Blood Glucose Control

How much effect does healthcare team cohesiveness have on EHR-associated treatment in diabetics?

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.

Woman, 55 years of age, type 2 diabetes for 15 years. When first diagnosed, did all she could to learn everything about managing her diabetes. She even went to two complete diabetes education courses. The second she paid for on her own. In time, she started checking less, ate more and more unfriendly diabetes foods, and due to a chronic ankle problem, became more and more inactive. After losing her insurance, she then stopped taking her medications and checking her glucose, until she noticed bloody drainage on her clothes from rashes several places on her body.

New study shows reduction in hypoglycemia.

Nutrients found in lemon zest, specifically polyphenols, can help improve insulin resistance.

Woman, 58 years of age, history of PCOS, prediabetes, strong family history of type 2 diabetes, cardiovascular disease and obesity. This patient lives a healthy lifestyle, including a lower carb meal plan, is very active, and keeps her weight down. Those interventions did not lower her A1C, so she educated herself and asked her NP/CDE if she should start metformin. This was about 20 years ago. Since starting metformin, A1C is in the 5.1-5.5% range. Patient regularly checks glucose, which was recently rising. A1C rose to prediabetes range again. Started on GLP-1 by NP/CDE. Patient then went to a new PCP who told her she should not be taking metformin or the GLP-1 because she does not have diabetes. Wanted to refer her to an endocrinologist....

In part 2 of this Exclusive Interview, Dr. Andy Rhinehart shares the benefit of keeping up with various diabetes guidelines, even from outside of the U.S.

Metformin, sulfonylureas, and insulin show varied survival rates in patients with type 2 diabetes.

While interval training is routinely used by sports teams and athletes, is this type of training beneficial for most individuals with diabetes? It certainly saves time—who can’t fit in 10 minutes of exercise three days per week?—but would it benefit weight control in the average person?

A 15-year-old type 1 diabetic is seen who frequently forgets to take her insulin because of time issues. At the time of her initial appointment, her A1C was 10.4. After discussing issues preventing her from taking her insulin, I suggested that she take her insulin through her clothes.