Wednesday , September 19 2018
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Clinical Case Study: Metformin Side Effects

Mr. Hernandez' lab results are A1C 7.5%, FPG 137 mg/dL, LDL 190 mg/dL, HDL 38 mg/DL and triglycerides 232 mg/dL. He is started on metformin, lifestyle modifications, an ACE inhibitor, and a statin. He was asked to return in 3 months' time to evaluate how everything is going. However, he fails to keep his appointment. He returns 1 year after his initial diagnosis for a recurrent yeast infection. His A1C is currently 7.7%. Upon questioning, he admits that while he has been good about taking his “heart meds,” he has not taken the “sugar pill” because he didn’t like it. What side effect did the patient most likely find intolerable? A. Diarrhea and abdominal cramping B. Paresthesias C. Increased appetite D. Insomnia Follow the link for the answer.

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ACP’s New A1C Targets

The American College of Physicians (ACP) has issued a new recommendation that type 2 patients should not have a target A1C level below 8 percent for any patient population and should not have any A1C targets for older adults (e.g., age 80 and older) or younger individuals with limited life expectancy because of other serious diseases and illnesses. Do you agree with the American College of Physicians' new A1C target recommendations? Follow the link to share your opinion.

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Know the Difference When Choosing Between CGMs

You may wonder which CGM monitor is best for your patients. I know I do. Learn from Dr. Stephen W. Ponder, MD, FAAP, CDE-AADE Educator of the Year, Board Certified Pediatric Endocrinologist, Pediatric Residency Program Director at Baylor Scott & White McLane Children's Hospital and 50 year Joslin Medalist. He also helps people with diabetes through the "sugar surfing" method to empower individuals who have diabetes to live fuller and more satisfying lives.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #121: The Insulin Resistance Syndrome Part 2

Concept of ectopic fat as a cause of tissue insulin resistance: It appears that individuals prone to T2DM (based in part on their nonmodifiable characteristics) show a greater propensity to accumulate visceral or ectopic fat for a given weight. Interestingly this characteristic, in turn, may be a downstream consequence of “impaired” subcutaneous fat storage capacity, the mechanisms of which deserve further research. As an extreme example of this concept, lipodystrophic individuals have an impaired ability to store subcutaneous fat and, as a consequence, they accumulate fat in visceral and ectopic tissues and so have marked insulin resistance.

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