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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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The Benefits of Motivational Interviewing

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Woman, 57 years of age, prediabetes, hyperlipidemia, class I obesity and history of gestational diabetes. I’ve been working with her for the past two years. The first year she was very motivated because of her new diagnosis of prediabetes and her weight being what it was. Her son was getting married and she wanted to lose weight for the wedding. We discussed a plan for her.

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When Changing to Combo Pill, Know the Dosages You are Changing

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Woman, 62 years of age, musician, travels often, type 2 diabetes, obesity, hyperlipidemia, fatty liver. Was traveling for two months straight on the road. Late nights/parties and a lot of drinking. Admitted not having taken her GLP-1 or really following any meal or healthy life plan/schedule she was following before leaving. Since last office visit 3 months ago, weight up 10 pounds, fasting glucose 170 in office.

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Non-Compliant No More!

Patient and doctor

A patient, 48 years of age, female, type 2 diabetes and obese, was referred to me for diabetes and weight management. Her first visit was 8 a.m., after fasting for 10 hours. Her A1c was 7.4%, BMI 37, BP 164/92, HR 92. The previous hcp had recorded she was recommended a low carb diet and the following medications: Metformin, 1,000mg twice daily; Byetta 10mcg sq twice daily. It was also written that she was non-compliant.

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Sometimes You’ve Got to Get in Their Face

Refusing to take medicine

Woman, 86 years of age, very active, history of type 2 diabetes, but does not check glucose or even admit she has diabetes. She has refused to take any medications at all for the last 20+ years I’ve known her. Had gastroenteritis for 3 days. Even when well, she does not drink anything but coffee, and sometimes sugar-sweetened beverages, but only a few ounces of that at a time.

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Sugar Free, Gluten Free, And Vegan Are NOT Carb Free

Closeup on young housewife with vegetables in kitchen

Woman, 53 years of age. Type 2 diabetes and is obese. Patient’s daughter was getting married. She was very motivated to lose weight for the wedding and she did. Her A1C lowered from 7.5% to 6.6%. She cut back on her carbs to <100gm/day, increased her activity and took her metformin regularly. She lost 22 pounds over 6 months. The wedding was 2 months ago and she has gained 6 pounds. That may not seem like much, but it was enough to raise her A1C and open her eyes.

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Valentine’s Days, Holidays, Obligations, and Associations

Senior woman exercising, taking pulse

Woman, 63 years of age, history of ovarian cancer, prediabetes, hyperlipidemia, has been trying to lose weight for years but was unable to do so. She is very family-, friend-, colleague-oriented. Every holiday she thought she had to make or bring and eat whatever special holiday food was associated with the holiday. She couldn’t let anyone down by not bringing, or by not eating what other people brought. We met weekly for the past three years. Every week there was some excuse about how or why she “cheated” or if there was a week she didn’t think she “cheated,” then she was afraid she would.

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Life Happens to Our Patients Too. Be Understanding.

Diabetes test in the office

Woman, type 1 diabetes, 63 years of age. Well-educated diabetes wise. Reached out to me saying: "HELP!! Normally I take 10 units of Toujeo at 9 pm. I did that last night. This morning I meant to take an additional 2 units because I'm not getting any exercise due to a knee injury. By mistake I took my usual dose of 10 units." Before I read the rest of her email, I thought, I know her. She knows what to do. She wears a CGM, she’ll be watching that. Then I read on...

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Teach Not to Hate Insulin

Nurse caring about elder man

Man, 63 years of age, type 2 diabetes, obesity, hypertension and hyperlipidemia, referred to me, a CDE, to start him on and teach him how to use insulin. He has had diabetes education in the past, tried lower carb eating and physical activity, but glucose levels still elevated. He told me he felt like a failure. He said he learned he was insulin resistant, made too much insulin, which was causing his co-morbidities. He was very resistant to start insulin, especially since he thought insulin was the cause of his problem.

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A Different Kind of Disaster

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When we think about disasters, we usually think of the outcome, a poor health outcome. We don’t always think about the journey. The journey to poor health outcomes are many. Today I am reminded of not having the insurance coverage for the correct medication. Without it, one can have a disaster, poor diabetes management. The consequences of that, as well as the disruption to running a smooth office.

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