April 25, 2017 : DCMS #342

DISASTERS AVERTED — Near Miss Case Studies

Assessing and Changing Insulin Onset

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Michael Hill Part 5, Emergency Alerts

HOMERUN SLIDES — Great Clinical Presentation Highlights

Insulin & Vascular Function Part 1

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #72: Regulation of Glucose Metabolism in Liver Part 8 of 11

MOST POPULAR ARTICLES OF THE MONTH

#1 A Major Shift in Diabetes Treatment Targets and Goals
#2 New ADA 2017 Standards of Medical Care in Diabetes
#3 Type 2 Diabetes Remission With Intensive Treatment

We all know of patients who walk around with glucose levels of 400mg/dl without any problems functioning. Most of our patients are often 100-200 points too high and they don’t even know it. When we start them on insulin, we usually go slow for fear of hypoglycemia, as often it is not the number that we have to watch but rather the change in glucose levels. Many of our patients never get good enough control to worry about hypos, but patients who manage their readings closely are more likely to experience the symptoms of hypoglycemia. This has always been a problem for pump users who might overestimate their need for insulin. Now that we have “closed loop” pump systems, we should be able fix low levels as easily as high levels.

This week, our publisher, Steve Freed, puts that question to Michael Hill, Vice President of Global Marketing at Medtronic, to get his feedback.

Dave Joffe

Editor-in-chief

Female, 26 years of age, type 1 diabetes for 15 years, well-educated, uses insulin pump. Recent A1C 7.6%; has been rising from 6 to 6.5. Thinks her mealtime insulin is not working fast enough. She does bolus about 20 minutes before eating. Assessed pump, CGM, food intake and activity. Her report seemed to be the case.

Michael Hill explains how the system works when a patient’s blood glucose drops.

Dr. Stanley Schwartz asks and begins to answer the question: is insulin beneficial for the vasculature as well as the patient — or not?

Linking molecular and metabolic regulation of hepatic glucose metabolism: Cross-talk between metabolism and molecular biology is an emerging mechanism of metabolic regulation and is particularly relevant to the control glucose metabolism in liver. Some transcription factors and nuclear receptors are activated in response to metabolites. During fasting lipid metabolites are released that activate PPARα and induce the gene expression of oxidative metabolism.

Out with the old, in with the old and new?

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

Theory proposed that type 2 diabetes can be reversed in the short term with medical approaches over bariatric surgeries.