Disasters Averted

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.

In his fifth year with Team Novo Nordisk, Stephen Clancy is slated to race his second consecutive Tour of Utah. At last year’s race, Stephen said it was an unforgettable experience racing at arguably the toughest race in the United States.

I have type 1 diabetes and have been living with it for the past 11 years. I take daily insulin injections to stay alive and well. A couple of years ago, I had a very frustrating incident when my insulin stopped working. I began injecting loads of insulin, and even with multiple doses my blood glucose wouldn’t drop.

As we know, the most ineffective medication is the one needed but never taken. There are many reasons our patients don’t take prescription medicines, but a biggy is the cost. If a medicine is too expensive, the patient will not fill the prescription, therefore won’t take it. For example, when ordering an SGLT-2 and/or GLP-1, each can cost hundreds or more for a month’s prescription. Some are covered for both. Some are covered for one brand, but not the other.

Male, 62 years of age, type 2 diabetes, class III obesity. Has been on metformin, 1,000mg twice daily. Glucose in the 200-300mg/dL range. A1C. Taught about lower carb meal plan, started on Trulicity, first 0.75mg, then 1.5mg/dL. Made the dietary changes right away with the addition of the Trulicity. Within 2 weeks glucose levels averaged 125, patient losing weight, decreased appetite and feeling good. More energy. Insurance did not cover Trulicity, but did cover Victoza, so started on Victoza. When made the change, started with the 0.6mg daily, then increased weekly to the 1.8mg/day.

Since Team Novo Nordisk’s inaugural season in 2013, 30-year-old Romain Gioux has dreamed of racing as part of the world’s first all-diabetes pro cycling team. Diagnosed with type 1 diabetes at age 15, he raced as an amateur for a French-based Club, but this year serves as his professional debut.

Problems associated with the use of U-500 insulin syringes. We received two reports of accidental prescribing of the new BD U-500 insulin syringes for outpatients who were using a U-100 insulin product. In one case, an endocrinology clinic called the hospital pharmacy to ask how to order U-500 syringes. During the conversation, it became apparent that there was some confusion about the use of these syringes. The pharmacist stressed that the patient should not use a U-500 syringe to measure any insulin concentration other than U-500, or the measurement would be incorrect, leading to a 5-fold underdose.