Disasters Averted

Last week I saw a patient who seemed to be losing control of her blood glucose levels. She had been doing well and her A1c had been around 6.0 – 6.3 for the past couple of years. She was doing this while only on metformin 1000 twice a day. She …

I had a new patient who has had diabetes for decades. She was referred to me after her blood sugars went from good to bad. I asked her to bring her supplies with her when she came in to the office for her appointment. She did so and during her …

A patient came to my office to learn to use long-acting insulin. The referring provider’s note stated that the new patient, who was establishing care without outside records, was taking only mealtime insulin: NovoLog. During my assessment, the patient stated "NovoLog 75/25" was used three times per day, before meals. Knowing …

A woman with type 2 diabetes was taking Lantus using a vial and syringe, and Novolog using a prefilled insulin pen device. Novolog was a new medication for her, and she had only been on it for 10 days. Her pre-meal glucose readings were still high though, in the mid …

I had a type 2 patient on metformin whose blood sugars were elevated every day at lunchtime. All of his other readings including fasting, pre- and post- dinner, and bedtime, were fine. When he demonstrated his testing method over a Skype internet video call, everything he did seemed correct. After …

Recently I saw a type 1 diabetes mellitus patient who was diagnosed in 1980 at 15 years of age. She had not seen an educator in quite some time but had changed from NPH/Regular to Lantus & Regular. She was interested in learning more about the insulin pens that were …

At our podiatry clinic, we had a Native American patient who came in once a week for diabetic ulcer debridement and dressing changes. He would do his home care and then return for further debridement and a new topical if the current one wasn’t healing the ulcer. Because it was …

I do a lot of inpatient diabetes education. One of my patients was new to insulin and needed to go home on twice daily injections of 70/30. We educated her with all she needed to know to be successful at home. Two weeks after discharge the patient experienced a severe …

When sitagliptin (Januvia) first came out, I was called by our legal affairs department about a patient of another MD at the University of Penn whose house staff had ordered 1000 mg sitagliptin instead of 100mg. As the drug had just come out, the staff was not very familiar with …

One of my patients had a serious head injury from a fall which resulted in an unconscious period of time when on vacation. She spent five days in a hospital neuro unit during recovery. She had a list of all her medications, medical history (brief), and latest lab work including liver …