January 17, 2017 : DCMS #328

DISASTERS AVERTED — Near Miss Case Studies

A Different Kind of Disaster

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Altamash Shaikh Part 2, Diabetes Among the Young

HOMERUN SLIDES — Great Clinical Presentation Highlights

EMPA-REG Outcome Trial, Part 5

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #58: Mechanisms of Insulin Signal Transduction Part 2 of 8

MOST POPULAR ARTICLES OF THE MONTH

#1 New ADA 2017 Standards of Medical Care in Diabetes
#2 Preventing CV Death in Patients With Diabetes
#3 How to Best Add or Adjust Medications

When we explain to a patient how insulin release occurs, we often oversimplify it. We tell them that the release is caused by signals sent to the beta cells when food enters our body. We often add in the “simplicity” of, if you eat the right foods your pancreas will be able to cover the glucose. Patients then go home and try to follow our advice. One day the system works and the next day it does not. This frustrates the patients and they just stop trying. Part of the problem that causes these failures are all the cell affinity binding processes that occur. This week in our Clinical Series we have part 2 of insulin transduction signaling, and how binding, activity and mutations affect our patients.

Dave Joffe

Editor-in-chief

When we think about disasters, we usually think of the outcome, a poor health outcome. We don’t always think about the journey. The journey to poor health outcomes are many. Today I am reminded of not having the insurance coverage for the correct medication. Without it, one can have a disaster, poor diabetes management. The consequences of that, as well as the disruption to running a smooth office.

Dr. Altamash Shaikh talks with Diabetes in Control Associate Medical Editor Joy Pape at the 2016 AACE Meeting. In part 2 of this Exclusive Interview, Dr. Shaik explains the pervasiveness of diabetes among the younger Indian population and the three reasons for this occurrence.

In this week’s Homerun Slides, the cardiovascular outcomes of patients in the placebo vs empagliflozin study.

Insulin receptors, ligand binding: The insulin action sequence is initiated with specific binding to high-affinity receptors on the plasma membrane of target cells. The insulin receptor is a large transmembrane glycoprotein consisting of two alpha- and two beta- subunits that form a heterotetramer, as depicted in Figure 12.1. The insulin receptor is synthesized from a single gene as a polypeptide pro receptor comprised of alpha- and beta- subunit sequences in tandem.

Psychological health, access to care, expanded and personalized treatment options and the tracking of hypoglycemia emphasized.

What do we need to tell our patients about preventing the risk for death?

Man, 51 years of age, type 1 diabetes for 32 years. Patient also has history of Class II obesity, CVA, MI and insulin resistance. Patient referred to Obesity Center for weight loss. A1c was 8.2%. Plan was to start Symlin. Symlin was added at 30mcg daily before dinner. I recommended he get a CGM. He did.