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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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Watch Out. It’s That Time of Year Again.

Yes, it’s that time of year again when your phone/email/computer is busy with patients wanting appointments and making commitments to make their New Year’s Resolutions. Often at this time of the year, my patients come in wanting to change just about everything about what they eat, when they eat, how much they eat, and the same for being physically active. So many of these patients have told me they have tried and tried and tried and failed in the past, but now it’s the New Year and it’s going to be different.

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Winter Highs

Female, 20 years of age, type 2 diabetes, is obese with anxiety disorder, untoward response to several classes of agents. Reports eating lower carbs since last seen. During the warm weather, random glucose levels and A1C were near normal. Today is a cold winter day. Random glucose 188mg/dl.

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The 5 Rights of Medication Administration

Male, 56 years of age, type 2 dm, hypertension with orthostatic hypotension, peripheral neuropathy, hyperlipidemia, class II obesity. He fills his pill box every month and has been doing so for years. It has taken some time, but we finally came up with a plan with his meds and lifestyle where he has been feeling very well and his numbers are better than ever. He filled his med box a week before contacting me. He wasn’t feeling well. Feeling dizzy and his legs were feeling like rubber.

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Time Will Tell What Patient Will Do

Male, 21 years of age has class III obesity, binge eating disorder, fatty liver, and asthma, and was recently diagnosed with type 2 diabetes. It is his freshman year at a college away from home. He eats in the cafeteria, and has no refrigerator or stove in his room. He visits today after not taking metformin or GLP-1 agonist since at starting school. He is under a lot of stress and states the food at school is terrible, unhealthy, and not diabetes-friendly at all. Note, he has been taught a lower carb meal plan. He says he is not taking Glucophage or Victoza; each of them at low doses gives him terrible diarrhea. He states he checks his glucose twice a week, with fastings in the 90-100 range. He is up 10 pounds since our last visit in September.

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When Losing Weight, Warn ’em!

I work in obesity medicine. As many of us know, losing weight isn't the problem for most, but weight regain is. As the saying goes for many, you can't be rich enough or thin enough. Many of our patients come in with unrealistic goals regarding their weight loss, and don't give themselves enough credit for the weight they have lost. Many, for many reasons, regain.

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Sometimes You Gotta Use the Brand Name

Many of our patients have intolerable GI side effects from metformin. We use ER to try to decrease these, but that doesn’t always work. If they have these symptoms, I recommend they take it slow and take it after they eat. If they still have problems, I recommend they break the tablet to 250mg, even though the label may say one shouldn’t break the tablet.

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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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