May 28, 2016 : Issue #835

• Fasting and Probiotics Do Make a Difference
• What You Need To Know When Adding A DPP-4 Inhibitor
• Hospitalization Rates for Patients with Prediabetes and Diabetes Increasing
• Gender Differences In Diabetes Progression
• SSRi Use Increases Stroke Mortality Risk in Diabetes
• CGM Motivates Prediabetes and Type 2 Patients to Increase Physical Activity

Back in December in my Editors Desk, I mentioned that a CDE/dietitian friend of mine enlightened me on the reasons that artificial sweeteners might have some effects on the gut flora of patients. Her solution was to start taking probiotics to correct the imbalance that was occurring. Over the years we have had many articles on the use of probiotics, including this one from 2013 looking at probiotics, obesity and diabetes and another that looks at the way probiotics can increase GLP-1 levels and maybe prevent diabetes.

This week, we have new information on how important these probiotics can be when we use intermittent fasting to treat or prevent diabetes and why together they make an unbeatable combination.

Announcements:

dLifeTV.com: Sunday, May 29, 7PM ET

From dLife.com: “Meet Charlie O’Connell, a person with type 1 who has devoted his life to helping others achieve their fitness goals; Chef Michel Nischan serves up a tasty alternative to white semolina flour that lets you have your noodles and eat them, too, without spiking that sugar count; Jim Turner stars in his very own Jim Turner’s Diabetes Theatre; Joy Pape RN, CDE answers your diabetes questions from the dLife mail.” Sundays live online at dLifeTV.com at 7 PM ET, 6 PM CT, and 4 PM PT. Keep up on the latest dLife news at dLifeTV.com.

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We can make a difference!

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Dave Joffe, Editor-in-chief

We’re delighted to congratulate Sheri Colberg, Diabetes in Control Advisory Board member and Featured Writer, who has been announced as the recipient of the American Diabetes Association’s 2016 Outstanding Educator in Diabetes Award. This award recognizes “a distinguished health professional who has made outstanding educational efforts in the field of diabetes and has demonstrated significant contributions to the understanding of diabetes education.” Sheri will be recognized with this honor during the Association’s 76th Scientific Sessions®, June 10-14, 2016, at the Ernest N. Morial Convention Center in New Orleans. She will deliver the Outstanding Educator in Diabetes Award Lecture, titled “From Froot Loops® to Fitness—My Journey as an Educator and PWD,” on Saturday, June 11.  Visit her article collection on our web site to see numerous examples of the kind of great work that earned her this recognition.

Ramadan 2016 begins in the evening of Sunday, June 5 and ends in the evening of Tuesday, July 5, 2016. Ramadan is a holy month for Muslims and, as one of the five pillars of Islam, fasting during this time is prescribed. The month lasts for 29–30 days, during which time the consumption of food and drink, as well as oral and injected medications, is forbidden between dawn and dusk. Depending on the season and geographic location, each period of fasting may last for up to 20 hours. Fasting is mandatory for all Muslim adults, with certain groups exempted, such as those with a medical condition – this may include some individuals with diabetes. Estimates suggest that there are 148 million Muslims living with diabetes worldwide. Download your Practical Guideline for Diabetes and Ramadan.

Do you feel comfortable recommending an SGLT-2 Inhibitor drug to your patients? Follow the link to share your opinion and see what others think!

Mr. Fontello is an overweight, Caucasian 63-year old patient who comes in for a 6-month check-up. He has a 12-year history of type 2 diabetes. He was diagnosed at age 33 with high blood pressure, but had never really done much about it as it was “too much of a hassle” and he felt “just fine.” At the time his diabetes was diagnosed, he was referred to a diabetes education program and was started on metformin, lovastatin, losartan and aspirin. He has an individualized A1C goal of 7%. Four years after diagnosis, pioglitazone was added to Mr. Fontello’s diabetes regimen. Three years ago, he came in for an appointment complaining of polyuria, polydipsia and fatigue with an office A1C of 9.3%. At that time he was started nightly basal insulin detemir. Since that time, he has made concerted efforts to eat a healthy diet and get to the gym. Today, he reports his SBGM fasting plasma glucose levels are on target (FPG below 130mg/dL). He also states that his feet always feel a little bit swollen. BP 128/78, HR 73, RR 19. Physical exam is remarkable for peripheral edema and mildly decreased pedal pulses. Current medications: metformin, pioglitazone, insulin detemir, lovastatin, losartan, aspirin. At today’s visit, his office A1C is 8.1%.

What changes would you recommend for his antihyperglycemic regimen?
Select one answer:
[A] Add a premixed insulin to all three meals of the day
[B] Increase his detemir dose
[C] Add a sulfonylurea to his regimen
[D] Add a rapid-acting insulin analogue to his largest meal of the day

Are you right? Follow the link to find out!

Signaling a potential new approach to treating diabetes, researchers at Washington University School of Medicine in St. Louis and Harvard University have produced insulin-secreting cells from stem cells derived from patients with type 1 diabetes. This discovery suggests a personalized treatment approach to diabetes may be on the horizon — one that relies on the patients’ own stem cells to manufacture new cells that make insulin. The researchers showed that the new cells could produce insulin when they encountered sugar. The scientists tested the cells in culture and in mice, and in both cases found that the cells secreted insulin in response to glucose. First author Jeffrey R. Millman, PhD, an assistant professor of medicine and of biomedical engineering at Washington University School of Medicine, had used similar techniques to make beta cells from stem cells derived from people who did not have diabetes. In these new experiments, the beta cells came from tissue taken from the skin of diabetes patients.

Very low calorie diets and probiotics can not only help in improving blood glucose for those with diabetes, but also help to prevent the development of diabetes.

Reduce the dose of sulphonylureas when adding DPP-4 inhibitor treatment in patients with type 2 diabetes, study warns.

Age-adjusted hospitalization rates for acute MI and stroke on the rise as more people are diagnosed with diabetes and prediabetes.

According to a BMJ study, men with prediabetes who increased their physical activity levels and women with prediabetes who reduced their waist circumference had lower risks of progressing to diabetes.

Current use of selective serotonin reuptake inhibitors was associated with a 23.3% risk of 30-day stroke mortality among diabetes patients hospitalized for stroke, compared with a 15.8% risk among those who didn’t take the drugs.

Using a continuous glucose monitor helps those with prediabetes and type 2 diabetes to self-regulate their exercise.

Quote of the Week!

“Take chances, make mistakes. That’s how you grow. Pain nourishes your courage. You have to fail in order to practice being brave.”

…Mary Tyler Moore

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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USA
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