Disasters Averted

A patient who had had diabetes for over a year visited the office complaining that her A1c was high. Still, when she checks her blood sugars, they are low almost every day; she’s had many hypoglycemic reactions and doesn't understand how that could happen.... 

Surveys indicate that eyesight is the one sense that Americans fear losing most. Several weeks ago, I examined a patient who complained of "sudden" onset vision loss....

I am a diabetes educator and have built a small business helping senior citizens care for their animals with diabetes. It seems that most of the pets I see are small dogs and their owners use insulin to manage their animals' diabetes.

A patient called to report that they had the flu, were vomiting and had diarrhea. The patient was not eating and so assumed, because of this, that they should not be taking their insulin. I had the patient check their blood sugars which were found to be over 340mg/dL....

A female patient, 42 years of age, with type 2 diabetes, is overweight with a history of vaginal yeast infections with elevated glucose levels. Wanting to better manage her diabetes and lose some weight, the commercials about SGLT-2 inhibitors caught her attention.

A new patient of mine was diagnosed with type 2 diabetes and obesity. We discussed a weight loss treatment to target both her diabetes and obesity, and she followed our mutually agreed upon treatment plan. Things were going well -- she would visit every three months and we would reassess and make treatment decision changes as needed. Then, my patient did not visit for two years. When she returned, she had gained back her weight plus a few more pounds, and her blood glucose, blood pressure and lipids were out of her target range....

A 29-year-old woman with insulin-dependent diabetes noted a painful erosion at the site of the tattoo which she had gotten 7 days before. A culture isolated staphylococcus aureus confirming the clinical impression of staph. This diagnosis was not entirely unexpected, since patients with diabetes mellitus are predisposed to staphylococcal infection.

A patient of mine who had diabetes and peripheral neuropathy came home from the hospital after a below-the-knee amputation of her right leg. She lived alone and was housebound. Having lost one leg, I knew she was at increased risk for losing her other leg. While in rehab, she had a professionally custom molded shoe made for her left foot which she started to wear.

A man with type 1 diabetes started an exercise program to help him manage his early morning highs. He exercised every evening, at which time his glucose levels would drop during and after exercise. Thinking that exercise would lower his early morning highs, he did not take his insulin before exercise. He was surprised to see his glucose would go up after exercise rather than go down.

One of my long term patients called my office because she could not figure out what was happening with her post breakfast glucose readings. She counted carbs and would typically have a 2 hour ppg of no more than 145 mg/dl but even though her pre-breakfast readings were around 110 mg/dl she was experiencing glucose levels near 200 mg/dl. I had her do a morning food diary for 7 days and we identified 3 days when she was eating French toast when her readings were going over 200 mg/dl. This meal had never been a problem in the past.