August 8, 2017 : DCMS #357

DISASTERS AVERTED — Near Miss Case Studies

Don’t Blame All Symptoms on Glucose Levels

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Karl Nadolsky Part 4, Lifestyle Therapy Plan

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 6

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #85: Measuring Insulin Action In Vivo

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When it comes to diabetes, there seems to be a thousand right ways to get your patients to lose weight. While weight loss is only one component of managing diabetes, it is often the most quoted and hardest to do. This week in Part 4 of our Exclusive Interview with Dr. Karl Nadolsky, we hear more about the Lifestyle Therapy plan that he shared at the recent AACE meeting and learn about his preferences for helping his patients to lose weight and why.

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.

In part 4 of this Exclusive Interview, Dr. Karl Nadolsky talks with Diabetes in Control Publisher Steve Freed during the AACE 2017 convention in Austin, Texas. Dr. Nadolsky explains his preferences for patients when discussing weight loss.

In this week’s Homerun Slides, the implications of new guidelines for the preservation of beta cells.

Insulin action dynamics: Insulin sensitivity from the clamp is expressed in terms of the steady-state value reached after a period of hyperinsulinemia. A dose–response can be constructed and sensitivity can be expressed as the ED50, that is, the concentration for half-maximal stimulation of Rd as a function of dose. Alternatively, sensitivity can be expressed (as it usually is) as the Rd at a specific dose of insulin, which may be low, intermediate, or a maximum dose. It is often assumed that steady-state rate of glucose uptake is reached by 180 min after onset of the insulin infusion. In fact, steady-state glucose uptake is not reached at 3h. Glucose uptake rate at 3h is only 2/3 the “true” steady-state, which is not achieved until 6h. Certainly, shorter periods (e.g. 120 min) are inadequate to reflect steady-state rates of uptake.

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.