July 12, 2016 : DCMS #301

DISASTERS AVERTED — Near Miss Case Studies

What’s Puzzling May Take a Simple Fix

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. A. Paul Chous Part 5,  Expanding the Clinical Trial of a Nutritional Supplement

HOMERUN SLIDES — Great Clinical Presentation Highlights

Pharmacologic Management of Type 2 Diabetes Part 5

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #32: Beta-Cell biology of insulin secretion Part 2 of 5

MOST POPULAR ARTICLES OF THE MONTH

#1 Blood-Pressure Drug Could Be A Possible Type 1 Diabetes Cure
#2 Victoza LEADER Trial Top-Line Results Announced
#3 Misuse of New Insulin Strengths

Pyruvate cycling pathway is a term I have not heard in many years. When I was in pharmacy school, I remember our Medicinal Chemistry professor posting a slide on the overhead, and telling us if we learned this by the end of the semester we would pass the class. Although I don’t remember the pathway, I do remember the term. Now we fast forward 30 years and we see that there are multiple cycling pathways, and many of them have some effect on glucose metabolism, and more importantly, on Pancreatic Beta cells. This week, our excerpt from the clinical text explains how all this functions together.

Dave Joffe
Editor-in-chief

16-year-old male, type 1 diabetes since 2 years of age, pump therapy. Eats about the same thing daily. Post prandials vary widely. When corrects for highs, gets low.

In part 5, the finale, of this Exclusive Interview, DIC publisher Steve Freed asks about the possibility of expanding the study of the nutritional supplement to address diabetic retinopathy.

In this week’s Homerun Slides, part 2 of the Canadian Diabetes Association’s specific recommendations for patient-centered diabetes care.

Metabolism-secretion coupling, triggering pathway: Glucose metabolism increases the cytosolic ATP concentration in pancreatic beta cells, this rise in ATP causing closure of the KATP channels and depolarization of the beta-cell membrane. Thus, KATP channels couple the cell’s metabolic state to electrical activity. The beta-cell KATP channel is composed of two subunits: Kir6.2 as a pore-forming subunit and the sulfonylurea receptor SUR1 as a regulatory subunit. Activity of the KATP channel is critical for GIIS. Membrane depolarization opens VDCCs, which allows Ca2+ influx into β cells, the resultant rise in intracellular Ca2+ triggering exocytosis of insulin granules. Thus, KATP channels and VDCCs are major ion channels required for metabolism-secretion coupling in insulin release.

A common blood pressure drug is showing new promise to help treat and cure type 1 diabetes.

Victoza LEADER trial of 9,000 adults with type 2 diabetes found that drug significantly reduced the risk of heart attack or stroke.

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.