January 29, 2019 : DCMS #434

DISASTERS AVERTED — Near Miss Case Studies

Try Living Like Your Patients

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Adam Brown on Diabetes Apps and Technology

HOMERUN SLIDES — Great Clinical Presentation Highlights

Diabetes Apps Presentation Part 1

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #162: Immunopathogenesis of Type 1 Diabetes in Western Society Part 5

MOST POPULAR ARTICLES OF THE MONTH

#1 Warn, Teach, and Revisit Metformin
#2 Confusing Insulins Still A Common Mistake
#3 What Can Happen When Patients Take Diabetes Holidays

Many of us remember hearing the TV show police message, “1-ADAM-12, a 211 is in progress downtown.”  1-Adam-12 was the squad car identifier for a ’67 Plymouth Belvedere driven on the streets of Los Angeles in the late 60’s. During the show’s heyday and beyond, most every guy named Adam was called “1-Adam 12.” In fact, we have 2 Adams that ride in our bike club and we often call them 1-Adam-12.

This week, we have a “2-Adam-Brown” edition as both our Homerun Slides and video interview focus in on Adam Brown, head of Diabetes Technology & Connected Care at Close Concerns, and Senior Editor at diaTribe.org, as he shares his thoughts on diabetes apps, technology, and keeping up with the latest innovations.

Dave Joffe

Editor-in-chief

When I was studying to become a CDE, the students in our class who did not have diabetes were given the assignment to live as though we did have insulin-requiring diabetes for a period of time. It was very helpful. At that time, we did not have continuous glucose monitors (CGM), but we did have insulin, vials and syringes (not sure about the pens but I don’t recall those), glucose monitors, and other supplies. We gave ourselves normal saline as if it were insulin, checked our glucose at least four times/day, carb counted, and everything else required to manage our “diabetes” daily. One incident that stands out to me was a friend faking having a hypoglycemia event while waiting for her food at a restaurant. It was quite an eye-opening period of time for all of us.

Adam Brown, diagnosed with diabetes in 2001, serves as Senior Editor and columnist at diaTribe.org and Head of Diabetes Technology & Connected Care at Close Concerns. Adam writes an acclaimed column for diaTribe, Adam’s Corner, which has brought actionable diabetes tips to over 1 million people since 2013. Adam writes and speaks extensively about diabetes and chronic disease, and, at age 29, is recognized as a leading expert in diabetes technology. Adam graduated summa cum laude from the Wharton School of the University of Pennsylvania in 2011 as a Joseph Wharton and Benjamin Franklin Scholar.

In this week’s Homerun Slides, we begin taking a look at Adam Brown’s presentation as he answers the question, “Can diabetes apps make our lives easier?”

Autoimmunity persists in many patients even many years after diagnosis: Studies in patients with long disease duration suggest that beta-cell function may persist long after diagnosis in a significant proportion of patients. There is also evidence suggesting the co-existence of some low level of regeneration with chronic autoimmunity, as islet autoimmunity may also persist or perhaps be reactivated years after diagnosis. Indeed, significant proportions (30–40%) of islet or pancreas transplant recipients express one or more autoantibodies when evaluated prior to transplantation. Moreover, persisting autoreactive T-cell responses detected prior to transplantation correlate with islet graft failure on follow-up.

If this happens in my practice, I’m sure it likely happens with your patients too.

So many of our patients take metformin. They may be new to using metformin or have been taking it for many years. Either way it’s not unusual to have untoward GI side effects from taking it. They may have done fine taking it for years, so they don’t even think about it being their metformin.

I have a patient who has type 2 diabetes. He was started on long-acting insulin 8 months ago. Before adding the insulin, he was taking a daily GLP-1. He had experienced diabetic ketoacidosis (DKA) while on a SGLT-2, and did not tolerate metformin due to GI side effects. Therefore, these two were no longer options. …

Man, 36 years of age, type 2 diabetes, obesity class II, fatty liver, was taking metformin 1,000mg twice daily, and lower dose of SGLT-2. A1C was elevated 9% due to steroids; had been in the 6-7% range. Came in for 3-month follow up — A1C 9.9%, glucose 359, urine positive for glucose and for ketones, gained 19 pounds since last office visit, B/P 126/78-HR 78 and regular.

The patient reports he took a “holiday” from everything during the holidays. He ate and drank anything and everything he wanted, including alcohol, and stopped his medications. He complained of  increased hunger and thirst. Very thirsty.