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Disasters Averted

Disasters Averted are stories submitted by our readers and medical editors from direct experience in the field. Do you have a story? If your story is used, we will send you a $25 Amazon Gift Card! Submissions can be anonymous.

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Long-Term Follow Up Key to Keeping Patients on Track

A new patient of mine was diagnosed with type 2 diabetes and obesity. We discussed a weight loss treatment to target both her diabetes and obesity, and she followed our mutually agreed upon treatment plan. Things were going well -- she would visit every three months and we would reassess and make treatment decision changes as needed. Then, my patient did not visit for two years. When she returned, she had gained back her weight plus a few more pounds, and her blood glucose, blood pressure and lipids were out of her target range....

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Custom Molded Shoes: If the Shoe Doesn’t Fit…

A patient of mine who had diabetes and peripheral neuropathy came home from the hospital after a below-the-knee amputation of her right leg. She lived alone and was housebound. Having lost one leg, I knew she was at increased risk for losing her other leg. While in rehab, she had a professionally custom molded shoe made for her left foot which she started to wear.

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Insulin Before Exercise May Be Needed to Lower Morning Highs

A man with type 1 diabetes started an exercise program to help him manage his early morning highs. He exercised every evening, at which time his glucose levels would drop during and after exercise. Thinking that exercise would lower his early morning highs, he did not take his insulin before exercise. He was surprised to see his glucose would go up after exercise rather than go down.

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Is It Sugar-Free or Isn’t It?

Sugar

One of my long term patients called my office because she could not figure out what was happening with her post breakfast glucose readings. She counted carbs and would typically have a 2 hour ppg of no more than 145 mg/dl but even though her pre-breakfast readings were around 110 mg/dl she was experiencing glucose levels near 200 mg/dl. I had her do a morning food diary for 7 days and we identified 3 days when she was eating French toast when her readings were going over 200 mg/dl. This meal had never been a problem in the past.

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Friend’s Advice Causes Patient Problems

Last week I saw a patient who seemed to be losing control of her blood glucose levels. She had been doing well and her A1c had been around 6.0 - 6.3 for the past couple of years. She was doing this while only on metformin 1000 twice a day. She was referred to me by her physician because of high after-meal readings ranging up to 350 mg/dl. I went over her medical history and medications looking for a possible problem and found nothing.

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Syringe Type Mystery

My colleague and I were working with a client new to insulin. We each saw him separately. He was taking Lantus and Humalog by syringe at meals. He had been taught how to use the syringe by his physician's office staff. He was claiming much different numbers than expected for his mealtime doses.

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