August 23, 2016 : DCMS #307

DISASTERS AVERTED — Near Miss Case Studies

When There’s Water, Check the Shoes

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Kimberly Ward Part 6, Insurance Reimbursement

HOMERUN SLIDES — Great Clinical Presentation Highlights

Beta-Cell Classification of Diabetes and the Egregious Eleven Part 6

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #38: Normal Beta-cell Function Part 3 of 6

MOST POPULAR ARTICLES OF THE MONTH

#1 Probiotics for the Management of Diabetes
#2 Blood-Pressure Drug Could Be A Possible Type 1 Diabetes Cure
#3 Ghost Pills

Last week, I had a new patient referred to me with adult onset type 1 diabetes. The patient was 63 years old and — although she had been losing weight over the past year — it was a 16 pound loss over the previous 2 weeks that got the physician concerned. An A1c test came in at 13.1  and the C-peptide was 0.89, so they placed the patient on 40 units of Lantus every morning. My goal was to help the patient learn how to eat and exercise better, and of course the number of carbs that she was eating needed to be reduced. When we told her that she should keep the carbs below 100, she decided that if below 100 was good, below 50 would be better. Her levels improved, and in 7 days we were down to 24 units every morning.

She was still getting a rise in post-meal glucose even when consuming no carbs, only protein and fat, and was becoming frustrated. I called her back in and we sat down and talked about how non-glucose secretagogues can cause an increase in glucose levels. Although she had no idea of what a secretagogue was, by the time we were done she understood how her mix of protein and fat was possibly causing an increase. If you want to understand this confusing process you would be well served by reading this week’s clinical text. Dave Joffe Editor-in-chief

People who have diabetes are usually taught to purchase protective soft leather shoes with a wide toe box. That doesn’t mean everybody who has diabetes follows those recommendations. A woman, type 2 diabetes, who is knowledgeable about diabetes and foot complications was wearing cloth shoes with a “corded” bottom and manmade rubber sole. She was caught in the rain. Her shoes were soaked.

In the conclusion of this Exclusive Interview, Kimberly Ward explains how Roche can help the patient with private insurance to get help obtaining a preferred co-pay for the Accu-Check system.

In this week’s Homerun Slides, the call for patient-centered approach to diabetes therapy that factors in the patient’s individual cause of metabolic dysregulation.

Beta-Cell response to nonglucose secretagogues: Proteins and amino acids — The insulinotropic effect of oral proteins was first described almost 50 years ago and recently confirmed. After the ingestion of a small amount of proteins (30–50 g) or a larger amount of proteins (2 g kg−1), plasma insulin was raised two- to threefold over baseline and remained persistently elevated for 90 or 240 minutes, respectively. In either case, blood glucose did not change, whereas both GLP-1 and GIP levels were raised threefold over fasting values.

Can probiotics improve A1c’s, plus much more?

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

When it comes to metformin, when appropriate, I recommend the extended release version. Last week my patient, female, 56 years of age, type 2 diabetes, visited. A1C was elevated, and she gained 5 pounds. She had been on metformin ER for the last 6 months and doing well. She said she recently noticed a bean-looking/pill-looking thing in her stools that seemed to be related to her metformin.