Disasters Averted

Nausea is a common side effect of GLP-1 therapy. Recently a few of my patients took the recommended low starting dose, but got so nauseated they refused treatment beyond that. From this, I’ve learned to start my patients on half the low dose of the daily or twice daily GLP-1’s …

A female patient on insulin, 67 years of age, required more and more insulin to manage her glucose levels. She was eating healthily, exercising, monitoring, and taking her insulin as prescribed. I asked her when she had last seen her dentist. She confessed that this was one part of her …

The patient, a woman, 52 years of age, has type 2 diabetes and is on metformin, a GLP-1 agonist, and a long-acting insulin. Over the past few months, I’ve received calls and emails from her every now and then to let me know her glucose levels were rising, but whenever …

A male patient, 56 years of age, with type 2 diabetes, hypertension, congestive heart failure, and sleep apnea visited. We hadn’t seen him for 6 months. His blood pressure was up, in the 140-160/90–102 range, glucose levels were higher than his targets, he was gaining weight, and continually complaining of …

A married male patient, 68 years of age, has been prescribed long-acting insulin twice a day because once-daily does not work 24 hours for him, and his dose is large. Therefore breaking it into two smaller injections helps bring down his glucose, but only when he remembers to take his …

A woman, 59 years of age, was diagnosed with diabetes while in the hospital. She was discharged on basal bolus insulin. The diabetes educator (CDE) was contacted to teach insulin administration via insulin pens upon discharge. The patient was taught, and performed return demonstration correctly. She was sent home with …

It was a beautiful day. A patient of mine who has type 1 and her friends who do not have diabetes decided at the last minute to go out and enjoy it. They walked and walked, ate out for lunch, and walked and walked some more. She walked a lot …

I recently received a text message from a type 1 patient who has been wearing a pump over 10 years. “I need your guidance. My blood sugars have been in the high 200s and 300s since Thursday. I woke up with a 398 blood sugar. I’ve been eating out a …

In an inpatient setting, a type 1 diabetes patient was scheduled for surgery the next morning. The patient was to be NPO after midnight and so the RN on duty withheld the patient’s Lantus. The patient’s glucose crept up, but this was not communicated with the house staff until it …

A young man, 32 years of age, with a history of ADHD and being treated with Adderall, was diagnosed with type 2 diabetes. He had symptoms upon diagnosis — frequent urination, weight loss, and his BMI was 20. He followed a low carb diet, was taking metformin, and exercised, however, …