April 19, 2016 : DCMS #289

DISASTERS AVERTED — Near Miss Case Studies

Inpatient Teaching Should Include Outpatient (Real Life) Education and Supplies

HOMERUN SLIDES — Great Clinical Presentation Highlights

Diabetes and Periodontitis Part 8

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. George Bakris Part 5, Perfecting the At-Home Kidney Test

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #20: Development and Maintenance of the Islet Beta Cell Part 4 of 4

MOST POPULAR ARTICLES OF THE MONTH

#1  Most Effective Hypertensive Medications that Prevent Nephropathy in Diabetic Patients
#2 What You Don’t Know About Statins and Exercise Can Hurt You
#3 How Low is Too Low? Blood Pressure Goals for Diabetic Patients

Last week I had my physical. When they checked my blood pressure, it was 141/81 and my doctor was a little concerned that it was elevated. He asked me if it was like this most of the time and I told him it was not. I asked him to check it again at the end of the appointment. Since this was my first time in his office, the appointment lasted 30 minutes. At the end, he had the MA come in and when they checked again it was 119/77, more in line with my normal readings.

If he had only checked once he would have likely wanted to start me on a medication, and I wondered how often that happens every day. The reason I asked for the second check has to do with ambulatory blood pressure and the value of properly interpreting those values. This week, in his latest video, Dr. George Bakris explains how to use ambulatory blood pressure screening to accurately assess hypertension.

Your partner in diabetes care,
Dave Joffe
Editor-in-chief

One day a 31-year-old woman who had recently been hospitalized and subsequently diagnosed with type 1 diabetes came into our diabetes clinic for education. She had been discharged from the hospital less than a week prior to coming to our clinic. She was frustrated when she arrived, as her blood sugars had become increasingly elevated after leaving the hospital. She had called her primary care physician and he instructed her to increase her dose of long-acting insulin. Still, her blood sugars had not improved.

In this week’s Homerun Slides, periodontitis treatment and therapy results.

In part 5 of this exclusive video, DIC publisher Steve Freed concludes his discussion with Dr. George Bakris about the use of an at-home kidney test as one method of early capture of possible kidney disease.

For many years it was speculated that beta cells, much like neurons, were postmitotic and that their turnover in the mammal was minimal or zero. Over the last two decades, studies in mice have suggested a more dynamic picture, wherein beta-cell mass can change in response to physiologic states such as growth, pregnancy, and obesity.

25-40% of hypertension patients require only monotherapy to control BP, so choice of right single therapeutic agent is critical.

I recently received an email from a person with type 1 diabetes living in Denmark (Guido) whose physician believes in prescribing many medications to manage cholesterol and high blood pressure in anyone with diabetes, regardless of need. Guido has been taking a statin (Atorvastatin, brand name Lipitor), along with at least four others for blood pressure control. He used to take Simvastitin (Zocor), but a year prior had been changed to Atorvastatin (and his dose doubled). That’s when his problems with exercise began.

Research indicates setting more aggressive blood pressure goals for diabetic patients may cause harm.