September 20, 2016 : DCMS #311

DISASTERS AVERTED — Near Miss Case Studies

We Don’t All See the Same. See the World Through My Eyes

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Stanley Schwartz Part 4, Conference Anticipations

HOMERUN SLIDES — Great Clinical Presentation Highlights

Team-Based Approaches to Help Older Adults with T2 Achieve Individualized Glycemic Goals Part 4

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #42: Neuropeptides and Islet Hormone Secretion Part 1 of 5

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This past weekend, I presented a talk to Consultant Pharmacists, Directors of Nursing, and Medical Directors in Long Term Care. We were focusing on the team approach to diabetes care and how that has changed over the past couple of years. (Part of that presentation is in this week’s Homerun slides.)

We discussed how in the past we would try to target everyone to an A1c below 7, but now we are expected to look at the individual patient and take into consideration current health and co-morbidities in setting targets. Many of the attendees were in agreement with that concept, and shared that the older their patients were, the less they were concerned about reaching that target. While that is a general statement, sometimes we may neglect patients who have conditions we think will preclude reaching a good A1c.

This week, our Disaster Averted looks at how blindness could get in the way of a good A1c, and how one Diabetes Educator went out of her way to make sure that did not happen.

Dave Joffe

Editor-in-chief

I received a call from a physician’s office regarding a patient who needed education as soon as possible. Her A1C had risen to 7.5 and at 64 years old, the patient needed to make changes. The only problem: the patient was blind. The patient lived alone with her Seeing Eye dog and was assisted by her brother. She lived a relatively normal life despite her blindness, working a clerical job and visiting the gym 2 days per week. As an educator, I had never dealt with a truly sightless individual and was feeling ill-equipped to take on this challenge. The majority of the diabetes patients in our small rural clinic have sight enough to manage their disease. I started to think of all the things we take for granted when teaching our patients, such as lancing their fingers, reading a label, even simply putting the correct amount of food on their plate. All that was thrown out the window. How did I help this patient to see her diabetes care?

In part 4 and the conclusion of this Exclusive Interview about the new diabetes classification, Dr. Schwartz highlights what he is looking forward to at the AACE and ADA conferences, particularly the results of the LEADER and GLP-1 studies.

In this week’s Homerun Slides, the potential role of diabetes medications in the improved management of type 2 in older patients.

The traditional view is that islet hormone secretion is mainly regulated by circulating nutrients (glucose, amino acids, free fatty acids) as well as the gut incretin hormones (glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)). However, in certain circumstances regulation of insulin and glucagon secretion is also dependent on the autonomic nerves which innervate the islets. These nerves belong to the parasympathetic, sympathetic, and sensory branches of the autonomic nervous system.

In a controlled trial, 600 overweight and obese people with prediabetes were given metformin.

College student, type 1 diabetes, wears a pump and CGM. She has good family support. Several of her family members get her CGM readings on their phone. She received a call from her mother about 2:45 am waking her up. She told her to treat her low blood glucose, which patient reported to be 41.

Starting patients diagnosed within the last 7 years on 2-4 weeks of intensive insulin therapy could help keep them off additional medications for at least 48 weeks.