October 23, 2018 : DCMS #420

DISASTERS AVERTED — Near Miss Case Studies

What Not to Trust

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Sylvia Ley on Red Meat Consumption and Diabetes

HOMERUN SLIDES — Great Clinical Presentation Highlights

Endocrinology Jeopardy: Pituitary for $300!

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #148: Glucose Toxicity Part 4

MOST POPULAR ARTICLES OF THE MONTH

#1 A Major Diabetes Complication That We Fail to Address
#2 WHO Guidelines Recommend Treatment Intensifications in Type 2 Diabetes
#3 Nuts, Nuts, and More Nuts Lower A1c and Cardiovascular Disease

More and more clinicians are recommending low carb food programs for both the prevention and treatment of diabetes. This swing has led toward the consumption of more red meat and processed meats, which may actually have the opposite effect for our patients. This may happen because processed meats such as ham or roast beef are easy to eat and often become snack foods, and that tends to increase consumption. When you add that to the consumption of fast food meats that are often cooked at very high temperature, there could be an additive effect on the risk of diabetes and increased A1c’s.

This week, our publisher, Steve Freed, sat down with Sylvia Ley, PhD, RD from Harvard University and asked some tough questions to try to unwind the intricacies of her research and how we can best advise our patients on eating meats.

Dave Joffe

Editor-in-chief

I received a call and glucose numbers from patient who has type 2 diabetes, usually with hyperglycemia, never hypoglycemia. I noticed there was at least a 12-hour span since the last glucose reading. His glucose levels after the over-12-hour lag showed hypoglycemia during the  night when the numbers start showing. His glucose averaged 53 during that time, but it has been running 150 and over, and we have been slowly increasing his insulin.

Sylvia H Ley, PhD, RD is a Research Scientist at Harvard T.H. Chan School of Public Health and Associate Epidemiologist and Instructor at Brigham & Women’s Hospital and Harvard Medical School. Her overall research objectives are to develop the dietary strategies to prevent and manage diabetes and to investigate earlier life reproductive risk factors for diabetes and cardiovascular disease over the lifecourse.

In this week’s Homerun Slides, round 3 in the pituitary category from Dr. Claude Lardinois’ Endocrinology Jeopardy. This week’s clue is visual, so click to see what it is!

The hexosamine/O-linked N-acetyl glucosamine pathway: One metabolic fate of glucose is the hexosamine biosynthetic pathway (HBP), and high flux through this pathway, such as occurs in diabetes or overnutrition, has been convincingly linked to insulin resistance and beta-cell failure. In this pathway a relatively small fraction of cellular glucose flux—a few percent in most tissues—is converted to UDP-N-acetylglucosamine (UDP-GlcNAc) and other amino sugars. The rate limiting step is catalyzed by the enzyme glutamine: fructose-6-phosphate amidotransferase (GFA) that catalyzes the synthesis of glucosamine-6-P from fructose-6-P and glutamine.

Nonadherence to diabetes medications 2nd leading cause of hospitalizations

Medications suggested for second- and third-line treatments for diabetes management following treatment failure with metformin and sulfonylureas.

New study shows that nut intake may improve glycemic control and reduce risk of cardiovascular disease in people who have type 2 diabetes.