April 11, 2017 : DCMS #340

DISASTERS AVERTED — Near Miss Case Studies

It’s Allergy Season

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Michael Hill Part 3, System Accuracy

HOMERUN SLIDES — Great Clinical Presentation Highlights

Albuminuria Presentation Part 6,  Trial Takeaways

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #70: Regulation of Glucose Metabolism in Liver Part 6 of 11

MOST POPULAR ARTICLES OF THE MONTH

#1 New ADA 2017 Standards of Medical Care in Diabetes
#2 “Aspirin Resistance” in Type 2 Diabetes
#3 Don’t Be So Disciplined!

I got to the office in Atlanta after a week at home and it looked like the sidewalks have been coated with yellow paint. But it was pollen from all the trees. Evidently the rapid changes in temperature over the past month or so had driven the pollen factor into the dangerous range. For many patients, this means staying inside, but a lot of our patients have no choice but to try to treat their allergies with whatever they can find. They often take herbals, OTC and prescription medications without giving a thought to side effects or adverse reactions.

This week, our Disaster Averted looks at why your patients with diabetes have to be extra vigilant when medicating themselves.

Dave Joffe

Editor-in-chief

Female, 58 years of age, type 2 diabetes, obesity, taking (Qsymia- phentermine/topamax) for weight loss, antihypertensive for hypertension, and metformin for glucose management. Blood pressure usually in the 120-130/70-80 range, glucose averages ~120, and was losing weight. Today’s b/p 170/90, random glucose 232, c/o tinnitus. Weight was up 5 pounds since last seen 3 months ago. It’s now allergy season. After further discussion, she told me she was started on a medrol dosepak, and on her own purchased and is taking an OTC allergy medication.

In part 3 of this Exclusive Interview, Michael Hill explains the accuracy, fixed rate and insulin delivery delay of the Minimed 670G System.

In this week’s Homerun Slides, takeaways from the EMPA-REG Trial with empagliflozin, the LEADER Trial and the SUSTAIN-6 Trial.

Acute regulation of gluconeogenesis: Prior to discovery of the transcriptional mechanisms described earlier, the control of hepatic glucose metabolism was examined in great detail on the basis of substrate, allosteric, and posttranslational modification. These factors alter gluconeogenic flux rapidly (seconds to minutes) and are a critical first response to increased glucose demand.

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

The reason may be simpler than first thought.

I don’t know how many times I have the opportunity to teach patients and health care providers that it’s not all about food. I was recently reminded of that when I overheard a dietitian, a CDE, go over a 4-week CGM report with a patient, male, 53 years of age, type 2 diabetes, non-obese, actually not even overweight.