June 21, 2016 : DCMS #298

DISASTERS AVERTED — Near Miss Case Studies

Misuse of New Insulin Strengths

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. A. Paul Chous Part 2,  A1C Impact on Treatment of Vision Impairment

HOMERUN SLIDES — Great Clinical Presentation Highlights

Pharmacologic Management of Type 2 Diabetes Part 2

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #29: Insulin Gene Expression and Biosynthesis Part 5 of 6

MOST POPULAR ARTICLES OF THE MONTH

#1 Metabolic Surgery: Standard Treatment Option for Type 2?
#2 Wine Protects Against Diabetes?
#3 Where There’s One Autoimmune Disorder, There May Be Another

Two weeks ago, I gave a presentation to the Florida Chapter of the American Association of Consultant Pharmacists. The focus of the presentation was on the team concept for diabetes management and all the different professionals that play a role. One part of the presentation was about the new insulins and how the possibilities exist for dosing mistakes. This week, our Disasters Averted discusses the potential problems of dosing mistakes and below are some of the tips I shared during that presentation to make it easier to understand.

• Humulin U-500- Regular Insulin 5x strength U-100
• Dosed in pen based on units of U-100 needed
• Dosed in vials based on conversion from U-100
• Toujeo Pen- Glargine Insulin 3x strength of Lantus
• Dosed based on U-100 Units
• Humalog U-200 Insulin Pen  2x strength of U-100
• Dosed on U-100 Units

Dave Joffe
Editor-in-chief

We certainly have important education to accomplish with patients and health professionals regarding the new higher concentration insulin products that are available only in a pen, including U-300 TOUJEO (insulin glargine), U-200 TRESIBA (insulin degludec), and U-200 HUMALOG (insulin lispro). U-500 insulin is also available in a pen (HUMULIN), although vials remain on the market. Patients may not understand proper dosing and dose measurement with these higher concentrations of insulin products.

In part 2 of this Exclusive Interview, DIC Publisher Steve Freed asks about the success of anti-VEGF agents with lower A1Cs.

In this week’s Homerun Slides, prioritizing patient characteristics to determine best type 2 treatment agent.

Transport of proinsulin from the ER to Golgi apparatus: After proinsulin is translocated into the lumen of the ER, it is then delivered in transport “COP-coated vesicles” to the cis-Golgi apparatus. Up until relatively recently, it was thought that newly synthesized proinsulin was passed from the cis-Golgi network “stack” via the medial- to the trans-stack of the Golgi apparatus stacks in “COP”-coated vesicles,

New guidelines cite effectiveness, cost efficiency, and safety as reasons to consider procedure.

Study suggests wine consumption offers greater protection against type 2 risk, compared with beer or other alcoholic beverages.

Male, 32 years of age, type 1 diabetes, was following gluten free diet of his own choice. Was never diagnosed, just “feels better” when he doesn’t eat gluten. Has lab tests that were negative for celiac in the past. Came to see me for follow up diabetes education. Noted weight loss of 5 pounds in one week. Glucose levels were not elevated, in fact for the most part in target range.