Monday , February 19 2018
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Production Assistant, Diabetes In Control

Helping Patients to Achieve Behavior Change

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

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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Patient Motivation

Do you agree with the statement: Doing a monthly A1c test could act as a way to motivate patients to better care? Follow the link to share your response and see what your colleagues think!

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Smoking and Heart Disease

Test Your Knowledge

All the following are true about smoking and heart disease EXCEPT: A. Compared with nonsmokers, the incidence of myocardial infarction (MI) is increased 6-fold in women who smoke approximately 20 cigarettes per day. B. Male smokers are 25% more likely to develop coronary heart disease than female smokers. C. Smoking cessation rapidly increases high-density lipoprotein (HDL) cholesterol. D. Smokers who take a thrombolytic agent for an acute MI have better outcomes than nonsmokers. E. All of these statements are true. Do you have the right answer? Follow the link to see.

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What’s the Best Teacher?

Over the years I’ve found the best teacher for people who have diabetes is their numbers. Without teaching the patient targets, they don’t learn much. This patient is just one example of many. A man, 57 years of age, visits a community diabetes education course. He tells me he has type 2 diabetes, hypertension hyperlipidemia. He said his doctor told him his numbers were fine about 9 months ago. When he came to the course, he was losing weight, was thirsty and was very tired.

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