Wednesday , November 22 2017
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Don’t Blame All Symptoms on Glucose Levels

A woman, 72 years of age, type 2 diabetes, obesity, taking metformin, GLP1, ARB, and antidepressant (SSRI). Lost 20% total body weight in the past year. Recently complaining of dizziness and weakness. Glucose levels in the 60’s at home, at which time had symptoms of hypoglycemia. Glucose-lowering medications (metformin and GLP-1)  were stopped.  Continued to complain of dizziness and weakness especially in the morning. She thought these symptoms were related to not eating enough. Asked patient to come in so we could evaluate. Patient was hypotensive. Decreased her antihypertensive medication to 1/2 the dose. Patient reported feeling better except when she woke up with glucose levels in the 60’s. Again, asked patient to come in. Checked blood pressure, which was normal with no orthostatic hypotension. 2-hr post prandial was 109. After more discussion, patient reported not eating before getting active in the morning. Recommended patient eat first thing in the morning. She did so and has no further complaints.
Lessons Learned:
  • Don’t blame any and all untoward symptoms of people who have diabetes on their glucose levels.
  • As people who have obesity lose weight, check meds, vital signs, and meds frequently. Medications may often need to be adjusted.
  • Teach patients who are losing weight and taking glucose lowering medications and antihypertensive medications to check both glucose and blood pressure, including signs and symptoms of hypoglycemia and/or hypotension.
Anonymous

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