The patient, a woman, 52 years of age, has type 2 diabetes and is on metformin, a GLP-1 agonist, and a long-acting insulin. Over the past few months, I’ve received calls and emails from her every now and then to let me know her glucose levels were rising, but whenever I’d reach out to follow up with her or try to set up an appointment, she hasn’t returned my calls or emails. She recently called at an unexpected time to let me know her blood glucose was higher than it had ever been. She said, “I know my body. I think I’ll just stop all of my medicine and see how my body adjusts.”…
I informed her that this is not a good thing to do when you have diabetes. Her body is not telling her she needs less medication but more, and that “more” is most likely insulin. She did not want to increase her insulin for fear of gaining weight. I explained the importance of insulin, whether her body makes it or takes it, and since she’s had diabetes for years, she most likely isn’t making enough of her own insulin. I told her how dangerous this can be for her, explained what diabetic ketoacidosis (DKA) is and the dangers of it, and how she could end up in DKA. I recommended she take some rapid-acting insulin, start drinking water, and call me in two hours. She listened and sure enough, her glucose levels came down. She hasn’t said another word to me about decreasing anything except her carbs. In fact, she called me a week later to let me know she visited her endocrinologist. She is now taking twice the amount of insulin she was taking when she called me that day. Her glucose levels are in her target range, and she is feeling good.
- People who have diabetes, no matter what type, need to be taught about the pathophysiology of their type of diabetes.
- People need to be taught their personalized targets, how to prevent getting out of target range, and why.
- People need strategies to get their glucose levels back in target, and to know who and when to contact when these strategies are not working.
- It’s not just a high or low number. These numbers mean something.
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