Diabetes In Control. A free weekly diabetes newsletter for Medical Professionals. News and information for Medical Professionals.
Disasters Averted is consistently one of our more popular features, and we are glad to provide diabetes educators and health care professionals a place in which to share their own experiences with other DIC readers. Here are the five new stories that most engaged you this year.
#5 Don’t Blame All Symptoms on Glucose Levels (March)
#4 The New To-Do For Travel (March)
#3 Not All Neuropathies in Diabetes are Caused by Diabetes (May)
#2 Create Safe Environment for Your Patients to Tell You the Truth (Feb.)
#1 Misuse of New Insulin Strengths (June)
Editor's Note
When we publish clinical information most of the time it is a study where the parameters are closely controlled. This means that often the human factor is not included in the results. These human factors could be as simple as missing a dose, but even more likely these problems are caused by events unrelated to diabetes at all. Every week we provide you with an example of how the human factor influences care, and as we close out the year, we want to share the Disasters Averted that our colleagues provided us, and that you our readers most viewed during 2016.
Dave Joffe
Editor-in-chief
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.
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.
Female, 57 years of age, type 2 diabetes, metformin 1,000mg twice daily for 12 years, came in with weakness, anemia, tingling of fingers and toes. Her A1C had always been below 7%. Some in my office thought she had developed diabetic peripheral neuropathy. I could not disagree, but I also knew metformin can cause vitamin B12 deficiency.
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.
We certainly have important education to accomplish with patients and health professionals regarding the new higher concentration insulin products that are available only in a pen, including U-300 TOUJEO (insulin glargine), U-200 TRESIBA (insulin degludec), and U-200 HUMALOG (insulin lispro). U-500 insulin is also available in a pen (HUMULIN), although vials remain on the market. Patients may not understand proper dosing and dose measurement with these higher concentrations of insulin products.