Disasters Averted

When it comes to metformin, when appropriate, I recommend the extended release version. Last week my patient, female, 56 years of age, type 2 diabetes, visited. A1C was elevated, and she gained 5 pounds. She had been on metformin ER for the last 6 months and doing well. She said she recently noticed a bean-looking/pill-looking thing in her stools that seemed to be related to her metformin.

63-year-old male, moderate cognitive impairment and lives alone. Patient lost a significant amount of weight, frequent symptomatic hypoglycemia, including light-headedness and dizziness, requiring lowering and stopping some of his glucose lowering medications. GLP-1 was stopped and his glucose levels were in normal range. We were very clear that he should not resume his GLP-1 until we saw him again.

Male, 26 years of age, type 2 diabetes, obesity, hyperlipidemia, hypertension. Strong family history of type 2 diabetes with complications. Has been a patient since diagnosed 2 years ago. Has met with dietitian. Hasn’t made dietary changes, increased activity, or taken meds prescribed to lower his glucose. A1C 9.2% and rising every 3 months. He would also miss many of his appointments. Stated, “Nothing is going to bother me. Maybe it did my family, but that was a different time and it’s not going to happen to me. I’m going to go on enjoying my life.”

16-year-old male, type 1 diabetes since 2 years of age, pump therapy. Eats about the same thing daily. Post prandials vary widely. When corrects for highs, gets low.

African American male, 63 years of age, type 2 diabetes, hypertension, strong family history of type 2 diabetes, hypertension and stroke. A1C is 6.7%. Blood pressure 160/96 HR 88, despite being on ACE-I and Beta Blocker.

Male, 32 years of age. Works erratic hours. Recently came up with a plan of how to remember to take his meds. He started setting up and taking his pill box with him. He has succeeded at taking his medications and taking them on time…all except his injectable medications.

Male, 32 years of age, type 1 diabetes, was following gluten free diet of his own choice. Was never diagnosed, just "feels better" when he doesn’t eat gluten. Has lab tests that were negative for celiac in the past. Came to see me for follow up diabetes education. Noted weight loss of 5 pounds in one week. Glucose levels were not elevated, in fact for the most part in target range.

37-year-old woman has had type 1 diabetes since she was five years old. She was referred to me to help her manage her glucose levels because she wants to have a baby. She was wearing an insulin pump at the time, and had been for the past 20 years. Her glucose levels were very erratic. No pattern in sight.

When starting a patient on insulin, there’s more than just teaching how to give an injection and check glucose levels. Teach insulin’s action and side effects, especially the possibility of hypoglycemia, what it is, how to prevent, recognize and treat it.

Working with a patient, a woman, 44 years of age, who has had type 1 diabetes 21 years. She had a day of high glucose levels. We worked together very hard all day correcting to bring it down. After being closer to her target range, not low by any means, she told me she just had some chocolate. I asked her why, after the day she had, did she choose chocolate.