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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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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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Alternative Therapies for Type 1 Anger Me

I’ve been with many a person who has type 1, when the person is told if they would just eat, drink, or rub this potion on their body, or if they would just think a certain way, they would no longer have type 1 diabetes. When I see or hear this, I become very angry and protective. Today, a woman who has had type 1 diabetes for almost 30 years told me she went to an alternative healer for an essential oils treatment. The “healer” told her if she would rub the cinnamon oils on her ankles it would heal her diabetes. She asked me what I thought.

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Ghost Pills

When it comes to metformin, when appropriate, I recommend the extended release version. Last week my patient, female, 56 years of age, type 2 diabetes, visited. A1C was elevated, and she gained 5 pounds. She had been on metformin ER for the last 6 months and doing well. She said she recently noticed a bean-looking/pill-looking thing in her stools that seemed to be related to her metformin.

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Sometimes it Takes a Human

63-year-old male, moderate cognitive impairment and lives alone. Patient lost a significant amount of weight, frequent symptomatic hypoglycemia, including light-headedness and dizziness, requiring lowering and stopping some of his glucose lowering medications. GLP-1 was stopped and his glucose levels were in normal range. We were very clear that he should not resume his GLP-1 until we saw him again.

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What’s Important to Your Patient?

Male, 26 years of age, type 2 diabetes, obesity, hyperlipidemia, hypertension. Strong family history of type 2 diabetes with complications. Has been a patient since diagnosed 2 years ago. Has met with dietitian. Hasn’t made dietary changes, increased activity, or taken meds prescribed to lower his glucose. A1C 9.2% and rising every 3 months. He would also miss many of his appointments. Stated, “Nothing is going to bother me. Maybe it did my family, but that was a different time and it’s not going to happen to me. I’m going to go on enjoying my life.”

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