May 15, 2018 : DCMS #397

DISASTERS AVERTED — Near Miss Case Studies

With Injection Techniques, Seeing is Teaching

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

George Bakris Part 4, Kidney Disease and Cardiovascular Disease

HOMERUN SLIDES — Great Clinical Presentation Highlights

Hypertension Update 2018 Part 10

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #125: Beta-Cell Mass and Function in Human Type 2 Diabetes Part 1

MOST POPULAR ARTICLES OF THE MONTH

#1 Misuse of Insulin Strengths
#2 Know the Difference When Choosing Between CGMs
#3 A Summary of ADA’s New 2018 Standards of Medical Care in Diabetes

One of the ways that we look at the onset of type 2 diabetes is in the destruction of beta cells in the pancreas. We know that in type 1 diabetes a major autoimmune event occurs, destroying the beta cells. When a patient who has type 2 diabetes has to start on insulin, we tend to assume that they too have destroyed their beta cells.

Based on this theory, it would make sense that the beta cell mass in an insulin-requiring type 2 diabetes patient would be reduced. But is that true?

This week in our clinical text, we begin a discussion of Beta-Cell Mass and Function in Human Type 2 Diabetes as we look for the the answer to the above question.

Dave Joffe

Editor-in-chief

I asked a patient with erratic glucose levels where he usually gave his insulin injections to which he responded, “In my arms.” I asked, “Could you show me where?” The patient promptly rolled up his sleeves and pointed to the vein in his antecubital space.

Dr. George Bakris talks with Diabetes in Control Publisher Steve Freed during the ADA 77th Scientific Session in San Diego about the links between cardiovascular and kidney diseases.

In this week’s Homerun Slides, getting blood pressure to goal and the benefits of beta blockers.

Insulin-producing beta-cells are the predominant endocrine cell type in pancreatic islets, comprising 50 – 80% of islet cells. Studies with autoptic samples, organ donor specimens, and surgical cases have found that beta-cell mass in the human pancreas may vary from 0.6 to 2.1 g, with beta-cell volume and area (relative to the pancreatic tissue) ranging from 1.1 – 2.6% and 0.6 – 1.6%, respectively.

We certainly have important education to accomplish with patients and health professionals regarding the new higher concentration insulin products that are available only in a pen, including U-300 TOUJEO (insulin glargine), U-200 TRESIBA (insulin degludec), and U-200 HUMALOG (insulin lispro). U-500 insulin is also available in a pen (HUMULIN), although vials remain on the market. Patients may not understand proper dosing and dose measurement with these higher concentrations of insulin products.

You may wonder which CGM monitor is best for your patients. I know I do.

Learn from Dr. Stephen W. Ponder, MD, FAAP, CDE-AADE Educator of the Year, Board Certified Pediatric Endocrinologist, Pediatric Residency Program Director at Baylor Scott & White McLane Children’s Hospital and 50 year Joslin Medalist. He also helps people with diabetes through the “sugar surfing” method to empower individuals who have diabetes to live fuller and more satisfying lives.

Comprehensive recommendations feature notable new recommendations for people with cardiovascular disease and diabetes.