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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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Inpatient Teaching Should Include Outpatient (Real Life) Education and Supplies

One day a 31-year-old woman who had recently been hospitalized and subsequently diagnosed with type 1 diabetes came into our diabetes clinic for education. She had been discharged from the hospital less than a week prior to coming to our clinic. She was frustrated when she arrived, as her blood sugars had become increasingly elevated after leaving the hospital. She had called her primary care physician and he instructed her to increase her dose of long-acting insulin. Still, her blood sugars had not improved.

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What Do You Attribute The Change To?

56-year-old man, type 2 diabetes, had been prescribed SGLT-2 to lower his glucose levels. He had been taking an SGLT-2 for the past two years. His A1C, blood pressure and weight were elevated since the last visit 3 months ago. When asked if he was doing anything different, he said he had read articles and seen on TV about these types of medications causing heart disease, so he stopped taking his.

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Don’t Blame All Symptoms on Glucose Levels

A woman, 72 years of age, type 2 diabetes, obesity, taking metformin, GLP1, ARB, and antidepressant (SSRI). Lost 20% total body weight in the past year. Recently complaining of dizziness and weakness. Glucose levels in the 60’s at home, at which time had symptoms of hypoglycemia. Glucose-lowering medications (metformin and GLP-1) were stopped. Continued to complain of dizziness and weakness especially in the morning.

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The New To-Do For Travel

A patient with diabetes gets her meds, prescribed by a nurse practitioner, from a national chain pharmacy in New York. She was planning travel to Hawaii. Patient did not refill her meds at home in New York before leaving for her travel in Hawaii because it was too early. Insurance would not pay until closer to the refill date. She thought she could wait until the time insurance would cover, go to a location where she was traveling and pick it up there. She’d done that during her travels in the past. It did not work in Hawaii.

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Don’t Look, Don’t Know

Woman, 55 years of age, type 2 diabetes for 15 years. When first diagnosed, did all she could to learn everything about managing her diabetes. She even went to two complete diabetes education courses. The second she paid for on her own. In time, she started checking less, ate more and more unfriendly diabetes foods, and due to a chronic ankle problem, became more and more inactive. After losing her insurance, she then stopped taking her medications and checking her glucose, until she noticed bloody drainage on her clothes from rashes several places on her body.

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When Pills Are Hard to Swallow, Find Alternatives

Woman, 67 years of age, newly diagnosed with type 2 diabetes with an A1C of 7.8%. Met with PCP who prescribed metformin ER and referred patient for diabetes education. Patient made some dietary and physical activity changes at first, but upon return visit her A1C was 8.5%. She reported she did not take the metformin. “I can’t swallow big pills. The bottle said not to crush or break the tablets. They were just too big to swallow. So then I just gave up on everything.”

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Diabetes Information Best Shared By Patients and HCPs Alike

Woman, 58 years of age, history of PCOS, prediabetes, strong family history of type 2 diabetes, cardiovascular disease and obesity. This patient lives a healthy lifestyle, including a lower carb meal plan, is very active, and keeps her weight down. Those interventions did not lower her A1C, so she educated herself and asked her NP/CDE if she should start metformin. This was about 20 years ago. Since starting metformin, A1C is in the 5.1-5.5% range. Patient regularly checks glucose, which was recently rising. A1C rose to prediabetes range again. Started on GLP-1 by NP/CDE. Patient then went to a new PCP who told her she should not be taking metformin or the GLP-1 because she does not have diabetes. Wanted to refer her to an endocrinologist....

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Create Safe Environment for Your Patients to Tell You the Truth

A teenage type 1 on an insulin pump was seen in our office for follow up. The download on her pump revealed some interesting numbers. First off, her glucose levels were out of target range and secondly her I:CHO ratio and her insulin sensitivity looked more like the numbers of a type 2 diabetic vs a type 1. Her I:CHO was 1:16 and her insulin sensitivity was 1:30. In my experience, I'm used to seeing a lower I:CHO and a higher insulin sensitivity in type 1 vs type 2.

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