Disasters Averted

Recently a patient presented to our outpatient diabetes education center. His A1C had historically been elevated, despite the initiation of insulin therapy and increasing doses. The patient reported that he had taken all insulin doses as ordered, but was frustrated with his lack of progress....

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 am a primary care provider in a small private office. A long-term patient of mine, 32 years of age, was recently diagnosed with type 1 diabetes. His insurance is now one I do not participate in. Until his recent diagnosis, he visited annually and paid out of pocket. He wanted to stay with me for his care....

As the new vaccines for COVID-19 are rolled out, the Institute for Safe Medication Practices (ISMP) has called attention to some of the missteps in vaccine administration that have occurred, and offers safe practice recommendations.

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). 

I recently received a text message from a type 1 patient who has been wearing a pump for over ten years. 

"I need your guidance. My blood sugars have been in the high 200s and 300s since Thursday. I woke up with a 398 blood sugar. I've been eating out a lot and drinking too much. I need to follow a rigorous low carb diet and less alcohol." I called the patient and let her know I was sorry to hear she was feeling overwhelmed....

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....

Susan received a phone call from her clinician's office recommending that she start using a pen for her insulin. She had also been prescribed a GLP-1 receptor agonist and was to go to the pharmacy to pick them up.
She went and signed up for the long 'discourse' patients receive when they pick up new meds including questions such as whether or not the pharmacist had offered instructions and pages of small print. She, like many of our patients, signed the sheets and went on her own way without ever talking to a pharmacist or asking a question.

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....

Newer glucagon products provide additional options for the treatment of severe hypoglycemia.

We were asked to consult on a case involving a 68-year-old man with type 1 diabetes (T1D). He recently experienced a severe hypoglycemic event resulting in hospitalization. The patient currently lives independently with his wife of 40 years and has had T1D since the age of 12....