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I can’t remember HbA1c but the highest non - contaminated glucose I saw was 99 mmol/L (that’s 1782 mg/dL.) We had analysed a sample for a biochemical profile on a GP (physician) patient. At the time our SMAC analyser measured glucose but we didn’t report glucose on the serum sample unless it had been collected less than an hour before analysis. This sample didn't have a glucose request but the glucose was 34mmol/L. (612 mg/dL). The request form had all the symptoms of diabetes except thirst. I took the chart to the duty biochemist who immediately called the GP. With some difficulty he managed to persuade the GP to call the patient and send him to Accident and Emergency. This was at about 11 am. Eventually the patient turned up in A&E at about 11 pm.His glucose had by then reached 99 mmol/L . He was not in a coma. The next day the biochemist went to visit him on the ward. The patient said “I wish I’d known about this a week ago. I’ve spent a fortune on lemonade.”It’s one of the few times when I know I saved someone’s life.

I can give an example from the early 1980s. It’s one of the few times when I know for certain that I saved someone's life from my work in the lab.I had recently become the chief of the automated biochemistry lab at a very large hospital. I was running a large multichannel analyser but blood glucose was measured on a smaller analyser which was mechanically very unreliable. I had persuaded the head of biochemistry to add serum glucose to the main analyser. Since this meant glucose would be run on every sample the main lab computer was set to only report glucose on samples which were fresh inpatient samples. This is because serum glucose decreases rapidly in samples without a preservative.One of the samples which did not request glucose had a serum glucose of 35mmol/L (630 mg/dL). The sample had been sent to the hospital in the morning by a GP ( family doctor). The request form listed the patient as having all the symptoms of diabetes except thirst. Glucose had not been requested. I passed the result urgently to the biochemist currently authorising abnormal results. He phoned the GP who reluctantly agreed to contact the patient and tell him to come to accident and emergency. Since the glucose had not been requested if I had not forced through the addition of glucose to the analyser menu nobody would have known about the high glucose.The patient finally walked into the A&E department at 9:00pm. His blood glucose was 99mmol/L (1782 mg/dL). He was diagnosed as a new type 1 diabetic with ketoacidosis and with that glucose level he would very quickly have gone into a coma and died.The biochemist who phoned the GP went to visit the patient on the ward who said that he wished he had known about this a week earlier because he’d spent a fortune on lemonade.In the decades since then I have never seen a higher glucose - or anything even close.

NOVEL CORONA VIRUS (nCoV) ACTION PLAN• OPD: put up standees asking patients with recent travel (after Dec 20, 2019) to China to identify themselves at the time of registration.Front office staff- reception and registration: For all patients with fever &/ or respiratory illness1. Give a mask2. Ask about the following:a) A history of travel to Wuhan, Hubei Province China in the 14 days prior to symptom onset; orb) Close contact with nCoV patientc) Health care worker working with nCoV patientIf yes to 2a), 2b) or 2c), take permission of the consultant for transfer to ER immediately.• Doctor’s office- if there is a patient with fever or respiratory problems, ask for air travel history. If yes, transfer to ER, leave room and close door. Clean hands and notify HIC for cleaning (HIC Cleaning protocol – thorough deep cleaning)Infection Prevention and Control strategies in health-care settings:Early recognition and source control:Emergency room / OPD: Awareness to be given to the HCWs in the ER and OPD. Give suspect patient a medical mask Direct patient to triage zone Keep at least 1meter distance between suspected patients and other patients. Instruct all patients to cover nose and mouth during coughing or sneezing with tissue or flexed elbow. Perform hand hygiene after contact with respiratory secretionsStandard Precautions:a. Hand hygiene: 70% alcohol based hand rub or soap and water hand wash when visibly contaminated.b. Standard PPE usage: Gloves, Gown, snug fit surgical mask, and goggles depending on risk of procedure.c. Coughing/sneezing etiquette.Transmission based precautions:Contact and Droplet precaution for suspected nCoV infected patient: Patient placement in adequately ventilated single room In the absence of single room, Cohort at 1 metre distance Cohort HCWs for exclusive care Surgical mask on entering the room (including visitors) Goggles / face shield Gloves Gowns - disposable fluid resistant long sleeve gowns Dedicated patient equipment (BP apparatus, Stethoscope, thermometers etc.) Limit the movement and transport of patient from the room. Restrict visitors. Maintain a record of all persons entering patient’s room. Droplet precaution sign board.Guidelines for aerosol generating procedures:For aerosol generating procedures such as: open suctioning of respiratory tract, tracheal intubation, tracheotomy, non-invasive ventilation, bronchoscopy, cardiopulmonary resuscitation airborne precautions to be strictly followed: N95 particulate respirator mask or equivalent Goggles, long sleeve gown and gloves to be used as PPE Procedure room should have negative pressure with at least 12 air changes per hour. Post procedure cleaning and disinfection of surfaces and equipment to be followed as per standard guidelines.Guidelines for Laboratory specimens:Specimen types:a. Upper respiratory tract – Nasopharyngeal/ oropharyngeal swab.b. Lower respiratory tract – BAL/ Tracheal aspirate.c. Serum: Infant - 1ml, Children and adults – 5 to 10 ml in serum separator tube.Note:a. Do not use pneumatic tube system for transport of specimens.b. Deliver all specimens by hand only.c. Standard leak proof containers to be used as per bio safety requirements.d. Clear documentation of patient details on sample and request form.e. r RT-PCR test samples to be shipped to referral lab as per IATA regulations.Notification: Public Health authority notification to be given promptly without delay as per regional policy.Transfer To other hospitals: Receiving hospital to be intimated at least 6 hours before transfer. Appropriate PPE to be used during transport.  Complete patient records to be given.Linen and laundry management:To be handled as that of infectious linen. The laundry bag is to be placed within the patient room. Linen and soiled / used cloths to be transported to laundry in a leak proof yellow coloured biomedical waste bag, disinfected with sodium hypochlorite and washed in infectious linen washing machine with warm water.Biomedical waste management: Refer local / state regulations for handling and disposal of medical waste.Dishes and eating utensils: No special precautions required beyond Standard Precautions recommended for dishes and eating utensils.Environmental cleaning and disinfection: Standard procedures to be followed. Terminal cleaning after patient discharge to be strictly followed with reference to recommended disinfectant usage (such as sodium hypochlorite), proper dilution, contact time and care in handling. Give special attention to high touch surfaces such as bed rails, bedside tables, TV control, call button, telephone, lavatory surfaces, switches. Spills of blood and body fluids to be disinfected in accordance with recommended Standard Precautions.Handling dead bodies: Person handling the dead body should wear full PPE A body bag should be used for transferring the body Outer surface of the body bag should be decontaminated with 1% sodium hypochlorite immediately before the body bag leaves the anteroom. Trolley carrying the body must be disinfected prior to leaving the anteroom, including the wheels. Staff should remove the PPE in the anteroom and transport the dead body to mortuary. Once in the hospital mortuary, full PPE should be used if the body bag is opened. Mortuary staff must be advised of the biohazard risk. Embalming is not recommended After use, empty body bags to be discarded in yellow color biomedical waste cover.