June 13, 2017 : DCMS #349

DISASTERS AVERTED — Near Miss Case Studies

Just Because It Says “—” Doesn’t Mean It Is

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Felice Caldarella: Diabetes in Pregnancy

View Video | Read Transcript

HOMERUN SLIDES — Great Clinical Presentation Highlights

Insulin & Vascular Function Part 8

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #78: Insulin actions in vivo: glucose metabolism Part 4 of 9

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We often spend a lot of time looking for more ways for our patients to burn energy if they are overweight and use less energy if they are lean. This seems like a simple process of food in, energy out, but it never seems easy when we work on the problem. When we look at the physiology of glucose metabolism, we see how glucose disposal can be affected by glucose cycles, especially the “futile cycles.” These cycles can wreak havoc with our best plans. This week, in our Clinical Text, we take a close look at how these processes can be used to our patients’ advantage.

Dave Joffe

Editor-in-chief

Male, 62 years of age, type 2 diabetes, class III obesity. Has been on metformin, 1,000mg twice daily. Glucose in the 200-300mg/dL range. A1C. Taught about lower carb meal plan, started on Trulicity, first 0.75mg, then 1.5mg/dL. Made the dietary changes right away with the addition of the Trulicity. Within 2 weeks glucose levels averaged 125, patient losing weight, decreased appetite and feeling good. More energy. Insurance did not cover Trulicity, but did cover Victoza, so started on Victoza. When made the change, started with the 0.6mg daily, then increased weekly to the 1.8mg/day.

Dr. Felice Caldarella shares insights on how healthcare providers and patients can cope with a diagnosis of diabetes in pregnancy.

In this week’s Homerun Slides, a summary of the clinical trials assessing the impact of intensive therapy in type 2 diabetes.

Glucose disposal: In the basal state, steady/near steady-state conditions prevail and whole-body glucose disposal equals endogenous (hepatic) plus renal glucose production. Data on the individual contribution of organs and tissues to total glucose uptake have been obtained in regional catheterization studies. In the case of the splanchnic area, in which glucose uptake and production both occur simultaneously, such data have been derived from the combined use of glucose tracers and indwelling catheters.

In a departure from recommendations by cardiology societies, two endocrine groups issue new lipid-management guidelines that bring back LDL-cholesterol targets.

Ralph DeFronzo and his researchers at UT Health at San Antonio announced that they have cured type 1 diabetes.

Guest writer David Kliff of Diabetic Investor explains why he doesn’t expect any closed-loop systems to expand the overall insulin pump market by any significant amount.