Patient presenting with hypertension and type 2 diabetes.
Patient was originally going to start the program early in April but due to packing, moving, and traveling out of town for a week, was afraid of stress eating and not being able to stick to the diet. I advised her to wait and start the program after the move so she could focus and be more mentally and environmentally prepared to have the best possible outcome for both her short- and long-term health goals.
Patient began the SHAPE Program June 17th.
She was doing well but noticed having loose bowel movements a couple times a day. Since having her gallbladder removed in 1975, this was normal for her when she ate large amounts of fat but was not doing that currently. The patient was drinking near a gallon of water a day. Her weekly urinalysis tests were all within normal ranges on all values. I discussed craving an excess of water from the diabetes and that the kidneys actually control the amount of water that goes into the stool. The patient was having unpredictable loose stools about 4-5 times a day. It got to the point where she thought it might be a reaction to the SHAPE Drops and was thinking about stopping the program even though she was having great success otherwise. I assured her loose stools are usually not caused by the SHAPE Drops, and advised she also talk to her pharmacist and see if loose stools are a side effect of any of the medications she was taking. The pharmacist confirmed loose stools were a side effect of the Metformin and the Glimepiride drugs. I advised reviewing her medications with her prescribing physician.
Two days later she met with her endocrinologist. Due to her 9.2-pound weight loss, and her symptoms, he discontinued Glimepiride, but had her continue 2 Metformin, both morning and night. He wanted to reevaluate in 1 week if loose stools were still an issue.
The following day, she started feeling really tired for no known reason. She reported her sugar levels were great, so I had her monitor her blood pressure at home 2x’s a day for 2 days. Her blood pressure was now too low being on her blood pressure medication. Her doctor stopped her blood pressure medication for a day to see how she responded. She reported the following day that her blood pressure was normal that morning at 115/65 when she first woke up and 122/63 after being up and doing housework most of the day. He advised she stop taking the blood pressure medication. He reevaluated all medications the following week. She was still having loose stools at this point but not as bad. Since her blood sugar levels were improving, her doctor cut her Metformin in half (1 – 500mg at morning and evening meals instead of 2). Her doctor and I both thought, at this point, the Metformin was causing the loose stools.
Her stools returned to normal within 2 days of decreasing her dosage. The patient, myself and her doctor are hopeful that at her next follow–up visit, he will be able to completely take her off of the Metformin. The latest blood test showed A1c was within normal range. Her cholesterol was down to 176 from 231, and her triglycerides were down to 185 from 307, all within 2 months. Best lab results in the last 15 years! Needless to say, the patient and her doctor are ecstatic that she stayed on the program and worked so closely with me, the pharmacist, and her medical doctors to get to the bottom of her symptoms.
Guess who has now become a patient? Her endocrinologist himself, plus he has already referred me 3 other patients! This is a true testament that if we put the patient first, reach out and work with other traditional medical specialists, we can all work together to help a greater number of patients create and live a healthy lifestyle. Isn’t this the reason we became doctors in the first place?
Submitted by Dr. Jennifer Martin
Dr. Todd’s Teaching Assessment
We have all seen the remarkable reduction in medications once a patient embraces the SHAPE Program. Kudos to the pharmacist and endocrinologist for being open to Dr. Martin using the program to transform this patient’s total health profile. More often, mainstream medicine blames the SHAPE Program for the negative reactions patients experience. There is a tendency to blame that which is not understood. Great job, doc!