Non-invasive Glucose Monitoring

An Introduction to Decreasing Urologic Complications Related to Uncontrolled Diabetes Mellitus

Kristine Gromlovits

Disclosures

Urol Nurs. 2018;38(6):289-302. 

In This Article

Abstract and Introduction

Abstract

Diabetes mellitus increases the risk of infection, especially when poorly controlled. Prolonged hyperglycemia promotes bacterial growth leading to infection, such as urinary tract infections (UTIs), and eventually leads to bladder dysfunction and irreversible kidney damage. The use of a minimally invasive glucometer will increase glycemic control and reduce the incidence of UTIs and other sequalae.

Introduction

A 44-year-old male with type 2 diabetes mellitus presents to the hospital surgery center for admission to have a perirenal abscess percutaneously drained by the urologist. He has been seen in the outpatient surgery center previously for cystoscopy to evaluate painless microscopic hematuria and has experienced recurrent culture-positive urinary tract infections (UTIs) over the last year. He was diagnosed with type 2 diabetes mellitus at age 40 years and states his blood glucose levels are "always out of control."

During intake with the urology nurse practitioner in the holding area, he states he does not monitor his blood sugar closely due to the annoyance of pricking his finger multiple times per day and all of the supplies needed to check it. He recalls that he stopped checking his blood sugars routinely about one year ago, which corresponds with when he first started to experience UTIs. Other pertinent past medical history includes hyperlipidemia and hypertension. Past surgical history includes cholecystectomy at age 24 years. Vital signs obtained during intake include blood pressure (BP): 138/90, pulse: 82, respiratory rate (RR): 16, temperature: 98.4 degrees Fahrenheit. His current body mass index (BMI) is 29.8. His current medications include pravastatin 40 mg one tablet orally four times a day (PO QD), lisinopril 10 mg PO QD, Humulin N insulin 18 units subcutaneously before bed (QHS), and insulin aspart prior to meals. The patient states he has not been consistent with administration of the insulin as part, as he has not been monitoring his glucose levels regularly. He denies use of tobacco, alcohol, or illicit drugs. He works as an information technology (IT) specialist; he states his finances sufficiently cover his current medications and does not have a sexual partner at present.

Prior to presentation in the holding area, his management course was significant for inpatient admission. He was seen by his primary care provider (PCP) for treatment of his UTIs and was educated regarding controlling his blood glucose levels as a method to reduce his risk of acquiring another UTI. The patient's glucose levels remained in the 300s and were not well-controlled with his current insulin regimen. A few weeks later, the patient started experiencing high fevers, chills, dysuria, and abdominal pain, and his serum glucose was 375 mg/dL. He returned to his PCP febrile, with a temperature of 101.4 degrees Fahrenheit, and laboratory results showed white blood count (WBC) at 24 cells/L, erythrocyte sedimentation rate (ESR) at 60 mm/hour, blood urea nitrogen (BUN) at 39 mg/dL, and creatinine at 2.1 mg/dL. Urinalysis revealed significant pyuria, proteinuria, glucosuria, and microscopic hematuria. Stat computed tomography (CT) of the abdomen was ordered, and results showed a flank mass determined be a right-sided perirenal abscess.

His PCP sent him from the office to the local emergency room (ER). He received an urgent urology evaluation and was admitted to the urology service, where he received broad-spectrum antibiotics until he remained afebrile for 48 hours. His cultures were positive for Enterococcus, and he was discharged home on 2 weeks of oral antibiotics based on susceptibilities and the admonition that he must control his blood sugars. He was scheduled for the procedure to drain the perirenal abscess the following week and was found to have a serum glucose in the holding area of 279 mg/dL.

This case highlights that poorly controlled diabetes mellitus can result in recurrent or complicated urinary infections that can progress to a perirenal abscess, and will contribute to other co-morbidities, including diabetic nephropathy and renal failure. In this case, the patient was struggling with all requirements controlling his diabetes and presented with his medical regimen, resulting in poor glycemic control, infection, abscess formation, and utilization of emergency, and inpatient and surgical services that could have been avoided. This case also represents an instance in which a patient with diabetes mellitus developed urologic complications and required urgent management both inpatient and by a urology specialist, rather than as part of their medical home regime. With access to a minimally invasive glucometer, such as one of the continuously monitoring devices approved by the Food and Drug Administration (FDA), glucose readings can be easily obtained via continuous monitoring, resulting in prompt adjustment to therapy and increased glycemic control for patients that might otherwise fail to monitor their glucose levels.

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