Working with a patient, a woman, 44 years of age, who has had type 1 diabetes 21 years. She had a day of high glucose levels. We worked together very hard all day correcting to bring it down. After being closer to her target range, not low by any means, she told me she just had some chocolate. I asked her why, after the day she had, did she choose chocolate.

In part 4 of this Exclusive Interview, Eran Bashan explains how diabetes educators and physicians provide patient support with the d-Nav solution.

Chronically elevated glucose and/or free fatty acids: type 2 diabetes is characterized by increased circulating nutrients including glucose and free fatty acids (FFA).The literature clearly shows that chronic exposure of beta cells to elevated glucose results in impaired beta-cell function, but the data regarding cellular toxicity in response to this nutrient are more mixed.

Mrs. Wilson is an overweight 71-year-old African-American patient who has come to your clinic today for a new patient visit. She recently moved to the area to live with her daughter and is concerned about her diabetes care plan. She was diagnosed with type 2 diabetes 12 years ago at a wellness check through routine screening. In hindsight, she wonders if maybe she “went undiagnosed for a while” because she “didn’t get to the clinic very often and was having some problems with frequent urination at night” before she was screened. She currently takes metformin, glyburide, captopril, pravastatin, aspirin and has recently titrated to .6 U/kg/day insulin NPH as a nightly basal dose. Her current A1C goal is below 7.5% and she has been working hard to get to that level. However, for the first time in her life, she is finding herself to be nauseated and irritable in the morning, but always feels better after a little breakfast. She states she feels “pretty good for her age” although she occasionally has “a little chest tightness when walking more than 4 or 5 blocks.” Last time she remembered to check it a few days ago, her postprandial glucose was a little high at 214 mg/dL. Her office A1C is 8.6%. Based on her history, what would be an acceptable individualized A1C goal for this patient? A. A1C less than 6.5% B. A1C less than 7.0% C. A1C less than 8.0% D. A1C greater than 8.0% Are you right? Follow the link to find out!

How often do you recommend an A1c test for your type 1 patients? 1) Every month 2) Every 3 months 3) Every 6 months 4) Yearly Follow the link to see how your answer compares!

Vigilant is a companion to diabetes monitoring that uses advanced pattern recognition technology to notify you of upcoming periods of risk. Seeing patient patterns and risk of diabetes complications in just a few seconds, this software can alert you to risk of severe lows in the next 24 hours.

Female, 57 years of age, type 2 diabetes, metformin 1,000mg twice daily for 12 years, came in with weakness, anemia, tingling of fingers and toes. Her A1C had always been below 7%. Some in my office thought she had developed diabetic peripheral neuropathy. I could not disagree, but I also knew metformin can cause vitamin B12 deficiency.

Disturbances in pancreas/islet morphology in diabetes: Type 1 diabetes (T1DM) is classically associated with autoimmune destruction of beta cells. However, the pancreas is more broadly affected, with overall pancreas size being decreased in individuals with this form of diabetes, and loss of exocrine tissue occurring close to areas of immune infiltration.

Male, 66 years of age, type 2 diabetes, class III obesity, peripheral neuropathy, multiple toe amputations, hypertension, hyperlipidemia and, most importantly, a 2-year-old granddaughter. Patient taking 100 units long-acting insulin, sulfonylurea, metformin, beta blocker, and statin. Checks glucose once in a while; in the 200 to 270 range when checks. A1C 9.3%.

Islet vasculature: The islet is richly vascularized; while islets comprise only ∼2% of pancreas volume, they receive approximately 15% of the blood flow. Arterioles enter the islet and branch into tortuous capillaries, which have been suggested to contact almost every endocrine cell in the islet. These then converge on collecting venules outside the islet.