Disasters Averted

I have type 1 diabetes and have been living with it for the past 11 years. I take daily insulin injections to stay alive and well. A couple of years ago, I had a very frustrating incident when my insulin stopped working. I began injecting loads of insulin, and even with multiple doses my blood glucose wouldn’t drop.

As we know, the most ineffective medication is the one needed but never taken. There are many reasons our patients don’t take prescription medicines, but a biggy is the cost. If a medicine is too expensive, the patient will not fill the prescription, therefore won’t take it. For example, when ordering an SGLT-2 and/or GLP-1, each can cost hundreds or more for a month’s prescription. Some are covered for both. Some are covered for one brand, but not the other.

Male, 62 years of age, type 2 diabetes, class III obesity. Has been on metformin, 1,000mg twice daily. Glucose in the 200-300mg/dL range. A1C. Taught about lower carb meal plan, started on Trulicity, first 0.75mg, then 1.5mg/dL. Made the dietary changes right away with the addition of the Trulicity. Within 2 weeks glucose levels averaged 125, patient losing weight, decreased appetite and feeling good. More energy. Insurance did not cover Trulicity, but did cover Victoza, so started on Victoza. When made the change, started with the 0.6mg daily, then increased weekly to the 1.8mg/day.

Since Team Novo Nordisk’s inaugural season in 2013, 30-year-old Romain Gioux has dreamed of racing as part of the world’s first all-diabetes pro cycling team. Diagnosed with type 1 diabetes at age 15, he raced as an amateur for a French-based Club, but this year serves as his professional debut.

23-year-old female, type 1 diabetes since 5 years of age. A1C elevated to 8.9% after usually having A1Cs in the 6-7 range. Came to see me at the end of our workday after wearing LibrePro (Blinded CGM) to go over her food/insulin/glucose/activity/etc. patterns. First thing she said to me was that she had a Dexcom but hasn't worn it because battery in transmitter was out for the past 6 months. She told me she really hasn't been checking her glucose on a regular basis at all.

Female, 26 years of age, type 1 diabetes for 15 years, well-educated, uses insulin pump. Recent A1C 7.6%; has been rising from 6 to 6.5. Thinks her mealtime insulin is not working fast enough. She does bolus about 20 minutes before eating. Assessed pump, CGM, food intake and activity. Her report seemed to be the case.

57-year-old female, prediabetes, class II obesity, arthritis R knee, family history includes father with type 2 diabetes with renal disease. Verbalizes her fear of having diabetes. Besides discussing lower carbohydrate meal plan, discussed metformin, and being as active as she possibly can without causing further injury to her knee. First set of labs showed her A1C to be 6.4% and her FPG 118.

Female, 58 years of age, type 2 diabetes, obesity, taking (Qsymia- phentermine/topamax) for weight loss, antihypertensive for hypertension, and metformin for glucose management. Blood pressure usually in the 120-130/70-80 range, glucose averages ~120, and was losing weight. Today’s b/p 170/90, random glucose 232, c/o tinnitus. Weight was up 5 pounds since last seen 3 months ago. It’s now allergy season. After further discussion, she told me she was started on a medrol dosepak, and on her own purchased and is taking an OTC allergy medication.

I don’t know how many times I have the opportunity to teach patients and health care providers that it’s not all about food. I was recently reminded of that when I overheard a dietitian, a CDE, go over a 4-week CGM report with a patient, male, 53 years of age, type 2 diabetes, non-obese, actually not even overweight.

This patient was newly diagnosed, but I did not really think she believed she had diabetes. In other words, she was in denial. Once she saw the results of her labs, I could see things changed in her. She “got it."