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Letter From The Editor

Editor's Note, DCMS #230

We often take insulin for granted and reach in the fridge to start a patient on this drug without a lot of hesitation. But have you ever considered what it takes to make insulin, or how subtle differences in production can have big...


Letter from the Editor, #770

We all know the definition of insanity is "doing the same thing over and over again and expecting the same results." Nowhere has this been more true than in medicine. Thirty-five years ago, the...


Editor's Note, DCMS #229

This week's Clinical Mastery Series newsletter is chock full of great information to help with your patients. First we wrap up



Letter from the Editor, #769

No matter how you want to analyze it there is an impeding explosion in diabetes care and also in how much it will cost. Part of this is addressed by paying clinicians to deliver patient interactions via the internet. Although early studies seem to...


Editor's Note, DCMS #228

Have you had patients come to your office with the latest and greatest thing for "curing" diabetes? Not a day goes by without someone showing me a new way to lose weight and fix their diabetes. But the real question is, are these fixes...


Letter from the Editor, #768

When we do a diabetes education program for patients we always talk about food choices. The overwhelming key to success is not to give people impossible goals to follow and try to restrict everything they can have. Having them cut portions down too...


Editor's Note, DCMS #227

Ten years ago when a patient checked into the hospital for severe hypo- or hyperglycemia we took the attitude that if we could get them back to normal and get them home then our job was done. That was before we knew


Letter from the Editor, #767

I was working in the pharmacy and my technician attempted to process a prescription for a 71 y/o patient for glyburide 5 mg. The claim kept rejecting as "drug not covered, prior authorization requested." This...


Editor's Note, DCMS #226

Today I was working with two patients to convert them from sliding scale and mixed insulin to basal/bolus dosing. As I was going over the reasons for making the change and the...


Letter from the Editor, #766

When we see older men with diabetes in the office we often see the change in muscle mass and our first thought is to check testosterone levels. For many of these seniors the levels are acceptable and we just attribute the decline to their advancing...


Editor's Note, DCMS #225

According to researchers from the CDC in Atlanta, medical spending attributable to diabetes per person doubled between 1987 and 2011. "The economic burden of the disease...


Letter from the Editor, #765

There are finally some guidelines coming from the Endocrine Society on treating obesity. This is significant because the guidelines signify the recognition...


Editor's Note, DCMS #224

Sometimes thinking out of the box really is necessary to find ways to help our patients. Rosalyn Sussman Yalow won a Nobel Prize for developing the radioimmunoassay technique that revolutionized drug molecule discovery. Her interest in unique...


Letter from the Editor, #764

This was a particularly aggravating week for both my patients and insurance companies. The new year has brought copays and deductibles to many of my Part D patients. Most of them had no idea that they now had a $200 deductible and swore that their...


Editor's Note, DCMS #223

I was at a recent CE program about healthcare costs and when it came to diabetes the speaker stated that it cost U.S. employers over 100 billion dollars a year and at least 20% of that amount was spent on non-medical costs with a lot going to lost...


Letter from the Editor, #763

This past week I have been at CES in Las Vegas. During the four days I was there, I spent three of them in the fitness, digital health, and wellness areas. There were over 350 exhibitors with products that they promise will revolutionize health and...


Editor's Note, DCMS #222

There is one conflict that consistently recurs in healthcare. This conflict is between the use of newer, more expensive medications and older cheaper ones. As we have...


Letter from the Editor, #762

Now that we have jumped into 2015 many of our patients will be trying to live up to their yearly repeated resolution to lose weight. They will look for every shortcut and newfangled device or product that will "guarantee" that this will...


Editor's Note, DCMS #221

We sometimes think that if our patients are told what to do they will do it. We tend to forget that there is much more to managing diabetes with insulin than with pills. Patients who are very persistent in taking their oral meds can be completely...


Letter from the Editor, #761

This is the time of year when our patients start to think about their New Year's resolutions and taking care of their diabetes is one of the things they often decide on. Unfortunately, this is usually used as an excuse to...


Editor's Note, DCMS #220

Here is a word that's associated with diabetes that you might not know -- micro­angiopathy. This problem affects between 10-15% of all diabetes patients and is often overlooked, even though it is very simple to diagnose. If you want...


Editor's Note, The Best of 2014

We all know that when it comes to healthcare, "analytics" is a word that has jumped to the forefront. Hospitals, prescribers, and insurance companies all can earn more money if their analytics are good, and can be penalized if the results...


Letter from the Editor, #760

This week there was some really interesting information about patients, hospitals, rewards, and penalties. Propublica Communications, a non-government watchdog of financial healthcare issues, reported that increasingly non-profit hospitals...


Editor's Note, DCMS #219

Our pharmacy was recently included in a large training program from Novo to educate pharmacists on how to use the new FlexTouch pen. This new pen eliminates the thumb throw that makes it hard for many patients to delver larger doses of insulin. One...


Editor's Note, SGLT-2 Inhibitor Special Edition, December 2014

Merry Christmas, Happy Chanukah, and Happy New Year! I was cleaning out some old diabetes slide presentations from 2007-2010 from my computer and I happened to open a few of them to make sure I wasn't missing any good slides before I...


Letter from the Editor, #759

This past Thursday I got to see just how good cyclists can be when they're in competition. I had qualified for the Florida Senior Games and was in Cape Coral to attempt to qualify for the nationals in the 60-64 age group. The first race was 20K...


Editor's Note, DCMS #218

In our main newsletter last week we had an item about the effects of TZD's on metabolism and...


Editor's Note, GLP-1 Analog Special Edition, December 2014

As we close out another year in diabetes care there is a lot to look back at. GLP-1 analogs are continuing to grow in


Editor's Note, Insulin Special Edition, December 2014

Last month I shared an event that occurred in the pharmacy concerning a 22-year-old man with type 1 diabetes who came...


Letter from the Editor, #758

It has been about five years since Dr. Steven Nissen started his public attack on the TZDs. His outspoken observations drove many prescribers away from using pioglitazone or rosiglitazone, and the FDA even agreed with his opinions, which drove the...


Editor's Note, DCMS #217

It appears that the weather this winter may turn out to be worse than last year's. Even here in sunny St. Petersburg, Fla., I had to pull out the winter gear for cycling. During these cold times patients often complain about their feet hurting more...


Letter from the Editor, #757

When Walmart first introduced their $4 generic drug program we thought that it would be an oddity for a month or two and then go away. Then everyone jumped on the bandwagon and soon these programs were so commonplace that our patients felt anything...


Editor's Note, DCMS #216

Every time we talk to a patient newly diagnosed with diabetes we talk about the kidneys, the feet, and the eyes, and what can happen if we let our glucose levels run rampant. We focus on this because the concept of microvascular complications has...


Letter from the Editor, #756

When the first gastric bypass was done, the incision was about 6-9 inches long. Then came lap band surgery for weight loss. We have gone from 4 incisions to one small incision over the past five years. We are always looking for less-invasive ways...


Editor's Note, DCMS #215

A little over five years ago, a small company came to market with a low-dose rapid-acting dopamine receptor agonist with a claim that it could reset metabolism endpoints in the neuroendocrine system. Soon as prescribers heard the word "dopamine,"...


Editor's Note, SGLT-2 Inhibitors Special Edition, November 2014

A couple of questions came up last week during a review of SGLT-2 inhibitors by my interns.  The first question had to do with what was happening with SGLT-1 receptors in the research, as one of the students had remembered that there are 8 or...


Letter from the Editor, #755

For the past two months our well-written fitness guru Dr. Sheri Colberg has been discussing the reasons why activity improves your brain health. This week


Editor's Note, DCMS #214

The prevailing statistics say that 74% of all diabetes patients have high lipids, 75% have hypertension, and that 56% of all diabetes patients have both conditions. If you take the time to read all of this week's clinical newsletter you will learn...


Editor's Desk, GLP-1 Agonist Special Edition, November 2014

If you have never considered using a GLP-1 analog with insulin then you need to read this month's update, and then think about how insulin and these analogs can be used together. While most of the the GLP-1's are indicated with insulin, we don't...


Letter from the Editor, #754

Last week, my daughter was out for a 100 mile bike ride and at mile 78 she was coming down a bridge on Madera Beach at about 27 mph when a car cut in front of her to make a right turn. She braked very hard, hit some gravel and glass and...



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