January 24, 2017 : DCMS #329

DISASTERS AVERTED — Near Miss Case Studies

Teach Not to Hate Insulin

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Altamash Shaikh Part 3, Diabetes Severity in India and U.S.

HOMERUN SLIDES — Great Clinical Presentation Highlights

EMPA-REG Outcome Trial, Part 6

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #59: Mechanisms of Insulin Signal Transduction Part 3 of 8

MOST POPULAR ARTICLES OF THE MONTH

#1 New ADA 2017 Standards of Medical Care in Diabetes
#2 Preventing CV Death in Patients With Diabetes
#3 The Most Common Hassle For Type 1 Diabetes Patients

Many times, we become frustrated with our patients because they just don’t take diabetes seriously. One of the ways that we see this is the lack of refill persistence and medication adherence among these patients. Even with medications that you only have to take once per week, there is a large number of patients who still won’t take their medicines. This at times leads us to either threaten our patients with insulin or tell them if they do things right they will not ever need to start insulin. In this week’s Disasters Averted, one of our contributors shares what could happen if you use either threat or reward with insulin use.

Dave Joffe

Editor-in-chief

Man, 63 years of age, type 2 diabetes, obesity, hypertension and hyperlipidemia, referred to me, a CDE, to start him on and teach him how to use insulin. He has had diabetes education in the past, tried lower carb eating and physical activity, but glucose levels still elevated. He told me he felt like a failure. He said he learned he was insulin resistant, made too much insulin, which was causing his co-morbidities. He was very resistant to start insulin, especially since he thought insulin was the cause of his problem.

Dr. Altamash Shaikh talks with Diabetes in Control Associate Medical Editor Joy Pape at the 2016 AACE Meeting. In part 3 of this Exclusive Interview, Dr. Shaikh explains the life experience among the Indians that lends itself to the development and perpetuation of diabetes.

In this week’s Homerun Slides, the rate of heart failure hospitalization and all-cause mortality of patients on the placebo vs empagliflozin study.

Insulin receptor substrate molecules — receptor substrate/docking protein: Following insulin binding and receptor autophosphorylation, the next committed step in signal transduction is tyrosine phosphorylation of intracellular proteins. To accomplish this, autophosphorylation of the beta subunit mediates noncovalent but stable interactions between the receptor and intracellular substrate proteins, and this positions these molecules for tyrosine phosphorylation by the activated insulin receptor kinase.

Psychological health, access to care, expanded and personalized treatment options and the tracking of hypoglycemia emphasized.

What do we need to tell our patients about preventing the risk for death?

Barrier means more work including monitoring more often and making more adjustments.