March 6, 2018 : DCMS #387

DISASTERS AVERTED — Near Miss Case Studies

Make the Goal Personal to Motivate

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Karl Nadolsky, Holistic Treatment of Obesity

HOMERUN SLIDES — Great Clinical Presentation Highlights

Framework for Understanding DM Part 11

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #115: Diabetes and Sleep Apnea Part 5

MOST POPULAR ARTICLES OF THE MONTH

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

The pressures of reimbursement have taken their affect on the amount of time that a patient gets to spend with their clinician. This means that often there is no time for you to say everything to your patient that you would like to and that means that the obesity conversation rarely occurs. This does not bode well for the overweight diabetes patient who could be only a conversation away from changing their habits.

This week, we bring  all five parts of our interview with Dr. Karl Nadolsky, director of the Diabetes, Obesity & Metabolic Institute in Bethesda, MD, who explains the disease of obesity, shares his conversation with patients who have excess weight or obesity, and gives his recommendations for treating the disease.

Dave Joffe

Editor-in-chief

Male, 66 years of age, type 2 diabetes, class III obesity, peripheral neuropathy, multiple toe amputations, hypertension, hyperlipidemia and, most importantly, a 2-year-old granddaughter. Patient taking 100 units long-acting insulin, sulfonylurea, metformin, beta blocker, and statin. Checks glucose once in a while; in the 200 to 270 range when checks. A1C 9.3%.

Diabetes in Control Publisher Steve Freed talks with Dr. Karl Nadolsky at the AACE 26th Annual Scientific & Clinical Congress in Austin, Texas. Dr. Nadolsky discusses lifestyle as medicine and treating the disease of obesity in a holistic manner. Dr. Karl Nadolsky, DO is an endocrinologist at Walter Reed National Military Medical Center and currently …

In this week’s Homerun Slides, the conclusion of the framework for understanding diabetes focuses on appropriate medication according to patient need.

OSA and beta-cell function: While the impact of OSA in IR has been studied extensively, the impact of OSA on beta-cell function has received little attention, despite being an essential part of the pathogenesis of T2DM and prediabetes. A small number of animal studies showed that intermittent hypoxia increases beta-cell death, and results in beta-cell dysfunction, although the intermittent hypoxia used in this study is far greater than that which occurs in humans with OSA.

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.

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.