Disasters Averted

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!"

This is not one patient’s disaster averted but what I have experienced working in the field of diabetes and obesity for years. Many times patients who are taking glucose lowering and/or anti obesity medications will report different GI complaints-such as bloating, diarrhea, constipation, nausea, vomiting, and GERD. They tell me they are going to see a gastroenterologist for an evaluation.

Woman, 55 years of age, referred to me for obesity management. She visited without recent labs, so we got started with the agreement she would get her labs drawn soon after her visit. At our first visit, her blood pressure was 150/98, HR 64, and weight 204, BMI-35, therefore her BMI category was class II obesity. PMH-+Migraine Headaches. FH-+Mother died of lung cancer. Her mother was a smoker. Patient is not.

Many of your patients think they must use mail order pharmacies, but many times they have a choice. This past holiday weekend a patient of mine was out of her medication, a medication she cannot be without without having serious effects of missing a dose. She went to her local pharmacy.

I recently met a patient whose life is alternative medicine. Not complementary medicine but alternative medicine. A young woman in her early 30’s who was diagnosed with type 1 diabetes 10 years ago. Besides having an A1C of 10.5%, I could tell she was struggling. Her career is in alternative medicine. For years she has been looking for a way to stop taking insulin. She is looking for the cure, but as with many, has difficulty believing it’s not here yet. She has had diabetes education, but because she hasn’t really met the hcp she can relate to or who has given her the answer she wants to hear, she’s not really put things together yet.

This Disaster Averted is not just about one patient but about many who take insulin. Most think high A1C means one needs to increase insulin. Not always! Remember, A1C is an average. Just because someone has an A1C of <7% doesn't actually mean glucose is managed.

Woman, 67 years of age, type 2 diabetes for 22 years, class II obesity. Has recently been managing her glucose levels with weight loss, using Tresiba, Trulicity, and metformin. Recent A1C 6.5%, which she’s worked hard for and been extremely proud of. She hasn’t had numbers like she has recently had for years.

Young man, 21 years of age. type 1 diabetes since 9 years of age. Has not been to see hcp for a year. States he doesn’t like people interrogating him, but came in because he needs his insulin. States he doesn’t check his glucose because he can tell what it is. Tired of having type 1 diabetes and tired of checking numbers. A1C in office--10.2%.