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Production Assistant, Diabetes In Control

Question 827

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. Mr. Carlson makes an appointment with a registered dietitian. She discusses with him the benefits of medical nutrition therapy for weight, glycemic control, blood pressure, lipid profile and overall wellbeing. Which following statement regarding macronutrients is true? Select one answer: A. The ratio of carbohydrates, protein and fat is the same for all patients. B. Total calories consumed per day is the key strategy for achieving glycemic control. C. Reduced intake of trans fat lowers the HDL and raises the LDL. D. There is no single ideal dietary distribution of calories among carbohydrates, fats, and proteins for people with diabetes. Follow the link to test your knowledge!

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Don’t Blame All Symptoms on Glucose Levels

A woman, 72 years of age, type 2 diabetes, obesity, taking metformin, GLP1, ARB, and antidepressant (SSRI). Lost 20% total body weight in the past year. Recently complaining of dizziness and weakness. Glucose levels in the 60’s at home, at which time had symptoms of hypoglycemia. Glucose-lowering medications (metformin and GLP-1) were stopped. Continued to complain of dizziness and weakness especially in the morning.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #17: Development and Maintenance of the Islet Beta Cell Part 1 of 4

The discovery of insulin by Banting and Best in the early 1920s marked the beginning of a new era of diabetes research that focused on the study of insulin and the biology of the hormone-producing cells of the pancreas. In the ensuing decades, although much was learned regarding the synthesis, structure, and action of insulin, the developmental origins of insulin-producing β cells remained ambiguous.

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