November 8, 2016 : DCMS #318

DISASTERS AVERTED — Near Miss Case Studies

When Losing Weight, Warn ’em!

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Jeffrey Mechanick Part 2, Effective Diet Discussions

HOMERUN SLIDES — Great Clinical Presentation Highlights

Continuous Glucose Monitoring in the Hospital

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #49: Biosynthesis, secretion, and action of glucagon Part 3 of 4

MOST POPULAR ARTICLES OF THE MONTH

#1 ADA Issues New Recommendations on Physical Activity
#2 Sometimes You Gotta Use the Brand Name
#3 Blood-Pressure Drug Could Be A Possible Type 1 Diabetes Cure

Last week I visited a former patient of mine who was in the hospital, for a bike-related accident. He wasn’t coming down a hill at 45mph or trying to jump over a stump with a mountain bike. He was simply riding his townie cruiser on a bike trail when he came around a curve and ran across the long thin line of a retractable leash. The line got caught in his front wheel and caused him to go down, and he fractured his hip. As we were in his room discussing the freakiness of the accident, I couldn’t help noticing all the monitoring devices he was hooked up to. They were monitoring his heart rate, his breathing, his blood pressure, and even had an ekg running.

It dawned on me that, even though he has type 1 diabetes, they had no monitoring device to check his glucose. He was getting finger stick every 2-3 hours, and insulin was administered as needed. My first thought was he should be on a CGM, but when I inquired about it, no one had any idea what I was talking about. To see if I was overreacting, I reached out to one of our Advisory Board members, Stanley Schwartz, and he shared a set of Homerun Slides that look at the pros and cons of CGM use in the hospital.

Dave Joffe

Editor-in-chief

I work in obesity medicine. As many of us know, losing weight isn’t the problem for most, but weight regain is.

As the saying goes for many, you can’t be rich enough or thin enough. Many of our patients come in with unrealistic goals regarding their weight loss, and don’t give themselves enough credit for the weight they have lost. Many, for many reasons, regain.

Dr. Jeffrey Mechanick talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting. In part 2 of this Exclusive Interview, Dr. Mechanick emphasizes the importance of the doctor/patient discussion about proper nutrition and lifestyle and what is required for an effective discussion.

In this week’s Homerun Slides, Dr. Stanley Schwartz presents the question of whether the use of continuous glucose monitoring has a place in the current hospital setting.

Control of glucagon release: There is considerable evidence that the control of glucagon secretion is multifactorial and involves direct effects of nutrients on alpha-cell stimulus-secretion coupling as well as paracrine regulation by insulin, somatostatin and, possibly, other mediators such as zinc, γ-amino-butyric acid (GABA) or glutamate. Glucagon secretion is also regulated by circulating hormones and the autonomic nervous system.

Updated guidelines suggest short periods of movement every 30 minutes.

Many of our patients have intolerable GI side effects from metformin. We use ER to try to decrease these, but that doesn’t always work. If they have these symptoms, I recommend they take it slow and take it after they eat. If they still have problems, I recommend they break the tablet to 250mg, even though the label may say one shouldn’t break the tablet.

A common blood pressure drug is showing new promise to help treat and cure type 1 diabetes.