New FDA nutrition facts label aims to make it easier for consumers to make informed choices about what they’re eating.
Read More »Production Assistant, Diabetes In Control
Canagliflozin and the Risk of Leg and Foot Amputations
FDA issues alert about interim safety results from ongoing clinical trial, but study of potential canagliflozin amputation risk is ongoing.
Read More »Higher Fitness Levels Reduce Risk for Developing Diabetes
Higher level of cardiorespiratory fitness (CRF) over two decades was shown to reduce risk for developing prediabetes and T2, even after adjusting for changes in BMI.
Read More »Gun Education
With over 33,000 yearly accidental deaths from guns, should medical professionals have the responsibility to talk about safety to their patients who own guns? Follow the link to respond -- and to see what others think.
Read More »Question #836
(Continued from Question #835) Mr. Fontello is an overweight, Caucasian 63-year-old patient who comes in for a 6-month check-up. He has a 12-year history of type 2 diabetes. He was diagnosed at age 33 with high blood pressure, but had never really done much about it as it was “too much of a hassle” and he felt “just fine.” At the time his diabetes was diagnosed, he was referred to a diabetes education program and was started on metformin, lovastatin, losartan and aspirin. He has an individualized A1C goal of 7%. Four years after diagnosis, pioglitazone was added to Mr. Fontello’s diabetes regimen. Three years ago, he came in for an appointment complaining of polyuria, polydipsia and fatigue with an office A1C of 9.3%. At that time he was started on nightly basal insulin detemir. Since that time, he has made concerted efforts to eat a healthy diet and get to the gym. Today, he reports his SBGM fasting plasma glucose levels are on target (FPG<130mg/dL). He also states that his feet always feel a little bit swollen. BP 128/78, HR 73, RR 19. Physical exam is remarkable for peripheral edema and mildly decreased pedal pulses. Current medications: metformin, pioglitazone, insulin detemir, lovastatin, losartan, aspirin. At today’s visit, his office A1C is 8.1%. A rapid-acting insulin analogue was added to his largest meal of the day. Labs taken last year show Mr. Fontello had a serum creatinine 1.2mg/dL with an eGFR 61mL/min. Today, his serum creatinine is 1.6 mg/dL and his eGFR is 44 mL/min. Because guidelines indicate when a patient’s eGFR falls below 60mL/min, dose reduction of medications should be considered, you decide to adjust Mr. Fontello’s medication. In type 2 diabetes, which one of the following medications does not need to be considered for dose reduction? Select one answer: A. Glyburide B. Metformin C. Insulin D. Pioglitazone E. Exenatide Are you right? Follow the link to find out!
Read More »Disaster Averted: Yes, You Can!
37-year-old woman has had type 1 diabetes since she was five years old. She was referred to me to help her manage her glucose levels because she wants to have a baby. She was wearing an insulin pump at the time, and had been for the past 20 years. Her glucose levels were very erratic. No pattern in sight.
Read More »International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #26: Insulin Gene Expression and Biosynthesis Part 2 of 6
Glucose regulation of insulin gene transcription factors: Pdx-1 is mainly localized at the nuclear periphery at low glucose concentrations (1–2mM) in beta cells, and becomes phosphorylated and shuttles into the nucleus in response to concentrations stimulating insulin secretion.
Read More »When Newly Diagnosed, It’s Not Just About Taking an Injection
When starting a patient on insulin, there’s more than just teaching how to give an injection and check glucose levels. Teach insulin’s action and side effects, especially the possibility of hypoglycemia, what it is, how to prevent, recognize and treat it.
Read More »International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #25: Insulin Gene Expression and Biosynthesis Part 1 of 6
The unique property of the pancreatic beta cell is its ability to secrete insulin to enable circulating glucose levels to be maintained within a narrow physiologic range, despite wide fluctuations in energy intake and expenditure.
Read More »Diabetes Personal Calculator
Diabetes Personal Calculator is an all-in-one insulin calculator and carbohydrate database. It is developed for people with type 1 diabetes injecting pre-meal fast or rapid acting insulin.
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