I am a diabetes educator and have built a small business helping senior citizens care for their animals with diabetes. It seems that most of the pets I see are small dogs and their owners use insulin to manage their animals' diabetes.

A patient called to report that they had the flu, were vomiting and had diarrhea. The patient was not eating and so assumed, because of this, that they should not be taking their insulin. I had the patient check their blood sugars which were found to be over 340mg/dL....

A female patient, 42 years of age, with type 2 diabetes, is overweight with a history of vaginal yeast infections with elevated glucose levels. Wanting to better manage her diabetes and lose some weight, the commercials about SGLT-2 inhibitors caught her attention.

A 29-year-old woman with insulin-dependent diabetes noted a painful erosion at the site of the tattoo which she had gotten 7 days before. A culture isolated staphylococcus aureus confirming the clinical impression of staph. This diagnosis was not entirely unexpected, since patients with diabetes mellitus are predisposed to staphylococcal infection.

A man with type 1 diabetes started an exercise program to help him manage his early morning highs. He exercised every evening, at which time his glucose levels would drop during and after exercise. Thinking that exercise would lower his early morning highs, he did not take his insulin before exercise. He was surprised to see his glucose would go up after exercise rather than go down.

One of my long term patients called my office because she could not figure out what was happening with her post breakfast glucose readings. She counted carbs and would typically have a 2 hour ppg of no more than 145 mg/dl but even though her pre-breakfast readings were around 110 mg/dl she was experiencing glucose levels near 200 mg/dl. I had her do a morning food diary for 7 days and we identified 3 days when she was eating French toast when her readings were going over 200 mg/dl. This meal had never been a problem in the past.

As the incidence of diabetes increases, insulin use can reasonably be expected to increase, and the mistakes will no doubt increase as well. Insulin is a very powerful medication, and some of these mistakes will require the ambulance, the hospital, or worse.

Last week I saw a patient who seemed to be losing control of her blood glucose levels. She had been doing well and her A1c had been around 6.0 - 6.3 for the past couple of years. She was doing this while only on metformin 1000 twice a day. She was referred to me by her physician because of high after-meal readings ranging up to 350 mg/dl. I went over her medical history and medications looking for a possible problem and found nothing.

My colleague and I were working with a client new to insulin. We each saw him separately. He was taking Lantus and Humalog by syringe at meals. He had been taught how to use the syringe by his physician's office staff. He was claiming much different numbers than expected for his mealtime doses.

After starting a new medication (gabapentin) for his neuropathy, a patient of mine gained 30lbs and presented with peripheral edema without symptoms.