Friday , July 20 2018
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Clinical Case Vignette: Macronutrients

Mr. Carlson is a man, 52-years of age. He is Caucasian and works as a grocery store manager. His labs show that they were significant for elevated random plasma glucose 166 mg/dL, A1C 7.6% and elevated lipids (TG=175 mg/dL, LDL 148 mg/dL, HDL 38 mg/dL, total cholesterol 221 mg/dL). His physical exam is notable for central abdominal obesity (waist circumference 42”), BP 147/91, HR 72, RR 18, BMI 36 kg/m2, but otherwise normal. He is started on metformin and a dietitian is recommended. The dietitian discusses with him the benefits of medical nutrition therapy on weight, glycemic control, blood pressure, lipid profile, and overall wellbeing. Which following statement regarding macronutrients is true? 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. Saturated fat should be less than 7% of total calories. Follow the link for the answer.

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GLP-1, SGLT-2 Combo

Have you recommended to any patients the drug treatment of using a GLP-1 receptor agonist and a SGLT-2 inhibitor combination? Follow the link to share your opinion.

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Once A Pump, Always a Pump? Wrong Again!

(This is a follow-up to the patient who was under the impression he would always need an insulin pump.) It was a "rocky" start at first. The patient had some early morning highs and some unexpected lows, but likes being off the pump. He wears his Dexcom, which he plans to continue with. This has been extremely helpful with alarms during the adjustments to his long-acting and rapid-acting insulins. The endocrinologist knew the patient was extremely sensitive to insulin, so his rapid-acting insulin has gone from using 1-unit increments to 0.5-unit increments instead and is doing well. At this time, the patient wants to stay off the pump, continue with MDI and the sensor. We're still making minor changes, but getting close to goal.

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