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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #102: Pathogenesis of Nonalcoholic Fatty Liver Disease (NAFLD) Part 4

Hypertriglyceridemia and low HDL cholesterol, increased risk of type 2 diabetes: Under fasting conditions, the liver of subjects with NAFLD overproduces triglyceride-enriched VLDL particles despite hyperinsulinemia when compared to equally obese subjects without NAFLD. Insulin normally decreases production of VLDL by inhibiting adipose tissue lipolysis, and by directly suppressing hepatic production of VLDL.

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Exercise to Lower Your Risk of Dying (Prematurely) with Type 1 Diabetes

By Sheri R. Colberg, PhD: Much of the research on length of life for individuals living with type 1 diabetes is pessimistic, which makes a new study released recently a breath of fresh air. Data were collected for the ongoing nationwide, multicenter, Finnish Diabetic Nephropathy (FinnDiane) Study that tracked the death rate of 2,639 study participants.

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Implementing Insulin Change

A 47-year-old patient has done an excellent job with lifestyle modifications and medication adherence. However, she has not been able to yet achieve her individualized A1C goal. Her current regimen consists of a metformin, sitagliptin, and insulin detemir (insulin started 4 months prior). However, over the past month as she has titrated her basal insulin toward her A1C goal, her self-glucose blood monitoring log shows large drops in her overnight glucose levels. After consulting with the treatment team, you decide to add rapid-acting prandial insulin to her regimen. How would you implement this strategy? A. Decrease the basal insulin dose and add 1 daily prandial injection before the smallest meal of the day. B. Decrease the basal insulin dose and add 1 daily prandial injection before the largest meal of the day. C. Maintain the basal insulin dose and add 1 daily prandial injection before the smallest meal of the day. D. Maintain the basal insulin dose and add 1 daily prandial injection before the largest meal of the day. Follow the link for the answer.

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Deadline to Lower A1C

For your patients with an A1c of 6 to 6.4%, how much time do you allow them to use diet and exercise to lower their A1c before adding a medication? Follow the link to see how you compare to your colleagues.

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