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Production Assistant, Diabetes In Control

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #20: Development and Maintenance of the Islet Beta Cell Part 4 of 4


For many years it was speculated that beta cells, much like neurons, were postmitotic and that their turnover in the mammal was minimal or zero. Over the last two decades, studies in mice have suggested a more dynamic picture, wherein beta-cell mass can change in response to physiologic states such as growth, pregnancy, and obesity.

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Question 829

Test Your Knowledge

Mr. Carlson is a 52-year-old Caucasian grocery store manager you saw last week for a new patient visit. His labs from that visit were significant for elevated random plasma glucose 166 mg/dL, A1C 7.4% and elevated lipids (TG=175 mg/dL, LDL 148 mg/dL, HDL 38 mg/dL, total cholesterol 221 mg/dL). He has returned to your clinic for a follow-up appointment. His physical exam is notable for central abdominal obesity (waist circumference 42”), left eyelid xanthelasma, BP 147/91, HR 72, RR 18, BMI 36 kg/m2, but otherwise normal. A repeat A1C test shows A1C 7.6%. Mr. Carlson smokes between 1 and 1.5 packs of cigarettes daily. After discussing the labs and your findings with Mr. Carlson, you begin collaborating on a management plan. You write prescriptions for metformin, a statin and ACE inhibitor. Mr. Carlson doesn’t think “taking medication will be too tough,” but expresses skepticism about your recommendations for a change in his diet, exercise and smoking programs because he has tried them, without success, in the past. You are concerned about Mr. Carlson’s cigarette use because cigarette smoking has been shown to have multiple physiological impacts on health. Which one of the following statements regarding smoking and type 2 diabetes is true? A. It equally affects all-cause mortality in individuals with and without diabetes. B. In individuals with diabetes, it causes more rapid progression to micro- and macroalbuminuria. C. It has not been linked to worsening glycemic control. D. The use of bupropion is contraindicated in diabetes. Think you've got the right answer? Follow the link to check!

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Metformin for Prediabetes


For your patients with prediabetes (A1c of 5.7 to 6.4%), do you recommend they begin metformin even with providing them info on physical activity and nutrition? Follow the link to express your opinion!

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What Do You Attribute The Change To?


56-year-old man, type 2 diabetes, had been prescribed SGLT-2 to lower his glucose levels. He had been taking an SGLT-2 for the past two years. His A1C, blood pressure and weight were elevated since the last visit 3 months ago. When asked if he was doing anything different, he said he had read articles and seen on TV about these types of medications causing heart disease, so he stopped taking his.

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