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Daily Archives: Jun 12, 2018

June 12, 2018

This week, our Clinical Text discusses both loss of beta cell function and beta cell mass, and how granulation can mask loss of mass. The interesting thing about this week’s installment is the overwhelming evidence that treating to a goal A1c is not the most important thing for a type …

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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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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #129: Beta-Cell Mass and Function in Human Type 2 Diabetes Part 5

Loss of beta-cell functional identity: The dominance of beta-cell functional impairment in T2DM implies that beta-cells have lost, at least in part, their normal insulin secretory phenotype. The associated molecular features have been discussed in a number of insightful reviews and research articles, and the role of genetic, epigenetic, transcriptomic and proteomic changes has been described extensively. At the cellular level, beta-cell insulin degranulation and the recently hypothesized beta-cell dedifferentiation phenomenon could play key roles. Insulin granules can be easily identified by electron microscopy on the basis of their typical morphology, characterized by a dense core and a more or less clearly visible halo. In addition, secretory granules can be subdivided into mature and immature, based on distinct ultrastructural, biochemical, and functional, with a relative ratio of 6 to 10 in normal human beta-cells.

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