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Yearly Archives: 2017




July 25, 2017

dave

Many times when we least expect it there is a past and present combination in diabetes. This week in our Clinical text we start a discussion on the idea of measuring in vivo insulin. It was back in 1925 when Banting and Best first gave insulin to reduce glucose levels. ...

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Helping Patients to Achieve Behavior Change

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Man, 76 years of age, type 2 diabetes, obesity, SP right total hip replacement one year out. When preparing for hip surgery, was on basal and bolus insulin, metformin. Had been on a GLP-1 but had diarrhea so he stopped. Was able to, for the most part, follow a lower carbohydrate meal plan but was not active. When he first started coming to us for weight loss to prepare for his surgery, his weight was 304 pounds, BMI 45, A1c 9.9%, Cr 1.87, eGFR 34. We decreased his metformin from 2,000mg/day to 1,000mg day and referred to nephrology. With this change and being motivated for surgery, he lost weight and in 6 months went into surgery having lost 25 pounds with an A1c of 6.9%. Note, due to eating less carbs, he could take less insulin, which seemed to help his appetite. Surgery was performed and he did well.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #83: Measuring Insulin Action In Vivo

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The heralded isolation of insulin in Toronto in 1921 was followed immediately by treatment of diabetes. It soon became clear that while insulin was effective in regulating the blood glucose levels in most patients, there were some subjects in whom insulin appeared to be ineffective. This lack of insulin effect was termed “insulin resistance” as early as 1925.

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July 22, 2017

dave

It seems every week the SGLT-2 inhibitors are in the news, one time good and one time bad. Now there is a new study that shows that these products may have the ability to protect the kidneys in patients with type 2 diabetes. Since we have had so many articles ...

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