

4. Keep in touch with your NP classmates. There are 2-3 girls I'm in regular contact with. Whether to ask a question ("If the patient had the BCG vaccine in their original country, do they need treatment when their PPD comes back positive?" (No, order a CXR. Most likely positive from antibodies from BCG vaccine; pt shouldn't have another PPD, thanks Aileen!)), or if you just need to vent, it helps to have someone in the same boat as you.

5. Have a mentor. While I don't have a formal mentor, there are several nurses in my life and one NP friend. I love seeing her at conferences and sharing my experiences with her. She is always available if I have questions regarding nursing, my practice, or my personal life. She has more years experience than my classmates and knows me better than my colleagues.

Are you a new NP? A seasoned veteran? What have you learned about your job over the past several years?

Blood donation

Have you ever donated blood? Did you know that if you're 17 and weigh at least 110 lbs, you can donate? It's that simple!

The entire process takes about an hour. When you're done you get to sit and enjoy a snack and some juice or water.

There are several types of donations available but the most common, whole blood, takes a pint of blood. You're eligible to donate a pint of blood every 56 days. Believe me, once you're on the registry, they'll call you! 

There are two other processes; platelet apheresis and plasma apheresis. Both of these are longer, about 2-3 hours, and some of your "blood" is returned back to you! These allow specific blood components to be extracted for donation while the other products of blood are returned back into you via another IV in the other arm.

The most requested blood is O-, the universal donor. Anyone can receive blood from an O- donor. Especially during times of crisis (9-11, hurricanes, earthquakes), blood is needed. One pint of whole blood is just that; one unit and all given to one patient. One unit of plasma or platelets can help multiple people. All are extremely valuable and important.

Besides helping your fellow man, another great component of blood donation is a mini-physical! They check your vitals and keep record. They are able to notice trends in your blood pressure and weight, both of which you may not be aware! Finally, I had one patient bring me lab results from the Red Cross stating they had done extensive blood testing and found a genetic marker for a specific disease. He was following up with me for additional testing. Had he not donated he may never have known he was at increased risk!

What are you waiting for? Go donate today!