Disasters Averted

Having worked with patients, children, adolescents, and adults who have diabetes for oh so many years, I’ve learned it’s better to change what I teach than to expect my patients to change their entire lifestyle. One of the toughest things for patients to do is to change the way they eat, especially if deep rooted in their ethnic background. One example is asking patients who are from the Middle East or those who are brought up on rice and beans to avoid or cut back on rice.

Received a phone call from someone I know. Has not yet come in for a visit. Just called to see if she qualified to come in for a visit. Woman, 68 years of age, denies history of diabetes, hypertension or other health problems, except being overweight. She stated, “Last year my weight was up. I went on a diet because my triglycerides were high, in the 600’s, but they came down to 140’s when I lost 30 pounds last year. I think I gained back about 10 pounds so that would be about 155 pounds now.” I asked her if she’s weighed herself. She said, no, not since I got off the program, but when I was on the program, I weighed daily. You know, I had holidays, travel, I was with a group, paid for the food, so ate what they all ate, then I just couldn’t get back on track.”

Concerned about the extreme weather disasters we have had and those predicted, I reached out to Carol Atkinson, Director of Insulin for Life, a trusted organization, to see how we could help. She was so busy putting packages together for people who have diabetes, she quickly told me the story of Wharton, Texas. It was Labor Day weekend. Hurricane Harvey had just hit and it hit Wharton, Texas hard. They were in need of insulin.

We write about diabetes disasters every week. We write of how we have prevented some and share with you, our readers, how you too can prevent disasters. This week, we ask you to help us PREVENT DIABETES DISASTERS BIG TIME by giving to the many people who have diabetes and have been affected by the current weather disasters.

I have had several patients who did well at first with their GLP-1 agonists. Patient 1: Man, 46 years of age, used liraglutide 3mg daily for obesity. Patients 2 & 3: 2 women in their 60s were using liraglutide for type 2 diabetes & weight.

A disaster can be considered many different things to different people. For some it could mean developing type 2 diabetes rather than preventing or delaying it. If you watch our expert video series you will hear our Publisher ask many of our experts, “Whether or not you have diabetes, what would you like your A1C to be?” As our expert, Dr. Karl Nadolsky said, he’d like his to be in the normal range, ~ 5%. This is not unusual for us as health care providers to want and work towards a normal A1C, that is, depending on age, and risk for complications of hypoglycemia.

Fresh off the Larry H. Miller Tour of Utah and with little time to recover, Team Novo Nordisk tackled the high-altitude Colorado Classic. Team Novo Nordisk's squad included three neo-pros (new professionals), one stagiaire (basically an intern looking for a contract) and two veteran riders, so a very young and fairly inexperienced squad.

Team Novo Nordisk’s Sam Brand is making his men’s professional team debut at this year’s Tour of Utah. The Isle of Man native has been called up to race as a stagiaire, which stands for intern in cycling lingo, for the remainder of the 2017 season with the ultimate goal of earning a pro contract for next year.

Man, 76 years of age, type 2 diabetes, obesity, SP right total hip replacement one year out. When preparing for hip surgery, was on basal and bolus insulin, metformin. Had been on a GLP-1 but had diarrhea so he stopped. Was able to, for the most part, follow a lower carbohydrate meal plan but was not active. When he first started coming to us for weight loss to prepare for his surgery, his weight was 304 pounds, BMI 45, A1c 9.9%, Cr 1.87, eGFR 34. We decreased his metformin from 2,000mg/day to 1,000mg day and referred to nephrology. With this change and being motivated for surgery, he lost weight and in 6 months went into surgery having lost 25 pounds with an A1c of 6.9%. Note, due to eating less carbs, he could take less insulin, which seemed to help his appetite. Surgery was performed and he did well.

Over the years I’ve found the best teacher for people who have diabetes is their numbers. Without teaching the patient targets, they don’t learn much. This patient is just one example of many. A man, 57 years of age, visits a community diabetes education course. He tells me he has type 2 diabetes, hypertension hyperlipidemia. He said his doctor told him his numbers were fine about 9 months ago. When he came to the course, he was losing weight, was thirsty and was very tired.