June 27, 2017 : DCMS #351

DISASTERS AVERTED — Near Miss Case Studies

Monitoring Insulin Temperature

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Israel Hartman: Diabetes, Hyperlipidemia and Obesity

View Video | Read Transcript

HOMERUN SLIDES — Great Clinical Presentation Highlights

Insulin & Vascular Function Part 10

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #80: Insulin actions in vivo: glucose metabolism Part 6 of 9

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I had the good fortune of attending a Children with Diabetes conference some 10 years ago at Disney World in Orlando. During this conference, many of the kids had been keeping their insulin in their room refrigerators. One morning, some of the kids woke to find their insulin either frozen or with ice crystals floating in the bottle. However, an even greater number appeared to have nothing wrong at all. I was able to make calls to some local pharmacies and find insulin to replace all the ones that had appeared to get too cold. As the other kids were injecting their insulin, I wondered if some of them also had insulin that had frozen and then thawed, and if that ruined the insulin.

This week, our Disaster Averted looks at what happens when insulin freezes and then thaws, and how when this happened to one patient, he came up with a simple solution to make sure it never happens again.

Dave Joffe

Editor-in-chief

I have type 1 diabetes and have been living with it for the past 11 years. I take daily insulin injections to stay alive and well. A couple of years ago, I had a very frustrating incident when my insulin stopped working. I began injecting loads of insulin, and even with multiple doses my blood glucose wouldn’t drop.

In this Exclusive Interview, Dr. Hartman discuss practical points in the approach of the patient with diabetes, hyperlipidemia and obesity.

In this week’s Homerun Slides, the initiation of basal insulin.

Intravenous glucose: In the presence of euglycemia, insulin displays a potent suppressive action on hepatic glucose production, such that portal insulin concentrations of less than 100 mU L−1 abolish glucose entry into the circulation. Figure 14.7 shows a typical time course for endogenous glucose production following an acute increase in plasma insulin to levels of 60 – 70 mU L−1 in a healthy subject.

Ralph DeFronzo and his researchers at UT Health at San Antonio announced that they have cured type 1 diabetes.

As we know, the most ineffective medication is the one needed but never taken. There are many reasons our patients don’t take prescription medicines, but a biggy is the cost. If a medicine is too expensive, the patient will not fill the prescription, therefore won’t take it. For example, when ordering an SGLT-2 and/or GLP-1, each can cost hundreds or more for a month’s prescription. Some are covered for both. Some are covered for one brand, but not the other.

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