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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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Think Out of the Box!

An extremely insulin sensitive type 1 diabetic woman in her 60s came for review of carb counting and blood sugar logs. Pt had been running blood sugars above target range. When asking pt why she thought her blood sugars were running high, she stated she was fearful of having low blood sugars.

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In Search for Culprit Behind Glucose Swings, Investigate Non-diabetes Medications

Recently I had a patient who was referred to me due to increased glucose levels, which happens all the time. However, this patient was referred because of the recent changes in fasting glucose levels. After attending a group diabetes class, the patient seemed to be improving self care and average fasting glucoses had dropped from around 165 mg/dl to 130 mg/dl. The readings held like this for two months and then started to rise again. The patient's primary caregiver assumed that the patient was no longer doing the right things learned in the class and, after lecturing the patient on all the complications that occur because of elevated glucose, sent the patient to me for individual counseling.

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Look at Whole Picture Before Complimenting Patient’s Weight Loss

Some think you can’t be too rich or too thin. A stylish female, type 2 diabetes, 46 years of age came into the office (a weight loss clinic) for a follow up. Everyone was telling her how great she looked. She said she was feeling great and excited because she could fit into clothes she couldn’t fit in the past few years. She lost 9 pounds in three months. She had not been self monitoring her glucose. She was thrilled, but her doctor wasn’t so thrilled, at least not yet. He was concerned her glucose was elevated.

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Make Sure “Quick and Easy” Food Plans Meet Specific Patient Needs

19-year-old female, type 1, insulin pump, and counting carbs, wanted to use a particular food plan that touted no counting and no need to worry about numbers. She asked me what I thought of that and I informed her that for weight loss, this can work for some, but she has type 1 diabetes, and she will need to check her glucose and most likely count carbs, or at least make some adjustments in her boluses at each meal.

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How Long Does the Insulin Last? Do The Math!

In assessing an in-patient's diabetic educational needs, I was reviewing with him his in-home regimen for his insulin therapy. Per his report, he stated that he took Levemir 50 units twice a day. I asked if it was by needle, syringe and vial preparation, which it was. I instructed him re: the shelf life of Levemir of 42 days once opened. He stated, "I throw it out after a month, but there is always insulin in the vial.” He also said he has more than an adequate supply. He was receiving his insulin by mail-order, receiving as he should, but not using it in a timely fashion. In other words, he was stockpiling his insulin.

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The Danger of Assuming a Patient “Knows What to Do”

Female, 41 years of age, A1C 7%, Indian, family history of type 2 diabetes, at least one was insulin-requiring. For unknown reasons, perhaps the fact the patient was a personal trainer and “should have known what to do,” her hcp didn’t put much attention on her A1C, nor was she asked to return for follow up. For various reasons, one of which was not having insurance, she did not return to a hcp for 3 years.

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Lowering Carbs Can Be Helpful Tool in Weight Loss for People with Insulin-Requiring Diabetes

Female, 28 years of age, diagnosed with type 1 diabetes at age 25. She was taught to manage her diabetes with a basal/bolus insulin regimen and meal plan prescribed by health care team. She was taught she could eat anything she wanted as long as she covered her carbs with rapid-acting insulin. Her glucose was in control, but she gained 50 pounds over the first year. She then attributed her weight gain to taking insulin, so she would not take enough insulin to cover her glucose levels.

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Sometimes Long-term Patient/Healthcare Provider Relationship Must Be Severed

I am a primary care provider in a small private office. A long-term patient of mine, 32 years of age, was recently diagnosed with type 1 diabetes. His insurance is now one I do not participate in. Until his recent diagnosis, he visited annually and paid out of pocket. He wanted to stay with me for his care. I realized his needs were most likely more than he could afford.

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