letters to the editor
Dear Editor:
... Continued from pg. 9
bral edema and even death. Many children with DKA
present to a medical professional within a week of their
DKA admission, but symptoms of diabetes are not recognized or pending investigations delay the diagnosis.
When diabetes is clinically suspected, preliminary
diagnosis can be made on the basis of urine dipstick
(glucosuria +/- ketonuria) or finger prick measurement
of blood glucose. According to the Canadian Diabetes
Association (CDA) Clinical Practice Guidelines (2013),
laboratory testing, such as a random or fasting glucose
or a hemoglobin A1C, is not required prior to referral for further evaluation and management. If serum
measurements are obtained during the initial evaluation, a random blood sugar ≥ 11.1 mmol/L or a fasting
≥ 7.0 mmol/L, in the presence of diabetes symptoms,
are diagnostic.
When a diagnosis of diabetes is highly suspected or
confirmed, same-day consultation with a specialist is warranted. For very ill children, ER referral and/or admission to a pediatric ICU may be necessary. Initiation of
same-day insulin therapy is nearly always warranted, even
for well appearing children.
For pediatric patients, the Canadian Diabetes Association and pediatric diabetes care providers would
generally highlight these key messages:
1. lassic diabetes symptoms – particularly polyuria or
C
polydipsia – justify point-of-care screening investigations such as a blood glucose by glucometer or urine
dipstick analysis (glucosuria +/- ketonuria).
2. hen symptomatic diabetes is suspected, laboratory
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confirmation is not required prior to consultation.
3. uspicion of new-onset type 1 diabetes warrants
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same-day consultation with a specialist.
Sincerely,
Mark Inman, MD
Pediatric Endocrine Fellow
Hospital for Sick Children
Mark Palmert, MD
Head, Division of Endocrinology
Hospital for Sick Children
10
Re: Stolen Prescription Pads
(Volume 10, Issue 2, 2014)
When I opened my private practice many years ago,
I arranged to meet with my lawyer to have notarized
specimen signatures for cheques and prescription. The
cheque signature was a different combination of initials
and written out names. The specimen signatures were
written on my office letterhead. The original copy was
kept in my safety deposit box. My lawyer and my Power
of Attorney each had a copy of the specimen signatures.
I chose to do this because my cancelled cheques were
in my office in a locked cabinet but if someone stole
a prescription pad and a cancelled cheque to forge a
signature they would have some difficulty with the
prescription. I had duplicate prescriptions that I kept in
the patient files but I cut off the area where the signature was on the duplicate and shredded the signature.
I must admit that when I opened the office I was
shocked at how easy it was to have a prescription pad
printed. I walked into the printer and ordered all of my
office supplies without having to provide any identification. If I were in practice today, I would hope to have
a secure electronic prescription transmission to the
patient’s pharmacy.
Sincerely,
Greta Toni Swart, MD
Consulting Psychiatrist, Applied Research and
Education, CPRI
Omission:
In our last issue of Dialogue, we listed the names of all the
Ontario physicians who had participated in the activities of
medical regulation in the previous year. Unfortunate