Disasters Averted

Man, 67 years of age, had been on GLP-1, SGLT-2, and metformin for over 4 years without difficulty or reported untoward side effects. He started taking the SGLT-2 before most health care professionals knew about the risk of DKA in people who have type 2 diabetes when taking SGLT-2s.

A patient who has had type 1 diabetes became pregnant after nearly 20 years of having type 1 diabetes. She reported her OB-GYN referred her to a specialty clinic for high-risk pregnancy, including diabetes in pregnancy. They worked in tandem to ensure her care was carefully managed throughout the stages of her pregnancy.

This summer I had the opportunity as a student pharmacist to attend a camp for youth with type 1 diabetes (T1D) and assist as a member of the medical staff. We spent the first few days setting up, going over camp procedures and policies, and preparing for arrival of the campers. This was my first time helping at such an event, and my expectations of how deeply the camp experience would impact the lives of the campers (and myself included!) were greatly exceeded.

Summer, a time for travel for so many. Over the next few weeks, we will look at ways to prevent disasters during or after travel. When it comes to travel plans, a lot of people who have diabetes are most concerned about their medications — getting, bringing enough with them and so many issues associated with that. I've found most aren't concerned about protecting their feet.

When we first met this patient, he did not think he was getting the right treatment. When he visited one week later... When I asked him, and told him I would not judge him, he admitted to drinking a tea his mother recommended to bring down his glucose. He then mentioned several other supplements. His glucose was not lower, but higher.

Man, 55 years of age, type 2 diabetes, hypertension, was referred to see us. The patient reports coming to us because he does not think he is getting the right treatment. Reports having been put on insulin upon diagnosis 4 years ago--at which time he had lost 50 pounds, was very hungry, thirsty, and had urinary frequency. When visiting, he did not have his labs from diagnosis but did have labs from 3 months ago at which time A1C was 7, and C-Peptide was 2.2. He said his past endocrinologist changed him to oral meds after his glucose had come down to an average of 140.

What I love about going to conferences is the realization that what I’m doing in my practice is in line with what others I respect are doing. That is meaningful, and I always learn a new pearl. If that’s all I gain from these conferences, it’s okay, but it’s usually more than that. I have just returned from the 2018 ADA Conference, where there was so much about new technology, particularly continuous glucose monitoring.

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. …