Disasters Averted

When prescribed lifestyle changes and or medication(s), patients who have diabetes, obesity, hypertension, or any chronic condition that is easy to monitor, even from home, may agree to these changes at first. They can almost immediately get improvements in their numbers. It can be encouraging. For some, seeing those numbers change for the better encourages them to keep on keeping on. However, others may think they are healed and stop treatment. Their numbers may go back to the same or even "worse" than before the treatment.

(This is a follow-up to the patient who was under the impression he would always need an insulin pump.) It was a "rocky" start at first. The patient had some early morning highs and some unexpected lows, but likes being off the pump. He wears his Dexcom, which he plans to continue with. This has been extremely helpful with alarms during the adjustments to his long-acting and rapid-acting insulins. The endocrinologist knew the patient was extremely sensitive to insulin, so his rapid-acting insulin has gone from using 1-unit increments to 0.5-unit increments instead and is doing well. At this time, the patient wants to stay off the pump, continue with MDI and the sensor. We're still making minor changes, but getting close to goal.

We all know the benefits of the newer insulins, i.e., faster action times, less peak from the long actings, etc. But the cost, more often than we know, can lead to patients decreasing insulin doses, doing without until the next payday, or doing without it altogether, as we’ve read about. …

We know treating and living with diabetes and excess weight or obesity takes a village, a multidisciplinary village, not only related to the patient and health care providers but truly the whole village or world. It also helps to remember the seasons and reasons why we do the things we do. We sometimes forget about how changes in weather, our personal cultures, living environment, even friends and loved ones who seemingly mean well can “sabotage" the greatest intentions.

A man, lean and muscular, with type 1 for over 25 years, has been pumping for 15 years and wearing a sensor for the past five years. Glucose levels have been very erratic. We checked his sites and were concerned that the erratic glucose levels were mostly related to lack of subcutaneous fat and scar tissue, so he was actually getting insulin into his muscle, scar tissue, or subcutaneous tissue at various times. Also, the patient wears an OmniPod and thought it could only be in one particular direction.

Since I am a diabetes educator who also specializes in obesity medicine, I see a lot of different responses to travel. For all, I see both weight loss and weight gain after travel. The interesting thing is for people with obesity, I see both. What I also find interesting is a lot of my patients who go to Europe tell me they eat pasta, more bread and other carbs, but when they lose weight, glucose levels improve. Why? Usually because they also tell me they are more active.

Man, 52 years of age, with obesity and type 2 diabetes, was switched from daily liraglutide (Victoza) 1.8mg to weekly semaglutide (Ozempic) 0.25mg. I was very clear with patient about the switch being from a daily injection to a weekly and that we would be increasing the semaglutide weekly.

You may wonder which CGM monitor is best for your patients. I know I do. Learn from Dr. Stephen W. Ponder, MD, FAAP, CDE-AADE Educator of the Year, Board Certified Pediatric Endocrinologist, Pediatric Residency Program Director at Baylor Scott & White McLane Children's Hospital and 50 year Joslin Medalist. He also helps people with diabetes through the "sugar surfing" method to empower individuals who have diabetes to live fuller and more satisfying lives.

As I am working with patients, I have so many thoughts about how different each patient is. I also have thoughts about how in this day and age, with all we have available, some people who have had diabetes for oh so many years still have no clue how to manage their diabetes.

Last week I was teaching a patient how to self inject an injectable medication. As I was going through the steps, I told her twice of the importance of removing not only the outer cover of the needle, but also the needle shield. She gave me one of those looks like, "Why did you tell me this twice?" Then she said, "I know!"