A man 79 years of age was referred to me to start insulin. As a diabetes educator, I don't always have a full history and comprehensive labs given to me from the PCP. I met the patient and his family who told me his history, medications, lifestyle, etc....

I have a patient I introduced to using Lantus insulin (including why, injection technique, storage, etc.). She would then see her family doctor, get the prescription and return the next week to review titration and any new questions before she started. I saw her a week later at our supervised diabetes walking group. She reported that she had started using the insulin three days prior and started at ten units and stated she was now 20 units! (She had only had two doses). 

A patient, 62 years of age, with type 2 diabetes, obesity, and an intellectual disability disorder, had been a patient at our clinic for over ten years. Treatment included metformin and insulin. He met regularly with his endocrinologist and diabetes educator. He often spoke about wanting to lose weight....

I recently saw a patient for a diabetes follow-up and had just gotten her lab values faxed over. Her A1c came back at 9.6, despite the patient telling me that her glucose meter readings were much lower. She even showed me the meter, and upon doing some averaging, it appeared that her A1c should be a lot lower....

Female, type 1 diabetes for 42 years, 58 years of age, lives with husband and dog. The patient has hypoglycemic unawareness. We regularly readjust her treatment plan and have recommended CGM for this patient on numerous occasions. Still, she refuses, stating her dog wakes her up if and when she has hypoglycemia. She called to let us know her dog passed away....

Recently I assessed an 84-year-old inpatient with diabetes for his insulin usage at home. In reporting his dosing, he stated that after he checked his glucose before each meal, he took the "first two numbers of the result," and made his dosage for meal-time insulin....

I recently had a home care patient who had been discharged from a skilled nursing facility with a prescription for regular insulin, and who was put on a sliding scale dosage. The patient was experiencing hypoglycemic reactions....

Sometimes, just a simple instruction on the use of an insulin pen can prevent serious problems….

A young man, 32 years of age, with a history of ADHD and being treated with Adderall, was diagnosed with type 2 diabetes. He had symptoms upon diagnosis — frequent urination, weight loss, and his BMI was 20. He followed a low carb diet, was taking metformin, and exercised; however, his blood glucose and A1C continued to rise to 7.7%....

Can we "prevent" diabetes with weight loss? Or would it be better to say we can "delay" diabetes with healthy behavior?  Often people are reluctant to admit that they have diabetes or to initiate treatment. Many times the cause of the delay in treatment is feelings of guilt (they feel like diabetes is all due to their weight). I had a patient who delayed treatment for three years, thinking that he could treat diabetes with weight loss and exercise....