Our expectations for the first week of clinic in Sullivan County were exceeded: we saw more patients than we planned. One of the last patients we saw was Mr. Lopez (not his real name). He is a 59 year old diabetic gentleman who had not seen a doctor in a long time.

While he had no overt physical sign of any significant abnormality, the only hint of a problem was the finger stick showing a sugar level of over 400. Because of that, both urine and blood specimens were obtained and sent to Catskill Regional Medical Center.

His diabetic medication (metformin) dose was increased and he was given a full month’s supply with instructions to see us again.

That Saturday night the lab called me with critical results. The glucose was 456 and the hemoglobin A1C (indicator of the glucose levels in the previous several weeks) was 9.9. In other words his diabetes was out of control. Fortunately, there was not yet evidence of diabetes adversely affecting his kidneys. 

The following Monday, Mr. Lopez was seen by a diabetic specialist, given a new glucometer and started on Januvia to supplement the metformin.  Because diabetes affects the eyes, we are arranging for an ophthalmologist evaluation.

It is quite possible, though not certain, that Mr. Lopez will eventually need to go on insulin. But one thing is for sure, with our intervention and follow-up he is in a better position to mitigate the development of diabetic complications.