Disasters Averted

Man, 63 years of age, type 2 diabetes, obesity, hypertension and hyperlipidemia, referred to me, a CDE, to start him on and teach him how to use insulin. He has had diabetes education in the past, tried lower carb eating and physical activity, but glucose levels still elevated. He told me he felt like a failure. He said he learned he was insulin resistant, made too much insulin, which was causing his co-morbidities. He was very resistant to start insulin, especially since he thought insulin was the cause of his problem.

When we think about disasters, we usually think of the outcome, a poor health outcome. We don’t always think about the journey. The journey to poor health outcomes are many. Today I am reminded of not having the insurance coverage for the correct medication. Without it, one can have a disaster, poor diabetes management. The consequences of that, as well as the disruption to running a smooth office.

Man, 51 years of age, type 1 diabetes for 32 years. Patient also has history of Class II obesity, CVA, MI and insulin resistance. Patient referred to Obesity Center for weight loss. A1c was 8.2%. Plan was to start Symlin. Symlin was added at 30mcg daily before dinner. I recommended he get a CGM. He did.

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.

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.

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.

Woman, 42 years of age. Type 1 diabetes for the past 22 years. I’ve been working with her and reviewing her CGM reports, and teaching about checking patterns before making changes in her pump settings.

Laurie Klipfel, RN, MSN, BC-ANP, CDE was recently asked if she could offer any pearls of wisdom for another Disaster Averted regarding a patient with type 1 diabetes who couldn't afford his analog insulin. After reading her advice, keep reading to learn how you can take action to help make insulin more affordable.

In my experience, most people will check their fasting glucose levels, but due to time, place, not enough strips, or just the fact they don’t want to see…many will not check after eating. For those who will only check once a day, I recommend alternating a fasting blood glucose check with a bedtime blood glucose check.

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.