Disasters Averted

Male, 69 years of age, coronary artery disease,  two cardiac stents, hypertension, hyperlipidemia, prediabetes, bladder cancer.  His sister is 64 years of age, coronary artery disease, prediabetes, PCOS, elevated cardiac calcium score of >1000, no hyperlipidemia. HO early heart disease, stroke, and early death in family. There have been recent reports in the media speaking of the ASPREE Trial, which reported that taking aspirin daily is not effective for all people, and in some it may be more detrimental due to bleeding risks.

We recently had a new patient, 75 years of age, who has class I obesity and prediabetes, and has had hypothyroidism for over 25 years. She is very active and has purposely lost weight, about 6 pounds. She told me she has had hair loss over the years and has seen a specialist for this, but lately it's been worse. She takes spironolactone, biotin, and zinc for her hair loss. She wanted to know what she could do about her hair. She is taking 150 mcg levothyroxine and 5 mcg liothyronine.

When you have female patients who have type 2 diabetes, obesity, a history of irregular periods and/or the other symptoms of PCOS, ask them about their daughters. Do they have like symptoms of PCOS, as Dr. Cobin discusses in her videos?

You may have read Dave Joffe's Editor's Note on the relative risk of developing diabetes and how sometimes patients use it as an excuse for having diabetes. Although we don't like to blame patients, it is true some people do think and say, "Why try? I have a family history of diabetes. I'm sure to get it too." Well, we know that isn't 100% true. Hopefully we work with our patients to help prevent or delay type 2 diabetes.

Although GLP-1's don't usually cause hypoglycemia except when given with insulin or a sulfonylurea, I have found that when patients who do not have diabetes are started on a GLP-1, some can have symptoms of hypoglycemia and/or more untoward GI side effects if they start when they come in the office fasting.

This is about one patient but the situation is not unusual for many patients who have type 2 diabetes and take insulin. Woman, 67 years of age, type 2 diabetes, taking Tresiba 15u every day at 11am and Victoza every morning upon arising, about 8am. She wears a CGM. Glucose levels were in target range for some time. Family reported patient was having some subtle cognitive changes. We did send her for neurologic evaluation.

Many people who have diabetes, especially type 2 diabetes, tell me they have no one to talk with about their diabetes. Why, with all the education and tools we have, do people who have diabetes still feel this way? My patients who have excess weight or obesity tell me the same thing. We may not have as much clinical information on that as we do diabetes as of yet, but the patients tell me the same thing.

Health care professionals who are endocrinologists, cardiologists or who work in these specialized fields know the complications of prediabetes or diabetes. Many of us have these patients. Sometimes it’s almost natural to talk with these patients differently than we’d talk with most of our patients who aren’t as well-educated. A woman, 59 years of age with prediabetes and strong history of cardiovascular disease complained of a slight chest pain not associated with exertion or shortness of breath, just an ongoing discomfort. Other than this, the patient — who is herself a health care provider —  is feeling fine.

Teach patients what DKA is and how to prevent it. Include in your teaching that glucose can be normal or only slightly elevated and it can still happen. Teach that having an illness and/or dehydration increases this risk.

A patient who has had type 1 diabetes became pregnant after nearly 20 years of having type 1 diabetes. She reported her OB-GYN referred her to a specialty clinic for high-risk pregnancy, including diabetes in pregnancy. They worked in tandem to ensure her care was carefully managed throughout the stages of her pregnancy.