Disasters Averted

57-year-old female, prediabetes, class II obesity, arthritis R knee, family history includes father with type 2 diabetes with renal disease. Verbalizes her fear of having diabetes. Besides discussing lower carbohydrate meal plan, discussed metformin, and being as active as she possibly can without causing further injury to her knee. First set of labs showed her A1C to be 6.4% and her FPG 118.

Female, 58 years of age, type 2 diabetes, obesity, taking (Qsymia- phentermine/topamax) for weight loss, antihypertensive for hypertension, and metformin for glucose management. Blood pressure usually in the 120-130/70-80 range, glucose averages ~120, and was losing weight. Today’s b/p 170/90, random glucose 232, c/o tinnitus. Weight was up 5 pounds since last seen 3 months ago. It’s now allergy season. After further discussion, she told me she was started on a medrol dosepak, and on her own purchased and is taking an OTC allergy medication.

I don’t know how many times I have the opportunity to teach patients and health care providers that it’s not all about food. I was recently reminded of that when I overheard a dietitian, a CDE, go over a 4-week CGM report with a patient, male, 53 years of age, type 2 diabetes, non-obese, actually not even overweight.

This patient was newly diagnosed, but I did not really think she believed she had diabetes. In other words, she was in denial. Once she saw the results of her labs, I could see things changed in her. She “got it."

Woman, 57 years of age, prediabetes, hyperlipidemia, class I obesity and history of gestational diabetes. I’ve been working with her for the past two years. The first year she was very motivated because of her new diagnosis of prediabetes and her weight being what it was. Her son was getting married and she wanted to lose weight for the wedding. We discussed a plan for her.

Woman, 62 years of age, musician, travels often, type 2 diabetes, obesity, hyperlipidemia, fatty liver. Was traveling for two months straight on the road. Late nights/parties and a lot of drinking. Admitted not having taken her GLP-1 or really following any meal or healthy life plan/schedule she was following before leaving. Since last office visit 3 months ago, weight up 10 pounds, fasting glucose 170 in office.

A patient, 48 years of age, female, type 2 diabetes and obese, was referred to me for diabetes and weight management. Her first visit was 8 a.m., after fasting for 10 hours. Her A1c was 7.4%, BMI 37, BP 164/92, HR 92. The previous hcp had recorded she was recommended a low carb diet and the following medications: Metformin, 1,000mg twice daily; Byetta 10mcg sq twice daily. It was also written that she was non-compliant.

Woman, 86 years of age, very active, history of type 2 diabetes, but does not check glucose or even admit she has diabetes. She has refused to take any medications at all for the last 20+ years I’ve known her. Had gastroenteritis for 3 days. Even when well, she does not drink anything but coffee, and sometimes sugar-sweetened beverages, but only a few ounces of that at a time.

Woman, 53 years of age. Type 2 diabetes and is obese. Patient’s daughter was getting married. She was very motivated to lose weight for the wedding and she did. Her A1C lowered from 7.5% to 6.6%. She cut back on her carbs to <100gm/day, increased her activity and took her metformin regularly. She lost 22 pounds over 6 months. The wedding was 2 months ago and she has gained 6 pounds. That may not seem like much, but it was enough to raise her A1C and open her eyes.

Woman, 63 years of age, history of ovarian cancer, prediabetes, hyperlipidemia, has been trying to lose weight for years but was unable to do so. She is very family-, friend-, colleague-oriented. Every holiday she thought she had to make or bring and eat whatever special holiday food was associated with the holiday. She couldn’t let anyone down by not bringing, or by not eating what other people brought. We met weekly for the past three years. Every week there was some excuse about how or why she “cheated” or if there was a week she didn’t think she “cheated,” then she was afraid she would.