Disasters Averted

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....

Ricardo, a 35-year-old man, newly diagnosed with type 1 diabetes, was hospitalized for diabetic ketoacidosis (DKA).  Once he was stabilized, he wanted to go home. He refused to learn how to self-administer insulin. However, he was told he would not be discharged until he self-administered insulin, at least one time....

In an inpatient setting, a type 1 diabetes patient was scheduled for surgery the next morning. The patient was to be NPO after midnight and so the RN on duty withheld the patient's Lantus. The patient's glucose crept up, but this was not communicated....

John, a gentleman in his 70's who has diabetes, always visited my group after he exercised. I noticed he always had something (hard candy) in his mouth and he seemed tired. I asked him why he was doing this candy thing. He said, "After exercise I like to refresh my breath, and want to make sure I prevent a low blood sugar...."

We were running a clinical study on erectile dysfunction. An 68-year-old male with obesity came in looking for help for his ED, so he thought he might qualify for the study. He had not had a medical workup for some time and wasn't aware of any underlying diseases. I recommended he be screened for diabetes....

We were following up with a person with type 2 diabetes who was recently started on the new oral formulation of the GLP-1 receptor agonists semaglutide (Rybelsus®). This patient had a 12-year history of type 2 diabetes as well as several comorbidities that included hypertension, hyperlipidemia, obesity (BMI = 33 kg/m2), knee osteoarthritis, and hypothyroidism. The patient was previously resistant to initiating a GLP-1 receptor agonist due to his hesitancy toward self-injection. He agreed at his last primary care visit to start a trial of oral semaglutide to improve his glucose control and lose some weight....

A middle-aged woman, with mild obesity and type 2 diabetes, was hospitalized in the ICU, and the order on her chart was documented "Lispro 90 units at HS," then the "9" was crossed off and a "6" written above it....

I was working with a patient who'd recently had a pump upgrade and although he said he didn't have problems or issues with infusion set changes, I urged him to change his set while I was present....