Disasters Averted

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....

Female, type 1 diabetes for 42 years, 58 years of age, lives with husband and dog. The patient has hypoglycemic unawareness. We regularly readjust her treatment plan and have recommended CGM for this patient on numerous occasions. Still, she refuses, stating her dog wakes her up if and when she has hypoglycemia. She called to let us know her dog passed away....

Recently I assessed an 84-year-old inpatient with diabetes for his insulin usage at home. In reporting his dosing, he stated that after he checked his glucose before each meal, he took the "first two numbers of the result," and made his dosage for meal-time insulin....

I recently had a home care patient who had been discharged from a skilled nursing facility with a prescription for regular insulin, and who was put on a sliding scale dosage. The patient was experiencing hypoglycemic reactions....

A 56-year old male with type 2 diabetes and stage 3 chronic kidney disease contacted us recently regarding his new prescription for the SGLT2 inhibitor canagliflozin (Invokana)....

Sometimes, just a simple instruction on the use of an insulin pen can prevent serious problems….

A young man, 32 years of age, with a history of ADHD and being treated with Adderall, was diagnosed with type 2 diabetes. He had symptoms upon diagnosis — frequent urination, weight loss, and his BMI was 20. He followed a low carb diet, was taking metformin, and exercised; however, his blood glucose and A1C continued to rise to 7.7%....

Can we "prevent" diabetes with weight loss? Or would it be better to say we can "delay" diabetes with healthy behavior?  Often people are reluctant to admit that they have diabetes or to initiate treatment. Many times the cause of the delay in treatment is feelings of guilt (they feel like diabetes is all due to their weight). I had a patient who delayed treatment for three years, thinking that he could treat diabetes with weight loss and exercise....