February 20, 2018 : DCMS #385

DISASTERS AVERTED — Near Miss Case Studies

To Give Your Patients Hope, Listen Well to The Stories They Tell Themselves

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Angela Golden Interview 1, Part 1, Patients Over 65 with Obesity

HOMERUN SLIDES — Great Clinical Presentation Highlights

Framework for Understanding DM Part 8

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #113: Diabetes and Sleep Apnea Part 3

MOST POPULAR ARTICLES OF THE MONTH

#1 Know Your Insulins, Teach Your Patient
#3 Elevated A1C? Consider Lowering Insulin
#3 A Summary of ADA’s New 2018 Standards of Medical Care in Diabetes

There have been a lot of diseases associated with diabetes, and it is often said that, although it is never on the death certificate, diabetes is the biggest killer.

We often can think of some of the common ones, like heart failure, stroke, and kidney failure. And other conditions that worsen life, like blindness and amputations. Now we can add Obstructive Sleep Apnea to that list.

This week in part 3 of our clinical text we look at how the pathophysiology of OSA relates to diabetes. Be sure to check out part 1 and part 2 by clicking here.

Dave Joffe

Editor-in-chief

I recently met a patient whose life is alternative medicine. Not complementary medicine but alternative medicine.

A young woman in her early 30’s who was diagnosed with type 1 diabetes 10 years ago. Besides having an A1C of 10.5%, I could tell she was struggling. Her career is in alternative medicine. For years she has been looking for a way to stop taking insulin. She is looking for the cure, but as with many, has difficulty believing it’s not here yet. She has had diabetes education, but because she hasn’t really met the hcp she can relate to or who has given her the answer she wants to hear, she’s not really put things together yet.

In part 1 of this 2-part Exclusive Interview, Angela Golden talks with Diabetes in Control Publisher Steve Freed during the AACE 2017 convention in Austin Texas about obesity in people over the age of 65.

In this week’s Homerun Slides, practical implementation of the common origins of diabetes and its complications construct.

OSA pathophysiology: OSA is a very complex disorder, and although obesity and fat deposition around the neck plays an important role, there are many other important players that contribute to the development of this condition.

The human upper airway is a unique multipurpose structure involved in performing a variety of tasks such as speech, swallowing, and the passage of air for breathing. The airway, therefore, is composed of numerous muscles and soft tissue but lacks rigid or bony support. Most notably, it contains a collapsible portion that extends from the hard palate to the larynx, which allows the upper airway to change shape and momentarily for speech and swallowing during wakefulness; but this feature also provides the opportunity for collapse at inopportune times such as during sleep.

Woman, 67 years of age, type 2 diabetes for 22 years, class II obesity. Has recently been managing her glucose levels with weight loss, using Tresiba, Trulicity, and metformin. Recent A1C 6.5%, which she’s worked hard for and been extremely proud of. She hasn’t had numbers like she has recently had for years.

This Disaster Averted is not just about one patient but about many who take insulin. Most think high A1C means one needs to increase insulin. Not always! Remember, A1C is an average. Just because someone has an A1C of <7% doesn't actually mean glucose is managed.

Comprehensive recommendations feature notable new recommendations for people with cardiovascular disease and diabetes.