Female, 32 years of age, type 1 diabetes, presented with Stage II partial thickness ulcer between 1st and 2nd toe R foot, and several Stage I areas on both feet. She had recently traveled and had bought several pair of new shoes for her trip.
Read More »Can Smaller Forks Help Diabetes Patients?
Patient, female, 54 years of age, type 2 diabetes and obesity, told me she thought her weight and subsequent type 2 diabetes related to overeating, especially large portions. She is being seen by a behavior therapist for her eating disorder. I started her on a GLP-1. Even at starting dose, she reported feeling more satiated, but still overeating. The dose was increased...
Read More »Play It Safe With at Least TWO Pharmacies
With the prevalence of mail-order pharmacies, I’ve always recommended that my patients use their local pharmacy for at least one prescription. Why? If an emergency arises, and they need a medication or supplies right away, they can get great service locally because they have established a relationship
Read More »When Assessing Glucose Levels and Treatment, Look for the Patterns
Patient, type 2 diabetes and obesity, on basal/bolus insulin with an A1C of 10.7%. He was not following any particular meal plan, and was, for the most part, consuming a high carb diet. Diabetes education was provided, including how carbohydrates affect glucose levels, lowering his carbs, and ideal target glucose levels. We told him we did not expect him to reach these levels right away, in fact we wanted to see how he adjusted to the change in diet without low glucose levels, so we recommended he decrease both his basal and bolus insulin, with clear instructions on how much insulin to take...
Read More »Old Shoes Best Fit When New Shoes Bring New Problems
Two weeks ago, a patient came in to the pharmacy complaining that his feet were burning and sore, and he was developing blisters on the top of his left foot. The patient had diabetes for about 13 years and had recently been running an A1c of 7.9. He was also …
Read More »Case Study: The Importance of Patient-Centered Therapy
A 59 YOF is recently discharged from hospital after an allergic reaction to an anesthesia induction agent. She was placed on high-dose steroid for the reaction while she was in the hospital. Patient had completed her steroid tapering dose 2 months prior to her visit to endocrinology clinic today due to high blood glucose (a1c 8.9%). Past medical history included: hypertension, hyperlipidemia, atrial fibrillation, obesity and diabetes for 7 years. She was well controlled on metformin 1000mg BID before...
Read More »Once Informed, Many Patients Know Best
Female, 24 years of age, type 2 diabetes and obesity, wants better glucose management and to lose weight. Most of her meals consist of high carb, fast food take out, she skips breakfast and overeats during the evening hours. She has a sedentary lifestyle. She reports being an “all or …
Read More »Newly Diagnosed Patients Can Be Easily Overwhelmed
A female patient, 68 years of age, newly diagnosed with type 2 diabetes had her initial visit with her endocrinologist and diabetes educator. Her second visit was then scheduled for two weeks later. However, the patient was a no-show for her second appointment. She was contacted for reschedule. However, she …
Read More »Excessive Bleeding after Injection Raises Suspicions
A man 79 years of age was referred to me to start insulin. As a diabetes educator, I don’t always have a full history and comprehensive labs given to me from the PCP. I met the patient and his family who told me his history, medications, lifestyle, etc…. I instructed …
Read More »When Diabetes Gets Out of Control, Get Back to the Basics
A female chef, 28 years of age with type 1 diabetes over 18 years, reported extreme glucose excursions. She had pretty good control up until she took on this profession….
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