July 25, 2017 : DCMS #355

DISASTERS AVERTED — Near Miss Case Studies

Helping Patients to Achieve Behavior Change

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Karl Nadolsky Part 2, Pharmaceuticals for Obesity

HOMERUN SLIDES — Great Clinical Presentation Highlights

A Unifying Pathophysiologic Approach to The Complications of Diabetes in the Context of the Beta-cell Classification of Diabetes Part 4

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #83: Measuring Insulin Action In Vivo

MOST POPULAR ARTICLES OF THE MONTH

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Many times when we least expect it there is a past and present combination in diabetes. This week in our Clinical text we start a discussion on the idea of measuring in vivo insulin. It was back in 1925 when Banting and Best first gave insulin to reduce glucose levels. One of the interesting things the researchers found was that some patients did not respond, regardless of how much insulin they were given. These early researchers had no way to measure insulin but they actually thought patients were resistant, but had no way to prove it.

This whole idea was just a guess until Dr. Rosalyn S. Yalow won the 1977 Nobel Prize in Physiology or Medicine for the development of radioimmunoassays of peptide hormones. For the first time insulin secretion and values could be established, and this led to the pancreatic suppression test that you can read about in this week’s text.

As a side note, Dr. Yalow worked at the Bronx VA Hospital and she was a mentor to John Eng, a physician, who first discovered and then patented the first GLP-1 analog, which he found in “lizard spit.” To learn more about Dr. Yalow and Dr. Ing, and their work together click here.

Dave Joffe

Editor-in-chief

Man, 76 years of age, type 2 diabetes, obesity, SP right total hip replacement one year out. When preparing for hip surgery, was on basal and bolus insulin, metformin. Had been on a GLP-1 but had diarrhea so he stopped. Was able to, for the most part, follow a lower carbohydrate meal plan but was not active. When he first started coming to us for weight loss to prepare for his surgery, his weight was 304 pounds, BMI 45, A1c 9.9%, Cr 1.87, eGFR 34. We decreased his metformin from 2,000mg/day to 1,000mg day and referred to nephrology. With this change and being motivated for surgery, he lost weight and in 6 months went into surgery having lost 25 pounds with an A1c of 6.9%. Note, due to eating less carbs, he could take less insulin, which seemed to help his appetite. Surgery was performed and he did well.

In part 2 of this Exclusive Interview, Dr. Karl Nadolsky talks with Diabetes in Control Publisher Steve Freed during the AACE 2017 convention in Austin, Texas about the importance of using BMI when determining an obesity treatment plan.

In this week’s Homerun Slides, insulin resistance within the beta-cell centric construct.

The heralded isolation of insulin in Toronto in 1921 was followed immediately by treatment of diabetes. It soon became clear that while insulin was effective in regulating the blood glucose levels in most patients, there were some subjects in whom insulin appeared to be ineffective. This lack of insulin effect was termed “insulin resistance” as early as 1925.

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

Study shows age-related comorbidities decreased in males over 65 who take metformin.

Combination ANRI sacubitril/valsartan (EntrestoR) showed significant reduction in risk for cardiovascular death and hospitalization for worsening heart failure.