June 12, 2018 : DCMS #401

DISASTERS AVERTED — Near Miss Case Studies

Once A Pump, Always a Pump? Wrong Again!

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Yehuda Handelsman on Diabetes as a Cardiovascular Disease and the Impact of New Drugs

HOMERUN SLIDES — Great Clinical Presentation Highlights

Future Use of Technology in Outpatient Care Part 2

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #129: Beta-Cell Mass and Function in Human Type 2 Diabetes Part 5

MOST POPULAR ARTICLES OF THE MONTH

#1 Very Low Carbohydrate Diet Equals Better Diabetes Control
#2 Four New Drugs Waiting for Approval That Can Change the Diabetes Landscape (Part 1)
#3 Can’t Afford Insulin? There Are Options!

This week, our Clinical Text discusses both loss of beta cell function and beta cell mass, and how granulation can mask loss of mass. The interesting thing about this week’s installment is the overwhelming evidence that treating to a goal A1c is not the most important thing for a type 2 patient. Check out what the authors think could possibly be more important.

Dave Joffe

Editor-in-chief

(This is a follow-up to the patient who was under the impression he would always need an insulin pump.) It was a “rocky” start at first. The patient had some early morning highs and some unexpected lows, but likes being off the pump. He wears his Dexcom, which he plans to continue with. This has been extremely helpful with alarms during the adjustments to his long-acting and rapid-acting insulins. The endocrinologist knew the patient was extremely sensitive to insulin, so his rapid-acting insulin has gone from using 1-unit increments to 0.5-unit increments instead and is doing well. At this time, the patient wants to stay off the pump, continue with MDI and the sensor. We’re still making minor changes, but getting close to goal.

Yehuda Handelsman, MD, FACP, FNLA, MACE is an endocrinologist in private practice and Medical Director & Principal Investigator of the Metabolic Institute of America. He is a nationally and internationally recognized authority on Diabetes, Lipids, Obesity, HTN and the prevention of cardiovascular disease.

In this week’s Homerun Slides, the natural history and progressive behavior of type 2 diabetes.

Loss of beta-cell functional identity: The dominance of beta-cell functional impairment in T2DM implies that beta-cells have lost, at least in part, their normal insulin secretory phenotype. The associated molecular features have been discussed in a number of insightful reviews and research articles, and the role of genetic, epigenetic, transcriptomic and proteomic changes has been described extensively. At the cellular level, beta-cell insulin degranulation and the recently hypothesized beta-cell dedifferentiation phenomenon could play key roles. Insulin granules can be easily identified by electron microscopy on the basis of their typical morphology, characterized by a dense core and a more or less clearly visible halo. In addition, secretory granules can be subdivided into mature and immature, based on distinct ultrastructural, biochemical, and functional, with a relative ratio of 6 to 10 in normal human beta-cells.

Low carbs equals lower blood sugars and control, with less hypoglycemia, but how low do our patients need to go?

Two of the four exciting treatment options currently being trialed could change the way the disease is treated long term.

We all know the benefits of the newer insulins, i.e., faster action times, less peak from the long actings, etc. But the cost, more often than we know, can lead to patients decreasing insulin doses, doing without until the next payday, or doing without it altogether, as we’ve read about. (See David Kliff’s recent article.) …