What should be done if a patient spills 3+ glucose but has no diagnosis of diabetes mellitus?

When a patient spills 3+ glucose in their urine but does not have a diagnosis of diabetes mellitus, obtaining a fingerstick blood glucose level is a prudent first step. This immediate test allows for a quick assessment of the patient's blood glucose level to check for possible hyperglycemia.

Urinary glucose can sometimes indicate an issue with the body's management of blood sugar, but it doesn't provide a complete picture on its own. The fingerstick test can confirm whether the blood glucose level is elevated at that moment, which is critical for better understanding the patient's condition.

Conducting an A1C test is useful for assessing long-term glucose control but does not provide an immediate understanding of current blood glucose levels. While referral to an endocrinologist may be necessary later if abnormalities are confirmed, the initial step should prioritize immediate assessment. Advising fasting for 8 hours before the next visit is not a direct response to the current finding and would delay necessary evaluation. Hence, obtaining a fingerstick blood glucose level is the most immediate and appropriate action in this scenario.