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Conflicted in this scenario so I am putting out for the masses to advise. I'll keep it fairly to the point. Scenario: You have a new EMT join your volunteer squad who is a non-insulin dependent diabetic. They take oral hypoglycemic agents. This EMT has experienced multiple incidents involving low blood sugar while on duty or otherwise present at the station. Incidents have been varied in severity, but all resulting in inability to function in a patient care role. This EMT is considerably overweight and is openly engaging in crash dieting and you think the two are obviously connected. They have also been treated at the ER for fluid/electrolyte issues. They have been mandated by the chief to check their blood sugar every two hours while on duty; seems compliant. Also been mandated to consume a meal BEFORE reporting for duty, since they may have a call right at shift change and be unable to eat. They habitually fail to eat prior to reporting for duty and seem very hesitant to eat unless they start to feel sick. As a squad officer, what do you do? 1. At what point do you suspend them from duty? Is there any possibility that doing so could be considered discriminatory? 2. What conditions would you put in place if you were to allow them to return? (written contract, perpetual third rider status, MD letter, etc) 3. At what point do you consider contacting family/parents, etc due to suspected life threatening eating disorder? Age 19. You also have some suspicions of histrionic/Munchausen type behaviors.

I am trying to understand the relationship of a "high risk of diabetes" A1c and Blood Glucose Level as it concerns the primary diagnosis of diabetes. The scenario is a 72 y/o slightly overweight female that receives a consult at an urgent care clinic. Her chief complaint is "just haven't been feeling very good". Patient request blood testing. Physical examination is negative. Her BGL is 105 mg/dl and her A1c is 6.2 %. My questions are these: 1. Is the A1c only relevant in the diagnosis of diabetes because her BGL is over the threshold of 100 mg/dl? 2. If she lowered her blood glucose through diet and exercise would the A1c become less relevant or is an A1c of 6.2% have a free standing relevance? 3. Should the patient modify diet and exercise and have the test performed again after she seeks a consult with an internist?

What would you do if someone had a blood sugar of 558?>