July 19, 2016 : DCMS #302

DISASTERS AVERTED — Near Miss Case Studies

What’s Important to Your Patient?

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Kimberly Ward Part 1, Understanding the Accu-Chek Connect System

HOMERUN SLIDES — Great Clinical Presentation Highlights

Beta-Cell Classification of Diabetes and the Egregious Eleven Part 1

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #33: Beta-Cell biology of insulin secretion Part 3 of 5

MOST POPULAR ARTICLES OF THE MONTH

#1 Blood-Pressure Drug Could Be A Possible Type 1 Diabetes Cure
#2 Color Matters in Managing Hypertension
#3 Victoza LEADER Trial Top-Line Results Announced

Over the last 7 years we have heard all about the benefits of GLP-1 analogs. One of the benefits that is often touted is the increase in first phase insulin release. In simple terms, we define this as “the quick release of insulin at the first bite of food,” but what does it mean physiologically, and how does it occur? This week in our clinical text we discuss the dynamics of insulin secretion and explain the concept of bi-phasal insulin release.

Dave Joffe
Editor-in-chief

Male, 26 years of age, type 2 diabetes, obesity, hyperlipidemia, hypertension. Strong family history of type 2 diabetes with complications. Has been a patient since diagnosed 2 years ago. Has met with dietitian. Hasn’t made dietary changes, increased activity, or taken meds prescribed to lower his glucose. A1C 9.2% and rising every 3 months. He would also miss many of his appointments. Stated, “Nothing is going to bother me. Maybe it did my family, but that was a different time and it’s not going to happen to me. I’m going to go on enjoying my life.”

In part 1 of this Exclusive Interview, Kimberly Ward explains the goal and use of the Accu-Chek Connect System.

In this week’s Homerun Slides, the principles of the AACE/ACE comprehensive type 2 diabetes management algorithm.

Dynamics of insulin secretion: Biphasic insulin secretion — insulin release from pancreatic beta cells in response to glucose is characterized by biphasic kinetics: an initial component (1st phase), which develops rapidly but lasts only a few minutes, followed by a sustained component (2nd phase). It has been thought that the biphasic response of insulin secretion reflects primarily the dynamics of spatially and functionally distinct insulin granules. The prevailing hypothesis is that the 1st phase of insulin secretion is attributable to fusion of predocked granules from a readily releasable pool (RRP) that accounts for less than 5% of total granules, while the 2nd phase involves recruitment of granules from a more distant reserve pool (RP) that accounts for the great majority of total granules.

A common blood pressure drug is showing new promise to help treat and cure type 1 diabetes.

African American male, 63 years of age, type 2 diabetes, hypertension, strong family history of type 2 diabetes, hypertension and stroke. A1C is 6.7%. Blood pressure 160/96 HR 88, despite being on ACE-I and Beta Blocker.

Victoza LEADER trial of 9,000 adults with type 2 diabetes found that drug significantly reduced the risk of heart attack or stroke.