Tuesday , May 22 2018

From the Editor

May, 2018

  • 22 May

    May 22, 2018

    We preach good health, lean body muscle mass, exercise, and weight control to our patients, but at times we actually have patients who do too good a job. A good example of this can be seen in this week’s Disaster Averted. Our patient, the picture of perfect health and body …

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Latest Articles

May, 2018

  • 22 May

    Once a Pump, Always a Pump? Wrong!

    A man, lean and muscular, with type 1 for over 25 years, has been pumping for 15 years and wearing a sensor for the past five years. Glucose levels have been very erratic. We checked his sites and were concerned that the erratic glucose levels were mostly related to lack of subcutaneous fat and scar tissue, so he was actually getting insulin into his muscle, scar tissue, or subcutaneous tissue at various times. Also, the patient wears an OmniPod and thought it could only be in one particular direction.

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  • 22 May

    Prediabetes Part 1

    In part 1 of this 2-part Homerun Slides series, screening and monitoring prediabetes.

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  • 22 May

    International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #126: Beta-Cell Mass and Function in Human Type 2 Diabetes Part 2

    The role of beta-cell death and regeneration: The loss of beta-cells in T2DM has been mainly attributed to increased beta-cell death due to apoptosis and other forms of cell death, possibly driven by adverse environmental conditions and probably mediated by several intracellular mechanisms. Apoptosis is a type of programmed cell death morphologically characterized by cell rounding up, bleb formation and chromatin condensation. As a matter of fact, in autoptic pancreatic samples apoptosis has been shown to be significantly increased in both obese and lean type 2 diabetic cases as compared to BMI-matched, nondiabetic controls.

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  • 21 May

    Semaglutide Found to Be Effective Against Type 2 Diabetes

    The once-weekly glucagon-like peptide 1 receptor agonist cuts HbA1c, body weight

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  • 19 May

    Very Low Carbohydrate Diet Equals Better Diabetes Control

    Low carbs equals lower blood sugars and control, with less hypoglycemia, but how low do our patients need to go?

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Test Your Knowledge

Clinical Case Vignette: Treatment Next Steps

Mrs. Hunter is a 36-year-old African-American who comes to your office for her annual wellness exam. She has excess weight (BMI 27 kg/m2), but is otherwise healthy. She jokes that she, “just can’t seem to lose that extra baby weight” after giving birth 3 years ago. However, her daughter recently started preschool so she has been able to go to her new gym several times per week. In fact, one of the added bonuses of her membership is that she has been participating in their free, weekly nutrition and exercise support groups. In addition to her routine labs, you order an A1C, which comes back elevated at 7.1%. This measurement is confirmed several days later.

Based on Mrs. Hunter’s profile, what would a reasonable next step be?

Correct

Answer: C. Encourage lifestyle modifications and do not initiate drug therapy at this time.

Educational Critique: Encourage lifestyle modifications and do not initiate drug therapy at this time. In general, for patients who are already near target (A1C<7%) at time of diagnosis and are highly motivated to engage in lifestyle modifications, it is reasonable to give a window of opportunity to engage in lifestyle modifications for a trial period of 3-6 months before embarking on pharmacotherapy. In select patients (highly motivated, newly diagnosed, long life expectancy, no significant comorbidities), more stringent A1C targets (<6.5%) may be considered as long as they can be achieved without adverse treatment effects or significant hypoglycemia.

Incorrect

Diabetes & Endocrinology News

May, 2018

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May, 2018