May 4, 2019 : Issue #988

TOP STORIES — Diabetes News and Research

Can You Benefit from Using Exercise Technologies and Wearable Devices?
— by Sheri R. Colberg, PhD, FACSM

Gestational Diabetes Ups Type 1 Diabetes Risk in Kids

Beware: Diuretics Can Increase Risk of Amputations

Most of you know by now that my wife was diagnosed with type 1 diabetes at the age of 66. After trying to manage her with multiple medications for 3 years her endo confirmed she has absolutely no insulin production and was positive for the antibodies indicating type 1 diabetes. 

Since that diagnosis she has been started on a Dexcom 6 CGM and a Tandem pump is on the way. She currently uses an InPen and their dosage calculation software, and over the past 2 years has built her daily cycling up to 18-25 miles daily. Even with all this technology she has had problems getting great control over her glucose, and her levels will fluctuate wildly over during and after her rides. 

This week our activity expert Dr. Sheri Colberg looks at how she uses exercise technologies and monitoring to manage these fluctuations. 

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We can make a difference!

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Dave Joffe

Editor-in-chief

Zynquista is now approved in the European Union, at once-daily doses of 200 mg and 400 mg, for use as an adjunct to insulin therapy to improve blood sugar (glycemic) control in adults with type 1 diabetes (T1D) mellitus and a body mass index ≥ 27 kg/m2, who could not achieve adequate glycemic control despite optimal insulin therapy. The marketing authorization is based on evidence including data from the inTandem clinical trial program, which included three Phase 3 clinical trials assessing the safety and efficacy of sotagliflozin, involving approximately 3,000 adults with inadequately controlled T1D. Zynquista is an oral dual inhibitor of two proteins responsible for glucose regulation known as sodium-dependent glucose co-transporter types 1 and 2 (SGLT1 and SGLT2). SGLT1 is responsible for glucose absorption in the gastrointestinal tract, and SGLT2 is responsible for glucose reabsorption by the kidney.

By Sheri R. Colberg, PhD, FACSM
What do you do when someone asks you to participate in a physical activity on the spur of the moment, but you just took some insulin? You may be stuck trying to compensate for this activity entirely with food, but you may have some newer options that come from technology. For starters, if you wear a pump you can choose to lower your basal insulin delivery, and you can use its insulin-on-board calculator to see how much insulin you need to offset with either insulin reductions or food intake. However, just using your blood glucose meter can help you stay on top of your glucose levels, so check often during the activity.

According to results of a large observational cohort study, children and youth whose mothers had gestational diabetes were almost twice as likely as their peers to develop diabetes by age 22.

Adding a SGLT-2 inhibitor which acts as a diuretic can increase the risk.

Ten years ago we mostly cared about efficacy and reducing A1c. Now, with a variety of new pharmacologic options to reduce A1c in patients with diabetes, the decision needs to be made as to safety or lowering of A1c. Many studies have shown that for patients that develop diabetes at a younger age, it is important that their A1c is as low as possible without hypoglycemia to prevent the complications which come from elevated blood sugars over time. As a person ages safety may become a greater concern; now, because of multiple studies, we see that hypoglycemia is associated with a high risk of hospitalizations, complications and death. So safety has overcome the efficacy of reducing A1c, especially for older adults, which needs to be considered in terms of the individual patient.  Now, with the advent of new classes of diabetes drugs that can reduce not only the A1c, but also reduce the risk of kidney failure and CVD, there are more options for patients. When considering medications, two that should be considered for patients with a history of heart failure or stroke are GLP1-RA’s and SGLT2 inhibitors, which both provide substantial cardioprotective benefits. Unfortunately, lack of insurance and high cost prevents them from being commonly used.

Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletters:

Ghazal Blair, Pharm.D. Candidate 2019, LECOM School of Pharmacy

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Steve and Dave
Diabetes In Control
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