Today I got to see a referral in an Endo’s office. The patient had been referred by the primary care physician because he was on high dose Lantus and not in control. I asked my intern what she recommended and the suggestion came back meal-time insulin, but the patient refused to take any more injections. This meant that common practice could not be followed, and so after a couple of minutes she asked if the patient had ever taken metformin. According to the patient, “I was on it for many years and when I started on insulin my doctor had me stop all my oral meds.” The intern explained how the metformin worked and why she should be on it and we gave the patient an RX for metformin 500mg bid.
It is interesting to note that sometimes preconceived notions get in the way of good care (our Disasters Averted is a good example of this) and this often happens with patients with type 1 diabetes. Often clinicians are reluctant to try new combos because of the fear of hypoglycemia. Our publisher, Steve Freed, got a chance to sit down with Dr. Nitesh D. Kuhadiya, and discuss his success using GLP-1 analog therapies in type 1 patients. Click here to watch the video.