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Donna Pacheco

GLP-1s and Vision Loss: What Prescribers Should Know About the Emerging NAION Signal

Patient eye with semaglutide injection illustrating the potential GLP-1 NAION risk and sudden vision loss.

GLP-1 receptor agonists have transformed type 2 diabetes and obesity treatment, but a rare vision safety signal deserves clinicians’ attention. Emerging evidence has raised concerns about a potential NAION risk with GLP-1 therapy, particularly with semaglutide (Ozempic, Rybelsus, and Wegovy). Non-arteritic anterior ischemic optic neuropathy (NAION) can cause sudden, usually …

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Why Are We Ignoring the Gold Standard for Healing Diabetic Foot Ulcers?

Clinician applying a knee-high offloading device to help treat a diabetic foot ulcer and reduce plantar pressure.

Diabetic foot ulcer offloading is one of the most important parts of treating a neuropathic plantar ulcer, yet the most effective approaches are still not routinely used. Non-removable knee-high devices, including total contact casts and non-removable walkers, can reduce damaging pressure while supporting wound healing. So why does a treatment …

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The Hidden Hyperglycemia Trigger: When Dehydration Makes Blood Sugar Worse

Person with diabetes reaching for water beside a glucose meter, illustrating how dehydration can worsen high blood sugar.

For people with diabetes, an unexpected glucose spike may have a less obvious cause than food or missed medication. Dehydration and high blood sugar can create a self-reinforcing cycle. When the body loses too much fluid, glucose becomes more concentrated in the bloodstream. At the same time, rising glucose can …

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Forget the Gym? Why 2-Minute Exercise Snacks Could Improve Glucose Control

Woman taking a brief exercise break at her desk with a glucose meter and two-minute timer representing exercise snacking for diabetes.

Finding time for a full workout can be difficult, but what if two minutes of movement still mattered? Emerging research on exercise snacking for diabetes suggests that brief bursts of activity spread throughout the day may reduce post-meal glucose excursions and limit some metabolic effects of prolonged sitting. Instead of …

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Eat Your Carbs Last: Food Sequencing for Better Blood Sugar

Vegetables, grilled chicken, and brown rice arranged in food sequencing order with a glucose meter beside the meal.

Could changing the order of foods on your plate improve blood sugar without changing what you eat? Research on food sequencing for diabetes suggests it may. Eating vegetables, fiber-rich foods, and protein before carbohydrate-rich foods can reduce post-meal glucose rises in some people. Rather than removing rice, bread, pasta, or …

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Normal Blood Sugar, But Still in DKA? The Hidden Danger of Euglycemic Ketoacidosis

Euglycemic DKA SGLT2 inhibitor concept showing normal blood glucose, elevated ketones, medication, and kidney model.

Euglycemic diabetic ketoacidosis can challenge one of the most familiar clinical shortcuts in diabetes care: DKA should come with markedly elevated glucose. In patients taking sodium-glucose cotransporter 2 (SGLT2) inhibitors, however, dangerous ketoacidosis may develop while glucose remains normal or only modestly elevated. As a result, euglycemic DKA in patients …

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When Diabetes Technology Damages the Skin: Keeping Patients on CGMs and Insulin Pumps

CGM skin irritation around a continuous glucose monitor and insulin pump adhesive sites

Continuous glucose monitors (CGMs) and insulin pumps can transform diabetes management, but the technology only works when patients can comfortably keep wearing it. CGM skin irritation can turn a valuable device into a daily source of itching, redness, pain, or damaged skin. In some cases, the reaction becomes severe enough …

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Years After Bariatric Surgery, Blood Sugar Can Crash Without Warning. Here’s Why.

Patient checking blood glucose after experiencing symptoms of post-bariatric hypoglycemia

Blood glucose may improve dramatically after metabolic or bariatric surgery. Yet, for some patients, a very different glucose problem develops months or years later. Post-bariatric hypoglycemia can cause sudden drops in blood glucose after meals, with symptoms ranging from sweating and tremor to confusion, seizures, or loss of consciousness. Because …

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Your Eye Exam May Be Predicting More Than Vision Loss: AI Is Finding Hidden Diabetes Risks

Retinal AI analysis identifying cardiovascular, kidney, and metabolic risks in a patient with diabetes

For people with diabetes, a retinal photograph has traditionally answered one major question: Is diabetic retinopathy developing? However, artificial intelligence is beginning to uncover much more. Emerging retinal AI models for systemic risk assessment can detect patterns associated with cardiovascular disease, kidney disease, blood pressure, and metabolic health. As a …

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