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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 Family Members Are HCPs

Male, 68 years of age, type 2 diabetes, Italian, on long-acting insulin and GLP-1. Basal glucose levels are within target as are most post-prandials except every night after dinner. We have talked several times about lowering carbs, which he has done during the daytime, but has difficulty cutting back on dinner meal. We had in the past discussed taking rapid-acting insulin for meals, but he refused. After two weeks, patient sent me his CGM results. Even he started getting concerned about his evening post-prandial levels. Rapid-acting insulin added before dinner and post-prandials are now in target range. He has not once complained about taking the rapid-acting insulin before dinner.

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What Not to Trust

I received a call and glucose numbers from patient who has type 2 diabetes, usually with hyperglycemia, never hypoglycemia. I noticed there was at least a 12-hour span since the last glucose reading. His glucose levels after the over-12-hour lag showed hypoglycemia during the  night when the numbers start showing. His glucose averaged 53 during that time, but it has been running 150 and over, and we have been slowly increasing his insulin.

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Take a Second Look at Surgery Recommendations

Patient is male, 48 years of age, type 2 diabetes with hyperglycemia for eight years, class III obesity,  and very symptomatic GERD. Patient planned to have laparoscopic sleeve gastrectomy. I asked him why he chose that particular surgery. He said, "Because it's less invasive." I asked if his surgeon told him the sleeve gastrectomy could increase his GERD, and is not as effective for the treatment of type 2 diabetes nor for weight loss as is a bypass. He said, "No, the surgeon just left it to my choice. I said I wanted the sleeve and he was good with that."

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Talk About Aspirin With Your Patients

Male, 69 years of age, coronary artery disease,  two cardiac stents, hypertension, hyperlipidemia, prediabetes, bladder cancer.  His sister is 64 years of age, coronary artery disease, prediabetes, PCOS, elevated cardiac calcium score of >1000, no hyperlipidemia. HO early heart disease, stroke, and early death in family. There have been recent reports in the media speaking of the ASPREE Trial, which reported that taking aspirin daily is not effective for all people, and in some it may be more detrimental due to bleeding risks.

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What Your Patients Don’t Want to Hear

We recently had a new patient, 75 years of age, who has class I obesity and prediabetes, and has had hypothyroidism for over 25 years. She is very active and has purposely lost weight, about 6 pounds. She told me she has had hair loss over the years and has seen a specialist for this, but lately it's been worse. She takes spironolactone, biotin, and zinc for her hair loss. She wanted to know what she could do about her hair. She is taking 150 mcg levothyroxine and 5 mcg liothyronine.

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It Doesn’t Have to Happen

You may have read Dave Joffe's Editor's Note on the relative risk of developing diabetes and how sometimes patients use it as an excuse for having diabetes. Although we don't like to blame patients, it is true some people do think and say, "Why try? I have a family history of diabetes. I'm sure to get it too." Well, we know that isn't 100% true. Hopefully we work with our patients to help prevent or delay type 2 diabetes.

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When Starting a GLP-1 for Weight Loss

Although GLP-1's don't usually cause hypoglycemia except when given with insulin or a sulfonylurea, I have found that when patients who do not have diabetes are started on a GLP-1, some can have symptoms of hypoglycemia and/or more untoward GI side effects if they start when they come in the office fasting.

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Timing Matters, But Patient Reasons May Be a Factor

This is about one patient but the situation is not unusual for many patients who have type 2 diabetes and take insulin. Woman, 67 years of age, type 2 diabetes, taking Tresiba 15u every day at 11am and Victoza every morning upon arising, about 8am. She wears a CGM. Glucose levels were in target range for some time. Family reported patient was having some subtle cognitive changes. We did send her for neurologic evaluation.

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Diabetes and/or Obesity: Whose Fault Is It?

Many people who have diabetes, especially type 2 diabetes, tell me they have no one to talk with about their diabetes. Why, with all the education and tools we have, do people who have diabetes still feel this way? My patients who have excess weight or obesity tell me the same thing. We may not have as much clinical information on that as we do diabetes as of yet, but the patients tell me the same thing.

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