October 4, 2016 : DCMS #313

DISASTERS AVERTED — Near Miss Case Studies

Don’t Blame All Symptoms on Glucose Levels

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Yehuda Handelsman, Part 2 – Focusing Beyond Cardiology

HOMERUN SLIDES — Great Clinical Presentation Highlights

Team-Based Approaches to Help Older Adults with T2 Achieve Individualized Glycemic Goals Part 6

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #44: Neuropeptides and Islet Hormone Secretion Part 3 of 5

MOST POPULAR ARTICLES OF THE MONTH

#1 Metformin for Prediabetes: Success
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#3 Early Short-term Intensive Insulin Causes the Remission of Type 2 

There are often times when I don’t know which of the features to select to comment on in the Editor’s Desk. This week is one of those weeks. The topics are diverse, and it is hard to see every subject appealing to every reader. If you are a science person, then the explanation of sympathetic nerves in the production of insulin in our Clinical Gem will cause you to want to focus on new ways for managing diabetes. If you are more of the patient-interactive person, then both the exclusive interview with Dr. Yehuda Handelsman and the Homerun Slides will open your eyes to some unexpected methods for improving diabetes care.

Dave Joffe

Editor-in-chief

A woman, 72 years of age, type 2 diabetes, obesity, taking metformin, GLP1, ARB, and antidepressant (SSRI). Lost 20% total body weight in the past year. Recently complaining of dizziness and weakness. Glucose levels in the 60’s at home, at which time had symptoms of hypoglycemia. Glucose-lowering medications (metformin and GLP-1) were stopped. Continued to complain of dizziness and weakness especially in the morning.

Dr. Yehuda Handelsman talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting. In part 2 of this Exclusive Interview, Dr. Handelsman explains where to put the focus first when treating diabetes and diabetes complications.

In this week’s Homerun Slides, case studies to test your response to various situations with type 2 patients.

Islet sympathetic nerves: Islets are densely innervated by sympathetic nerves, as demonstrated by fluorescence microscopy, electron microscopy, and immunocytochemistry. The islet sympathetic nerves are postganglionic nerve fibers with most nerve cell bodies located in the celiac ganglion and some in the paravertebral sympathetic ganglia. Electrical activation of the sympathetic nerves inhibits insulin secretion and stimulates glucagon secretion.

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.