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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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The Power of Numbers

A disaster can be considered many different things to different people. For some it could mean developing type 2 diabetes rather than preventing or delaying it. If you watch our expert video series you will hear our Publisher ask many of our experts, “Whether or not you have diabetes, what would you like your A1C to be?” As our expert, Dr. Karl Nadolsky said, he’d like his to be in the normal range, ~ 5%. This is not unusual for us as health care providers to want and work towards a normal A1C, that is, depending on age, and risk for complications of hypoglycemia.

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Helping Patients to Achieve Behavior Change

Man, 76 years of age, type 2 diabetes, obesity, SP right total hip replacement one year out. When preparing for hip surgery, was on basal and bolus insulin, metformin. Had been on a GLP-1 but had diarrhea so he stopped. Was able to, for the most part, follow a lower carbohydrate meal plan but was not active. When he first started coming to us for weight loss to prepare for his surgery, his weight was 304 pounds, BMI 45, A1c 9.9%, Cr 1.87, eGFR 34. We decreased his metformin from 2,000mg/day to 1,000mg day and referred to nephrology. With this change and being motivated for surgery, he lost weight and in 6 months went into surgery having lost 25 pounds with an A1c of 6.9%. Note, due to eating less carbs, he could take less insulin, which seemed to help his appetite. Surgery was performed and he did well.

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What’s the Best Teacher?

Over the years I’ve found the best teacher for people who have diabetes is their numbers. Without teaching the patient targets, they don’t learn much. This patient is just one example of many. A man, 57 years of age, visits a community diabetes education course. He tells me he has type 2 diabetes, hypertension hyperlipidemia. He said his doctor told him his numbers were fine about 9 months ago. When he came to the course, he was losing weight, was thirsty and was very tired.

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Monitoring Insulin Temperature

I have type 1 diabetes and have been living with it for the past 11 years. I take daily insulin injections to stay alive and well. A couple of years ago, I had a very frustrating incident when my insulin stopped working. I began injecting loads of insulin, and even with multiple doses my blood glucose wouldn’t drop.

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What is the Most Ineffective Medication?

As we know, the most ineffective medication is the one needed but never taken. There are many reasons our patients don’t take prescription medicines, but a biggy is the cost. If a medicine is too expensive, the patient will not fill the prescription, therefore won’t take it. For example, when ordering an SGLT-2 and/or GLP-1, each can cost hundreds or more for a month’s prescription. Some are covered for both. Some are covered for one brand, but not the other.

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Just Because It Says “—” Doesn’t Mean It Is

Male, 62 years of age, type 2 diabetes, class III obesity. Has been on metformin, 1,000mg twice daily. Glucose in the 200-300mg/dL range. A1C. Taught about lower carb meal plan, started on Trulicity, first 0.75mg, then 1.5mg/dL. Made the dietary changes right away with the addition of the Trulicity. Within 2 weeks glucose levels averaged 125, patient losing weight, decreased appetite and feeling good. More energy. Insurance did not cover Trulicity, but did cover Victoza, so started on Victoza. When made the change, started with the 0.6mg daily, then increased weekly to the 1.8mg/day.

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