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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #66: Regulation of Glucose Metabolism in Liver Part 2 of 11

Hepatic glucose production: Typical lean humans spend more than half of their lives in the post-absorptive state, with less than 5 g of glucose circulating in their blood to support life. Many tissues rely on glucose as their primary fuel source. Notable examples are brain, which has limited access to fatty acids, and erythrocytes which do not possess mitochondria and, therefore, rely on glycolysis to meet energy requirements. Even during rest the body uses roughly 8 g of glucose per hour, and during exercise this rate can increase more than twofold. The body would deplete circulating glucose in less than 30 min, resulting in severe hypoglycemia, loss of neurologic function and death, if not for a constant endogenous supply of glucose.

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2017 ADA Position Statement on Diabetic Retinopathy

This represents the first such update by the American Diabetes Association since 2002, and is notable for inclusion of the latest evidence and recommendations with respect to appropriate eye examination intervals, referral criteria, prevention of incidence and progression of diabetic retinopathy (DR), and treatment strategies.

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March 11, 2017

Test Your Knowledge

When asked in a survey, 77% got it wrong! In head-to-head trials of dipeptidyl peptidase 4 (DPP-4) inhibitors vs glucagon-like peptide 1 (GLP-1) receptor agonists, GLP-1 receptor agonists showed more favorable outcomes in all of the following areas except which one? A. Greater glycemic control B. Greater tolerability C. Greater weight loss D. Greater improvement in beta-cell function E. Greater reduction in postprandial triglycerides Were you able to get it right? Follow the link to find out!

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New Combination Drug

Now that a new combination drug of a GLP-1 plus DPP-4 is approved, will you: 1. Recommend it for current patients 2. Wait until we have further information on its use 3. Not sure Follow the link to respond and see what your colleagues think.

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Non-Compliant No More!

A patient, 48 years of age, female, type 2 diabetes and obese, was referred to me for diabetes and weight management. Her first visit was 8 a.m., after fasting for 10 hours. Her A1c was 7.4%, BMI 37, BP 164/92, HR 92. The previous hcp had recorded she was recommended a low carb diet and the following medications: Metformin, 1,000mg twice daily; Byetta 10mcg sq twice daily. It was also written that she was non-compliant.

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