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Monthly Archives: August 2016

August 30, 2016

Three days ago I got a call from a patient who needed some insulin. The problem was, I had not seen the patient in 6 years — since I had first trained him on his insulin pump. Apparently they had gone out of town; he had prefilled cartridges with him and left them in a …

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Out of Insulin, Too Early to Renew — What To Do?

It is not unusual for people to have difficulty keeping insulin from freezing or getting overheated. A patient, with type 1 diabetes for 17 years, had glucose that did not respond to his rapid-acting insulin as it usually does. He had two new vials in the refrigerator. He took a new vial out of his refrigerator earlier in the day, and started using it a few hours after he took it out. Had high post prandials that did not respond as usual to correcting. He had enough experience to wonder if perhaps something was wrong with his new insulin, so he thought he’d try another vial. He saw it was frozen. He had put the two vials at the back, where for many refrigerators it is colder. He thought back and wondered if the first vial looked any different, but remembered, he did not look closely at it.

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Dr. Stanley Schwartz Part 1, New Diabetes Classification

In part 1 of this Exclusive Interview, Dr. Stanley Schwartz explains how the current understanding of diabetes surpasses the diabetes classifications determined long ago. He explains how understanding the inner workings of a specific patient can determine the best therapy for that patient, whether diabetes classifications change or stay the same.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #39: Normal Beta-cell Function Part 4 of 6

Beta-Cell response to hormones and the nervous system: As already mentioned insulin is the only hormone with a blood glucose lowering effect, while many other hormones (glucagon, cortisol, adrenaline) exert a hyperglycemic action. The changes in glucose levels elicited by these hormones obviously will be detected by the beta cell, which will respond by enhancing insulin secretion. Yet, all these hormones, as well as others and the nervous system exert a coordinated direct effect on the beta cell resulting in an integrated and sophisticated control network.

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Aug. 27, 2016

Last week in our Clinical Series we had an excerpt from International Textbook of Diabetes Mellitus, 4th Ed., looking at Beta-Cell response to nonglucose secretagogues. This text dealt with how the beta cells might be affected by more than just glucose. We are learning more about how fat. protein, and non-insulin peptides might have effects we had never …

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