September 6, 2016 : Issue #309

DISASTERS AVERTED — Near Miss Case Studies

When Adding a GLP-1 for Patients Who Have Type 1 (off label use)

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Stanley Schwartz Part 2, Benefits of Early Combination Therapy

HOMERUN SLIDES — Great Clinical Presentation Highlights

Team-Based Approaches to Help Older Adults with T2 Achieve Individualized Glycemic Goals Part 2

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #40: Normal Beta-cell Function Part 5 of 6

MOST POPULAR ARTICLES OF THE MONTH

#1 Blood-Pressure Drug Could Be A Possible Type 1 Diabetes Cure
#2 Can a 100-Year-Old Vaccine Bring Us a Cure for Type 1?
#3 Impact of Carbohydrates in Diabetes Patients

Many times we get rushed when working with our diabetes patients and try to squeeze in too much in a 12-minute appointment. This means either things get overlooked or our patients are confused. Based on this, it is important to take advantage of the whole patient care team, especially when we are talking about older patients. This week in our Homerun Slides, we begin discussing the members of that Team and how to best utilize the help they offer.

Dave Joffe

Editor-in-chief

Female 43 years of age. Type 1 diabetes/insulin resistant, hyperglycemia, increasing insulin to manage glucose, but not covering well. Increasing appetite and gaining weight. GLP-1 (Victoza) added at 1/2 recommended start dose for people who have type 2 diabetes, which is 0.6mg, so patient started at 0.3mg daily. Patient started having hypoglycemic reactions, most often postprandially and nocturnally.

In part 2 of this Exclusive Interview about the new diabetes classification, Dr. Stanley Schwartz explains the necessity of treating beta cell dysfunction even as early as prediabetes, but also needing health organizations to agree on the early use of certain treatments.

In this week’s Homerun Slides, strategies and new models of care for each of the team members for the purpose of improving outcomes for older T2 patients.

Beta-cell mass and function: beta-cell mass can be accurately evaluated only through autopsy studies. Complex in vivo tests aiming at measuring maximal secretory capacity combining different stimuli have been proposed as an alternative. However, their ability to discriminate between defects in function and mass, as well as their feasibility, is a matter of debate. As thoroughly reviewed by Robertson, the acute response to an i.v. glucose bolus in normoglycemic subjects and the acute response to an i.v. arginine bolus in hyperglycemic subjects do correlate with beta-cell mass.

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

In part 1 of this exclusive interview, Dr. Faustman discusses her research and why an old tuberculosis vaccine may lead us to a cure for type 1.

Are very-low carbohydrate, low saturated fat diets the best choice for A1c control?