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Disasters Averted

Disasters Averted are stories submitted by our readers and medical editors from direct experience in the field. Do you have a story? If your story is used, we will send you a $25 Amazon Gift Card! Submissions can be anonymous.

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2nd Marriage Can Mean Expanded Family Obligations

It’s never too early to start talking about the holidays with our patients. For some, it’s a holiday almost every night. Man, 76 years of age, visits with his wife for obesity and type 2 diabetes management. Despite diabetes education, including medical nutritional therapy and medication, he was not losing weight nor were his glucose levels improving…especially his bedtime glucose levels.

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Reteach to Dispel Fear and Misunderstandings

Female, 76 years of age, type 2 diabetes, well managed, A1C 6%, on metformin 500mg daily. Patient also has well-managed hypertension, hyperlipidemia, and osteoporosis. She lives alone. Wants tighter diabetes control. Was having hypoglycemia when on 500mg twice daily. Requests, almost begs me, to increase her medication. States she’s afraid she’s going to have kidney problems.

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Denial: Numbers Don’t Lie

Woman, 64 years of age. History of Class II Obesity and hyperlipidemia. While she had obesity, her glucose levels were elevated. A1C 8.2%. She followed a lower carb meal plan, was active, took metformin and a GLP-1, a statin and an ACE-I. She lost 22% total body weight. A1C then remained in the 6-6.5% range for 3 years on this treatment plan. Over the past 8 months, due to insurance and her statement of denial that she ever really had diabetes, she stopped taking her glucose-lowering medication, statin, and ACE-I, wasn’t as strict with meal plan or activity, and stopped checking her glucose, but did not gain back her weight.

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A Lot to Learn from Your Patients

I am a diabetes educator and certified foot care nurse. Through the years, I’ve learned that most topics we teach people who have diabetes are really topics every person should know about. I teach patients how to care for their feet, how to prevent foot problems, and how to treat them if they should have problems.

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We Don’t All See the Same. See the World Through My Eyes

I received a call from a physician’s office regarding a patient who needed education as soon as possible. Her A1C had risen to 7.5 and at 64 years old, the patient needed to make changes. The only problem: the patient was blind. The patient lived alone with her Seeing Eye dog and was assisted by her brother. She lived a relatively normal life despite her blindness, working a clerical job and visiting the gym 2 days per week. As an educator, I had never dealt with a truly sightless individual and was feeling ill-equipped to take on this challenge. The majority of the diabetes patients in our small rural clinic have sight enough to manage their disease. I started to think of all the things we take for granted when teaching our patients, such as lancing their fingers, reading a label, even simply putting the correct amount of food on their plate. All that was thrown out the window. How did I help this patient to see her diabetes care?

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When Adding a GLP-1 for Patients Who Have Type 1 (off label use)

Female 43 years of age. Type 1 diabetes/insulin resistant, hyperglycemia, increasing insulin to manage glucose, but not covering well. Increasing appetite and gaining weight. GLP-1 (Victoza) added at 1/2 recommended start dose for people who have type 2 diabetes, which is 0.6mg, so patient started at 0.3mg daily. Patient started having hypoglycemic reactions, most often postprandially and nocturnally.

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Out of Insulin, Too Early to Renew — What To Do?

It is not unusual for people to have difficulty keeping insulin from freezing or getting overheated. A patient, with type 1 diabetes for 17 years, had glucose that did not respond to his rapid-acting insulin as it usually does. He had two new vials in the refrigerator. He took a new vial out of his refrigerator earlier in the day, and started using it a few hours after he took it out. Had high post prandials that did not respond as usual to correcting. He had enough experience to wonder if perhaps something was wrong with his new insulin, so he thought he’d try another vial. He saw it was frozen. He had put the two vials at the back, where for many refrigerators it is colder. He thought back and wondered if the first vial looked any different, but remembered, he did not look closely at it.

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When There’s Water, Check the Shoes

People who have diabetes are usually taught to purchase protective soft leather shoes with a wide toe box. That doesn’t mean everybody who has diabetes follows those recommendations. A woman, type 2 diabetes, who is knowledgeable about diabetes and foot complications was wearing cloth shoes with a “corded” bottom and manmade rubber sole. She was caught in the rain. Her shoes were soaked.

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Always Ask What Type

Female, 32 years of age, well aware of the fact she had type 1 diabetes, was suicidal, who reported she chose to stop taking her insulin a few days earlier. Was taken to the police station on a warrant (unknown reason), who took her to the ED due to her report of suicidal ideation. She was found to be hyperglycemic at that time, but did not say she had type 1. Acetone was negative. Given 5 units regular insulin and sent back with police. She then started complaining of not feeling well, taken back to ED, no treatment and sent back with police. The next morning, complained of nausea, vomiting, and abdominal pain.

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