October 16, 2018 : DCMS #419

DISASTERS AVERTED — Near Miss Case Studies

Take a Second Look at Surgery Recommendations

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Joshua Safer on Endocrinology and Transgender Patients

HOMERUN SLIDES — Great Clinical Presentation Highlights

Endocrinology Jeopardy: Pituitary for $200!

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #147: Glucose Toxicity Part 3

MOST POPULAR ARTICLES OF THE MONTH

#1 A Major Diabetes Complication That We Fail to Address
#2 Nuts, Nuts, and More Nuts Lower A1c and Cardiovascular Disease
#3 Association Between HbA1c and Coronary Artery Disease

We work very hard with our patients to help them lose weight. Often it is a slow and agonizing process but it will work. Many of our patients choose to have a surgical procedure like lap band, sleeve gastrectomy or bypass.

When you look at the procedures they may all seem good for the patient and similar in concept. However our very own medical editor, Joy Pape, shares her experience with a gastric sleeve candidate and why you need to ask the right questions to make the correct decision and prevent adverse reactions.

Dave Joffe

Editor-in-chief

Patient is male, 48 years of age, type 2 diabetes with hyperglycemia for eight years, class III obesity,  and very symptomatic GERD. Patient planned to have laparoscopic sleeve gastrectomy. I asked him why he chose that particular surgery. He said, “Because it’s less invasive.” I asked if his surgeon told him the sleeve gastrectomy could increase his GERD, and is not as effective for the treatment of type 2 diabetes nor for weight loss as is a bypass. He said, “No, the surgeon just left it to my choice. I said I wanted the sleeve and he was good with that.”

Joshua Safer, MD, FACP, is the Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery in New York. Previously, he was the inaugural Medical Director of the Center for Transgender Medicine and Surgery at Boston Medical Center. He is also Senior Faculty at the Icahn School of Medicine at Mount Sinai.

In this week’s Homerun Slides, it’s time for another round of Endocrinology Jeopardy, courtesy of Dr. Claude Lardinois! This week’s clue: 56-year-old male with loss of libido, testosterone 40 mg/dL, and prolactin 65 mg/dL (Normal <20).

Chronic hyperglycemia as a cause of impaired insulin secretion

In 1948, Lukens and Dohan administered large doses of glucose to normal cats and induced permanent hyperglycemia, hydropic degeneration of the islet of Langerhans, and ketonuria in 4 out of 35 cats studied. These investigators proposed that hyperglycemia could play a role in the pathogenesis of diabetes. In recent years, several approaches have been used to directly examine the harmful effects of chronic hyperglycemia on insulin secretion. These studies have established that chronic hyperglycemia impairs beta-cell responsiveness to glucose although the exact biochemical mechanism(s) mediating this effect remain to be clearly defined.

Nonadherence to diabetes medications 2nd leading cause of hospitalizations

New study shows that nut intake may improve glycemic control and reduce risk of cardiovascular disease in people who have type 2 diabetes.

Heart disease said cause of one on every four deaths in the U.S.