Disasters Averted

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.

Health care professionals who are endocrinologists, cardiologists or who work in these specialized fields know the complications of prediabetes or diabetes. Many of us have these patients. Sometimes it’s almost natural to talk with these patients differently than we’d talk with most of our patients who aren’t as well-educated. A woman, 59 years of age with prediabetes and strong history of cardiovascular disease complained of a slight chest pain not associated with exertion or shortness of breath, just an ongoing discomfort. Other than this, the patient — who is herself a health care provider —  is feeling fine.

Teach patients what DKA is and how to prevent it. Include in your teaching that glucose can be normal or only slightly elevated and it can still happen. Teach that having an illness and/or dehydration increases this risk.

A patient who has had type 1 diabetes became pregnant after nearly 20 years of having type 1 diabetes. She reported her OB-GYN referred her to a specialty clinic for high-risk pregnancy, including diabetes in pregnancy. They worked in tandem to ensure her care was carefully managed throughout the stages of her pregnancy.

This summer I had the opportunity as a student pharmacist to attend a camp for youth with type 1 diabetes (T1D) and assist as a member of the medical staff. We spent the first few days setting up, going over camp procedures and policies, and preparing for arrival of the campers. This was my first time helping at such an event, and my expectations of how deeply the camp experience would impact the lives of the campers (and myself included!) were greatly exceeded.

Summer, a time for travel for so many. Over the next few weeks, we will look at ways to prevent disasters during or after travel. When it comes to travel plans, a lot of people who have diabetes are most concerned about their medications — getting, bringing enough with them and so many issues associated with that. I've found most aren't concerned about protecting their feet.

When we first met this patient, he did not think he was getting the right treatment. When he visited one week later... When I asked him, and told him I would not judge him, he admitted to drinking a tea his mother recommended to bring down his glucose. He then mentioned several other supplements. His glucose was not lower, but higher.

Man, 55 years of age, type 2 diabetes, hypertension, was referred to see us. The patient reports coming to us because he does not think he is getting the right treatment. Reports having been put on insulin upon diagnosis 4 years ago--at which time he had lost 50 pounds, was very hungry, thirsty, and had urinary frequency. When visiting, he did not have his labs from diagnosis but did have labs from 3 months ago at which time A1C was 7, and C-Peptide was 2.2. He said his past endocrinologist changed him to oral meds after his glucose had come down to an average of 140.

What I love about going to conferences is the realization that what I’m doing in my practice is in line with what others I respect are doing. That is meaningful, and I always learn a new pearl. If that’s all I gain from these conferences, it’s okay, but it’s usually more than that. I have just returned from the 2018 ADA Conference, where there was so much about new technology, particularly continuous glucose monitoring.

When prescribed lifestyle changes and or medication(s), patients who have diabetes, obesity, hypertension, or any chronic condition that is easy to monitor, even from home, may agree to these changes at first. They can almost immediately get improvements in their numbers. It can be encouraging. For some, seeing those numbers change for the better encourages them to keep on keeping on. However, others may think they are healed and stop treatment. Their numbers may go back to the same or even "worse" than before the treatment.