July 31, 2018 : Issue #408

DISASTERS AVERTED — Near Miss Case Studies

Summer Camp Rejuvenation: Hitting the Reset Button

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Kathleen Wyne on Adult-Onset Type 1

HOMERUN SLIDES — Great Clinical Presentation Highlights

Pathophysiology of Type 1 Diabetes Part 2

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #136: Pathogenesis of Type 2 Diabetes Mellitus Part 7

MOST POPULAR ARTICLES OF THE MONTH

#1 37-Year-Old Hypertensive Drug Improves Beta Cell Function and Insulin Production
#2 How Much Monitoring is Too Much?
#3 New Omnipod® Closed-Loop Insulin Delivery System Improves Glycemic Control

This week it is all about insulin, and for a good reason. Although we have some great oral and non-insulin injectables for the treatment of type 2 Diabetes, and many of these can be used with our type 1 patients, the fact remains that if you have type 1 diabetes your main treatment modality will be insulin, and the more we know the more our patients will know. Last Saturday in our main newsletter we spent a good deal of time focusing on the technology of insulin delivery.

This week in this newsletter we have a Disaster Averted, a special feature from Tory Knebel, PharmD Candidate 2019, describing the value of Diabetes Camps for adolescents; while Joy Pape shares her private interview with Dr. Kathleen Wyne, an Endocrinologist from The Ohio State University, as she discusses how adults can possibly be diagnosed with type 1 diabetes. Finally, in our Homerun Slides, we look at insulin initiation and how to choose the right insulin.

Dave Joffe

Editor-in-chief

This summer I had the opportunity as a student pharmacist to attend a camp for youth with type 1 diabetes (T1D) and assist as a member of the medical staff. We spent the first few days setting up, going over camp procedures and policies, and preparing for arrival of the campers. This was my first time helping at such an event, and my expectations of how deeply the camp experience would impact the lives of the campers (and myself included!) were greatly exceeded.

Kittie Wyne, MD, PhD, FACE, FNLA is an endocrinologist specializing in the management of diabetes, lipids and hypertension. She has recently moved to The Ohio State University where she is the Director of the OSU Adult Type 1 Diabetes Program. Dr. Wyne earned her medical degree from the Pritzker School of Medicine at the University of Chicago.

In this week’s Homerun Slides, insulin initiation and a comparison of pharmacokinetic and pharmacodynamic insulins.

Cellular mechanisms of insulin resistance: The cellular events via which insulin initiates its stimulatory effect on glucose metabolism start with binding of the hormone to specific receptors that are present on the cell surface of all insulin target tissues. After insulin has bound to and activated its receptor, “second messengers” are generated and these second messengers activate a cascade of phosphorylation-dephosphorylation reactions that result in stimulation of intracellular glucose metabolism. The first step in glucose utilization involves activation of the glucose transport system, leading to glucose influx into insulin target tissues, primarily muscle. The free glucose, which has entered the cell, subsequently is metabolized by a series of enzymatic steps that are under the control of insulin. Of these, the most important are glucose phosphorylation (catalyzed by hexokinase), glycogen synthase (which controls glycogen synthesis), and phosphofructokinase (PFK) and PDH (which regulate glycolysis and glucose oxidation, respectively).

Researchers discover safe and effective therapy to reduce insulin requirements and hypoglycemic episodes in adult subjects with recent onset type 1.

What I love about going to conferences is the realization that what I’m doing in my practice is in line with what others I respect are doing. That is meaningful, and I always learn a new pearl. If that’s all I gain from these conferences, it’s okay, but it’s usually more than that.

I have just returned from the 2018 ADA Conference, where there was so much about new technology, particularly continuous glucose monitoring.

Hybrid closed-loop (HCL) system combines technology of CGM and insulin pumps, and a personalized, model-predictive control algorithm to deliver insulin day and night.