March 14, 2017 : DCMS #336

DISASTERS AVERTED — Near Miss Case Studies

When Changing to Combo Pill, Know the Dosages You are Changing

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Blandine Lacroix Part 4, How Long Does It Take?

HOMERUN SLIDES — Great Clinical Presentation Highlights

Albuminuria Presentation Part 2

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #66: Regulation of Glucose Metabolism in Liver Part 2 of 11

MOST POPULAR ARTICLES OF THE MONTH

#1 Health Benefits from Intermittent Fasting
#2 The Future For Insulin Pump Companies: Who Will Survive?
#3 New ADA 2017 Standards of Medical Care in Diabetes

I recently had a conversation with one of my riding buddies about his A1c. His doctor had recommended he go on metformin because his A1c was 5.9. This guy sometimes rides 700 miles in a week and is thin as a rail. Our conversation got a response from three other riders who also had elevated A1c’s but were in fantastic shape. Then I went and got my labs and mine came in at 6.0.

I started doing random testing and some mornings I would wake up with a reading over 125mg/dl, but every time I would check post prandial I was in the 80’s. I had a couple of these riders test as well, and to a person everyone had a lower reading after eating than before eating.

This had to be the effect of glucagon, as none of us ate enough carbs to supply the energy we needed to fuel long distance rides. I found the same thing when I looked at marathon runners and wanted to find some answers.

This week our clinical text looks at how and when the body uses glucagon to provide energy, and explains what is happening to these athletes.

Dave Joffe

Editor-in-chief

Woman, 62 years of age, musician, travels often, type 2 diabetes, obesity, hyperlipidemia, fatty liver. Was traveling for two months straight on the road. Late nights/parties and a lot of drinking. Admitted not having taken her GLP-1 or really following any meal or healthy life plan/schedule she was following before leaving. Since last office visit 3 months ago, weight up 10 pounds, fasting glucose 170 in office.

Blandine Lacroix talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting. In part 4 of this Exclusive Interview, Blandine Lacroix explains the motivational interview process.

In this week’s Homerun Slides, the mechanism of Glycocalyx degradation and defining albuminuria.

Hepatic glucose production: Typical lean humans spend more than half of their lives in the post-absorptive state, with less than 5 g of glucose circulating in their blood to support life. Many tissues rely on glucose as their primary fuel source. Notable examples are brain, which has limited access to fatty acids, and erythrocytes which do not possess mitochondria and, therefore, rely on glycolysis to meet energy requirements. Even during rest the body uses roughly 8 g of glucose per hour, and during exercise this rate can increase more than twofold. The body would deplete circulating glucose in less than 30 min, resulting in severe hypoglycemia, loss of neurologic function and death, if not for a constant endogenous supply of glucose.

Fasting shown to reduce risk of diabetes, heart disease, cancer and other diseases.

As problems for Tandem continue, and with Johnson & Johnson abandoning the insulin pump market, it’s beginning to dawn on some people that we soon could live in a world with just two insulin pump companies – Medtronic and Insulet.

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