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Donna Pacheco

Getting to 120 Safely: A Practical Guide to Intensive Blood Pressure Management in Diabetes

Healthcare professional monitoring blood pressure in a patient with diabetes using a digital blood pressure monitor, highlighting intensive blood pressure management and cardiovascular risk reduction.

Blood pressure control remains one of the most powerful tools for reducing cardiovascular and kidney complications in people with diabetes. While clinicians have traditionally focused on achieving targets below 140/90 mmHg, recent evidence and the 2026 American Diabetes Association Standards of Care support a more intensive approach for selected high-risk …

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Why Some Patients Wait Months for Automated Insulin Delivery—and How to Avoid It

Diabetes specialist reviewing automated insulin delivery system data with a patient during a clinic consultation to improve access and eligibility for advanced diabetes technology.

For many people living with diabetes, gaining access to an automated insulin delivery (AID) system can be life-changing. These technologies help improve glycemic outcomes, reduce hypoglycemia risk, and ease the daily burden of diabetes management. Yet despite their proven benefits, many patients continue to face lengthy delays before gaining access. …

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Should Hospitalized Patients Keep Their CGMs and Insulin Pumps? The 2026 Standards Say Yes

Hospitalized patient using a continuous glucose monitor and insulin pump while reviewing glucose data on a smartphone under clinical supervision in a modern hospital room.

For years, hospital admission often meant disconnecting patients from their personal diabetes devices. Continuous glucose monitors (CGMs) and insulin pumps were frequently removed, even when patients had used them successfully at home. However, the 2026 American Diabetes Association (ADA) Standards of Care introduce a significant shift in how hospitals approach …

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Protecting Muscle While Treating Obesity: New Protein Targets for Older Adults on GLP-1s

Older adult performing strength training with protein-rich foods and muscle anatomy model, illustrating sarcopenia prevention during GLP-1 therapy and obesity treatment.

The rise of highly effective GLP-1 receptor agonists and dual incretin therapies has transformed obesity treatment. Medications such as semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro) are helping patients achieve levels of weight loss that were previously difficult to attain without bariatric surgery. However, as clinicians celebrate these advances, a …

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Fasting or Random Glucose Testing? Navigating the New Rules for Cancer Therapy–Induced Hyperglycemia

Healthcare professional performing glucose testing on a cancer patient receiving treatment, illustrating monitoring for cancer therapy–induced hyperglycemia during oncology care.

As cancer treatment becomes increasingly sophisticated, clinicians are encountering a growing metabolic challenge. Cancer therapy–induced hyperglycemia has emerged as an important concern with the expanding use of immunotherapies and targeted therapies. In some patients, hyperglycemia develops gradually. In others, particularly those receiving immune checkpoint inhibitors, severe diabetes and diabetic ketoacidosis …

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Why Some Patients Abandon CGM Within Days—and What to Teach Before They Leave the Office

Healthcare professional educating a patient about continuous glucose monitoring (CGM) during an office visit, demonstrating sensor placement, glucose trends, and device use to improve long-term diabetes management.

Continuous glucose monitoring (CGM) has transformed diabetes management by giving patients real-time glucose data, trend arrows, and alerts that support better daily decisions. Yet some patients stop using their CGM within days of starting. Often, the problem is not the device itself. Instead, early frustration begins when patients leave the …

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What Really Happens When Patients Stop Insulin Without Telling Their Doctor?

Patient with diabetes sitting at a table with insulin supplies and glucose monitoring equipment, illustrating the risks of stopping insulin therapy without medical supervision.

For many people living with diabetes, insulin is more than a medication—it is a lifeline. Yet despite its critical role, some patients stop taking insulin without informing their healthcare provider. The reasons vary widely and may include medication costs, treatment fatigue, fear of side effects, weight gain concerns, or misunderstandings …

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The Diabetes Conversation Patients Don’t Want to Start: Addressing Sexual Health in Clinical Practice

Healthcare provider discussing sexual health concerns with a patient during a diabetes management consultation.

Sexual health remains one of the most overlooked aspects of diabetes management, despite its significant impact on quality of life. While clinicians routinely discuss glycemic control, cardiovascular risk, and medication adherence, conversations about sexual function are often avoided by both patients and healthcare providers. Yet sexual health concerns related to …

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The Overnight Danger Many Clinicians Miss: Why Nighttime Hypoglycemia Still Matters

Sleeping patient with diabetes beside a continuous glucose monitor showing low blood sugar levels during the night, illustrating nocturnal hypoglycemia risk.

Many healthcare providers focus heavily on daytime glucose control, yet some of the most dangerous hypoglycemic episodes occur while patients are asleep. Despite major advances in insulin therapy and glucose monitoring, nocturnal hypoglycemia remains a significant clinical concern for people living with diabetes. Because symptoms often go unnoticed during sleep, …

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The Diabetes Treatment Barrier Nobody Sees: When Prescriptions Are Never Filled

Patient declines a newly prescribed diabetes medication while a prescription bottle, glucose meter, and prescription form sit on a table, illustrating primary nonadherence in diabetes care.

When a healthcare provider writes a prescription for diabetes medication, most assume the treatment journey has begun. However, for many patients, the process never moves beyond the prescription pad. This hidden problem, often discussed as primary nonadherence in diabetes care, occurs when patients fail to obtain a newly prescribed medication. …

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