June 5, 2018 : DCMS #400

DISASTERS AVERTED — Near Miss Case Studies

Can’t Afford Insulin? There Are Options!

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

George Bakris Part 7, Kidney Disease Risk Reduction

HOMERUN SLIDES — Great Clinical Presentation Highlights

Future Use of Technology in Outpatient Care Part 1

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #128: Beta-Cell Mass and Function in Human Type 2 Diabetes Part 4

MOST POPULAR ARTICLES OF THE MONTH

#1 Very Low Carbohydrate Diet Equals Better Diabetes Control
#2 American College of Physicians Misses A1C Target
#3 Four New Drugs Waiting for Approval That Can Change the Diabetes Landscape (Part 1)

While we have been discussing Beta Cell Mass and Function in our clinic text, most of the conversation has been around insulin and what effects the destruction of Beta Cells has on insulin secretion and uptake. There are other hormones that come into play, and are affected even if they are not made in the Beta Cells. Two of the most recognized are GLP-1 and GIP.  These hormones have a very positive effect on glucose control and the understanding of how these hormones affect patient care can be put to good use to maximize patient care.

Speaking of insulin and patient care, this week’s Disaster Averted takes a look at the important issue of insulin costs and how educating our patients about how to use lower-cost regular and NPH insulins can help prevent disasters.

Dave Joffe

Editor-in-chief

We all know the benefits of the newer insulins, i.e., faster action times, less peak from the long actings, etc. But the cost, more often than we know, can lead to patients decreasing insulin doses, doing without until the next payday, or doing without it altogether, as we’ve read about. (See David Kliff’s recent article.) …

Dr. George Bakris shares his suggestions for reducing kidney disease risk in a talk with Diabetes in Control Publisher Steve Freed during the ADA 77th Scientific Session in San Diego.

In this week’s Homerun Slides, we begin to take a look at how the structure of technology’s use in outpatient care. Dr. Stanley Schwartz discusses how this might benefit the management of diabetes.

Incretin defect: Oral glucose elicits a greater insulin response than does intravenous glucose. As first demonstrated by Nauck et al., when tested at matched plasma glucose concentrations (iso- glycemic protocol) the oral route of glucose administration induces a robust increment in insulin secretion as compared with the intravenous route. In nondiabetic subjects, such potentiation — named incretin effect — averages 50 – 70% with a standard (75 g) oral glucose load, and increases with the size of the glucose load. As depicted in Figure 24.10, the incretin effect is characteristically lost in patients with T2DM.

Low carbs equals lower blood sugars and control, with less hypoglycemia, but how low do our patients need to go?

By Stanley S. Schwartz, MD and Mary E Herman, PhD

Despite guidelines, hypoglycemia can largely be avoided without shortchanging tight glucose control.

Two of the four exciting treatment options currently being trialed could change the way the disease is treated long term.