This case involves a male patient who presented to his family medicine physician with complaints of abdominal pain and weight loss, at which point he was referred to a gastroenterologist for a consultation. During the visit, the doctor noted symptoms that were consistent for deep vein thrombosis, while blood tests revealed extremely high levels of blood glucose, as well as seriously elevated levels of glycated hemoglobin. Despite these troubling findings, the patient was not slated for additional testing or treatment at that time. Over the ensuing weeks, the patient began to suffer damage to a number of organ systems, including his eyes, kidneys, heart, hands, and feet on a microvascular level. It was alleged that the treating gastroenterologist failed to order an appropriate follow-up after the patient’s troubling test results.
Question(s) For Expert Witness
- 1. Do you have extensive experience treating patients suffering from high blood sugar?
- 2. How soon should an evaluation of blood sugars be ordered when a patient is referred for that specific reason?
- 3. What are the necessary steps that should be taken when high blood sugar is detected?
Expert Witness Response E-004817
As an internal medicine/gastro specialist, I have extensive experience treating patients with high blood sugar, including diabetics. The time at which an evaluation of blood sugars should be ordered when a patient is referred for that specific reason varies. If a person is in ketoacidosis, then immediately. If the person has normal glucose levels then there is no need for emergency assessment. Depending on how high the blood glucose is dictates when or how soon a more thorough assessment or intervention is warranted. The high A1c value supports the presence of end organ involvement such as renal, neurological, and ocular. More information is needed to provide a definitive response, but I am very familiar with the necessary steps that should be taken when high blood sugar is detected and have more than enough experience in this field to serve as an expert on this case. At a glance, it appears that the treating gastroenterologist should have ordered additional follow-up after the patient’s initial test results proved troubling.