November 22, 2016 : DCMS #320

DISASTERS AVERTED — Near Miss Case Studies

Some Blood Glucose Number is Better than No Number

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Jeffrey Mechanick Part 4, Influx of Prediabetes Patients

HOMERUN SLIDES — Great Clinical Presentation Highlights

Continuous Glucose Monitoring in the Hospital Part 3

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #51: Incretin Physiology in Health and Disease Part 1 of 6

MOST POPULAR ARTICLES OF THE MONTH

#1 ADA Issues New Recommendations on Physical Activity
#2 Simple Cure For Remission of Prediabetes
#3 When Losing Weight, Warn ’em!

On Monday, the FDA gave approval to NovoNordisk’s new combination product, Xultophy. This is a combination of the super long-acting insulin degludec and the once daily GLP-1 agonist Liraglutide. The fixed dose combination is given in one to 50 dosing steps to maximize to glycemic control. The super long-acting insulin offers the patient the opportunity for flexible dosing without losing glycemic control.

This new combination is bound to cause some changes in how we look at GLP-1 therapy and how dosing with insulin can have a not always predictable effect on different patients. This week in our Clinical Text, we take a look at the relationship between natural GLP-1, GLP-1 agonists, pancreas-made insulin, and injected insulin. You will be surprised by how much interference in predictability of glucose levels the ratios of these 4 compounds can have.

Dave Joffe

Editor-in-chief

In my experience, most people will check their fasting glucose levels, but due to time, place, not enough strips, or just the fact they don’t want to see…many will not check after eating.

For those who will only check once a day, I recommend alternating a fasting blood glucose check with a bedtime blood glucose check.

Dr. Jeffrey Mechanick talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting. In part 4 of this Exclusive Interview, Dr. Mechanick explains the improved understanding of the need for the expertise of an endocrinologist in helping the prediabetes patient.

In this week’s Homerun Slides, the ideal glucose sensor for clinical care.

The incretin effect in health: The idea that gastrointestinal factors contribute to the control of postprandial glucose regulation dates back to the beginning of the twentieth century, when Moore and colleagues reported reductions in glucosuria after the oral administration of gut extracts xin patients with juvenile diabetes. Even though it is questionable whether these glucose-lowering effects were really attributable to the incretin activity of the extract (which is unlikely, because most gastrointestinal peptide hormones are inactivated by the gastric acid), this report can be considered as the first description of an incretin-like effect.

Updated guidelines suggest short periods of movement every 30 minutes.

There has been a controversy over the last 30 years as to which is the best diet to prevent diabetes.

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.