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Production Assistant, Diabetes In Control

Denial: Numbers Don’t Lie

Woman, 64 years of age. History of Class II Obesity and hyperlipidemia. While she had obesity, her glucose levels were elevated. A1C 8.2%. She followed a lower carb meal plan, was active, took metformin and a GLP-1, a statin and an ACE-I. She lost 22% total body weight. A1C then remained in the 6-6.5% range for 3 years on this treatment plan. Over the past 8 months, due to insurance and her statement of denial that she ever really had diabetes, she stopped taking her glucose-lowering medication, statin, and ACE-I, wasn’t as strict with meal plan or activity, and stopped checking her glucose, but did not gain back her weight.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #45: Neuropeptides and Islet Hormone Secretion Part 4 of 5

Sympathetic effects and mediation: Sympathetic nerves inhibit insulin and stimulate glucagon secretion. Their activation may help mediate stress-induced changes in islet hormone secretion including the glucagon counterregulatory response to hypoglycemia.These effects may be mediated by the combination of the classical neurotransmitter noradrenaline and the sympathetic neuropeptides (galanin and NPY). All three neurotransmitters can inhibit insulin and stimulate glucagon secretion, thus mimicking the effects of sympathetic activation on islet hormone secretion. In addition, galanin and NPY meet several other of the criteria needed to be classified as a physiologic neurotransmitter.

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Question #854

Test Your Knowledge

Please select the drug class that best fits the description. This shorter-acting insulin secretagogue may be associated with less hypoglycemia than the other secretagogues. 1. Biguanides 2. Sulfonylureas 3. Meglitinides 4. Thiazolidinediones Did you get it right? Follow the link to check your answer.

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