Tuesday , August 30 2016

From the Editor

August, 2016

  • 30 August

    August 30, 2016

    dave

    Three days ago I got a call from a patient who needed some insulin. The problem was, I had not seen the patient in 6 years — since I had first trained him on his insulin pump. Apparently they had gone out of town; he had prefilled cartridges with him and left them in a ...

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Latest Articles

August, 2016

  • 30 August

    Out of Insulin, Too Early to Renew — What To Do?

    Lab Detail

    It is not unusual for people to have difficulty keeping insulin from freezing or getting overheated. A patient, with type 1 diabetes for 17 years, had glucose that did not respond to his rapid-acting insulin as it usually does. He had two new vials in the refrigerator. He took a new vial out of his refrigerator earlier in the day, and started using it a few hours after he took it out. Had high post prandials that did not respond as usual to correcting. He had enough experience to wonder if perhaps something was wrong with his new insulin, so he thought he’d try another vial. He saw it was frozen. He had put the two vials at the back, where for many refrigerators it is colder. He thought back and wondered if the first vial looked any different, but remembered, he did not look closely at it.

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  • 30 August

    Dr. Stanley Schwartz Part 1, New Diabetes Classification

    stanley_schwartz

    In part 1 of this Exclusive Interview, Dr. Stanley Schwartz explains how the current understanding of diabetes surpasses the diabetes classifications determined long ago. He explains how understanding the inner workings of a specific patient can determine the best therapy for that patient, whether diabetes classifications change or stay the same.

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  • 30 August

    Team-Based Approaches to Help Older Adults with T2 Achieve Individualized Glycemic Goals Part 1

    Mature on sofa measuring sugar level in blood using glucometer a

    In this week's Homerun Slides, Dave Joffe, editor-in-chief of Diabetes in Control, presents strategies for helping type 2 patients to achieve their glycemic goals, starting with an outline of diabetes team members.

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  • 30 August

    International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #39: Normal Beta-cell Function Part 4 of 6

    DeFronzoCover

    Beta-Cell response to hormones and the nervous system: As already mentioned insulin is the only hormone with a blood glucose lowering effect, while many other hormones (glucagon, cortisol, adrenaline) exert a hyperglycemic action. The changes in glucose levels elicited by these hormones obviously will be detected by the beta cell, which will respond by enhancing insulin secretion. Yet, all these hormones, as well as others and the nervous system exert a coordinated direct effect on the beta cell resulting in an integrated and sophisticated control network.

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  • 30 August

    SGLT-2s and Evidence-Based Medicine

    Human kidney in abstract background

    In this exclusive interview transcript, Dr. Stanley Schwartz discusses SGLT-2s and evidence-based medicine: the risk of DKA in Type 2 diabetes is just five in 10,000, compared to a benefit of 38% reduction in cardiovascular mortality.

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Test Your Knowledge

Question #848

Clinicians treating patients with type 2 diabetes should include lifestyle interventions when developing diabetes management plans. Which of the following is NOT appropriate?

Correct

Answer: 4. A calorie fixed ADA diet

Educational Critique: All patients with diabetes should participate in a diabetes education program with ongoing support (DSME/DSMS). Lifestyle interventions are a key component of type 2 diabetes management and should address dietary intake and activity levels. Both should be adjusted for individual patient needs. Weight reduction has been shown to improve glycemic control as well as improve cardiovascular risk factors. Physical activity promotes weight loss/maintenance as well as has beneficial effects on lipid profiles, carbohydrate metabolism and insulin sensitivity.

Although still prescribed by some health care professionals, there is no such “diet” or meal plan as an ADA diet.

An individualized Medical Nutrition Therapy (MNT) program, preferably provided by a registered dietitian, is recommended for all people with type 1 or type 2 diabetes.

  •       For people with type 1 diabetes or those with type 2 diabetes who are prescribed a flexible insulin therapy program, education on how to use carbohydrate counting or estimation to determine mealtime insulin dosing can improve glycemic control.
  •       For individuals whose daily insulin dosing is fixed, having a consistent pattern of carbohydrate intake with respect to time and amount can result in improved glycemic control and a reduced risk of hypoglycemia.
  •       A simple and effective approach to glycemia and weight management emphasizing healthy food choices and portion control may be more helpful for those with type 2 diabetes who are not taking insulin, who have limited health literacy or numeracy, and who are elderly and prone to hypoglycemia.
  •       Because diabetes nutrition therapy can result in cost savings and improved outcomes (e.g., A1C reduction)
  •       MNT should be adequately reimbursed by insurance and other payers.
  •       Energy balance . Modest weight loss achievable by the combination of lifestyle modification and the reduction of energy intake benefits overweight or obese adults with type 2 diabetes and also those at risk for diabetes.
  •       Interventional programs to facilitate this process are recommended.

Eating patterns and macronutrient distribution

  •       As there is no single ideal dietary distribution of calories among carbohydrates, fats, and proteins for people with diabetes, macronutrient distribution should be individualized while keeping total calorie and metabolic goals in mind.
  •       Carbohydrate intake from whole grains, vegetables, fruits, legumes, and dairy products, with an emphasis on foods higher in fiber and lower in glycemic load, should be advised over other sources, especially those containing sugars.
  •       People with diabetes and those at risk should avoid sugar-sweetened beverages in order to control weight and reduce their risk for CVD and fatty liver B and should minimize the consumption of sucrose-containing foods that have the capacity to displace healthier, more nutrient-dense food choices.

Adapted from:

Nutrition therapy recommendations

Volume 39, Supplement 1, January 2016

Diabetes Care. Volume 39, Supplement 1, January 2016

Incorrect

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August, 2016