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.
She had some difficulty with the metformin. Changed to Brand, Glucophage, which she tolerated. Still not able to exercise much, but did make some dietary changes. Lost 5 pounds, and A1C now 6.1%. We discussed the use of a GLP-1 to help her glucose levels, appetite, and hopefully her weight. She cried and cried. She said she could not, would not take an injection. She watched her father take insulin over the years and she just can’t do it. Said she took a vitamin shot in her thigh in the past, and would not take an injection. I tried to show her how this is most likely a much smaller needle than she used in the past, and most people tell me they don’t think they can do it until they try it. One try and they tell me they can. I asked if she would let me try. She said absolutely not. I went no further, just encouraged her to do the best she can with dietary changes, Glucophage, in fact increased the Glucophage, and see physical therapist for exercises she can do. We’ll see in 3 months if there are changes.
- As a health care provider, I’ve not met many people who want to deal with injections. This includes both hcps and patients.
- When working with people who have type 1 diabetes, and no other choice, it is my responsibility to make sure the patient gets insulin. Of course, I teach the benefits (life) and risks (mainly hypoglycemia), I don’t force the person, but I do teach it is a lifesaver. Although difficult, we make it work.
- When teaching about GLP-1s, I teach people the benefits and risks of this hormone they may be lacking. Can I tell them at this time that it’s lifesaving? We may find out one day this is true, and thus far there is one study of a GLP-1 (liraglutide 3mg) treating obesity and decreasing the risk for type 2 diabetes, but can I assure a patient with a family history of type 2 diabetes that diabetes will be prevented? I can’t guarantee that.
- Teaching the use of insulin is different than the use of injectable GLP-1s at this time. Very different in many ways.
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