October 9, 2015 : Issue #802

• Fasting Until Noon Increases Postprandial Glucose Levels, Impaired Insulin Response After Lunch and Dinner
• Common Chemicals May Cause Obesity and Diabetes
• Sugar-Sweetened Drinks Cause Cardiovascular Damage
• Link Between Metformin and Neuropathy, B12 Deficiency
• Lifestyle Changes Superior to Metformin for Diabetes Prevention
• Diabetes Medication May Be Used In Treating Alcohol Dependence
• Artificial Beta Cell Technology Proves Useful at Home
• New Dimmer Switch For Controlling Insulin Production
• Mindfulness of Prediabetes and Risk-Reducing Behaviors
• Young Adults Have a Higher Risk for Diabetes

During the past week I saw a ton of commercials for prescription medications. I am not sure exactly why but there sure seems to be an increase during the fall season. In the Diabetes category I counted no less than 14 different commercials  and that does not include the ones at 3 AM in the morning. This onslaught often brings patients in with a list for you to choose from.

They sound great to the patient but what about in the real world? How can you check on all the side effects, dosages, interactions, and costs? This week we are happy to share our new updated diabetes drug list. In this list you will be able to find information including:

• Photo of the tablet
• Mechanism of Action
• Indications and combination usage
• Essential for efficacy
• Effect on glucose patterns
• Effect on glucose patterns
• Optimal efficacy possible
• Pharmacology
• Effect on A1C, Risk of hypoglycemia
• Dosing
• Titration pattern
• Optimal daily dose
• Maximal daily dose
• Dosage forms, Combination Tablets
• Drug interactions with potential for clinical significance
• Adverse events/side effects
• Contraindications and precautions

There is no other list anywhere that we can find to learn more about a drug than this one. Click here to put it to work for you!

Remember, this and our other “Tools for Your Practice,” are now subscriber-exclusive to reward our loyal readers. In order to access this content, you will need to register your subscription email  on the new website.

Announcements:

dLifeTV.com: Sunday, October 11, 7PM ET

From dLife.com: see “the amazing story of a man whose quest takes him through the frozen tundra of Alaska. Plus, step on stage with Jim Turner and his one-man diabetes show. And, Chef Michel Nischan shows us how to make the ultimate comfort food—meat loaf—the low carb way.” Sundays live online at dLifeTV.com at 7 PM ET, 6 PM CT, and 4 PM PT. Keep up on the latest dLife news at dLifeTV.com.

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We can make a difference!

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Dave Joffe, Editor-in-chief

How to Prevent Insulin Errors

For the last 25 years, insulin has been the number one drug for errors. Diabetes in Control has been invited to a summit which will bring together about 50-60 practitioners, CDE’s, regulators , Insulin vendors and ASHP, FDA NPSF, patients, and ISMP for the purpose of improving the safety of Insulin administration, patient education, and transition to home.

Because this is so important, we’d like you to send us your suggestions on how we could prevent some of these errors. Your advice can contribute to the new guidelines to prevent insulin errors at home, at pharmacies, and in the hospital, and to enhance the patient’s level of understanding in the management of insulin therapy.

The most helpful entries will be featured on DiabetesInControl.com and the winner will receive a $100 Amazon gift card. Click here to enter! You may submit as many entries as you wish. Deadline to enter is November 1^st.

For those who cannot afford to pay for the new insulins ($250), do you recommend going back to NPH ($25/vial) and Regular insulins ($25/vial)? Follow the link to respond!

(see Item #1)

This system is supposed to be available NOW! This will bring CGM data straight into a paired iPhone phone app (Android version in development) via Bluetooth, eliminating the need to carry a receiver (though a receiver can still be used, if desired, since the new Gen 5 transmitter can pair with two devices). Excitingly, Dexcom disclosed that the Gen 5 will be launched for both kids and adults. Currently a Dexcom user? Upgrading to G5 will range from free to $299 if you own a Share receiver (depending on when it was purchased this year). If you have the prior G4 Platinum receiver without Share, you will need to go through insurance.

Newly updated comprehensive list of Drugs to Treat Diabetes (you must be registered/logged in to DiabetesInControl.com to access)

(And next week we will have a comprehensive and updated list of insulins for you.)

A 54-year old male presents to your office for an initial visit. His past medical history is significant for hypertension, hypertriglyceridemia and acute pancreatitis. His current lab results show an A1C 9.1%, which is confirmed on a repeat lab. You would like to start him on an antihyperglycemic treatment regimen. Read More

High blood pressure and diabetes are linked. A new study suggests people with high blood pressure are 56 percent more likely to develop diabetes than those with normal blood pressure. While it is unclear if one causes the other, research could test if lowering blood pressure prevents or treats diabetes. The study looked at health records of 4.1 million adults from the United Kingdom who were initially free of both conditions. It found that every 20mm increase in the top blood pressure number (systolic) raised the risk of diabetes by 58 percent. The researchers also analyzed pooled data from 30 earlier studies and found a 77 percent higher chance of diabetes for every 20mm increase in systolic blood pressure. The George Institute for Global Health study 9/14/2015

Breakfast consumption led to a reverse metabolic state in individuals with type 2 diabetes.

Endocrine-disrupting chemicals pose a public health threat.

A review suggests that added sugar in drinks impacts more than the endocrine system.

One of the most common and beneficial T2DM drugs may contribute to neuropathy and vitamin deficiency.

Exercise and diet trumps medication in prevention of diabetes in high-risk patients.

Researchers have developed a technique to “reprogram” human pancreatic duct-derived cells, allowing them to replace beta cells and secrete insulin in the pancreas while avoiding genetic modification of the target cells. Researchers said that the human pancreatic duct-derived cells (HDDCs), which were reprogrammed using messenger RNA as a transcription factor, could be further developed to be used for patients with type 1 diabetes.  Researchers reprogrammed HDDCs to behave like beta cells and secrete insulin within the pancreas while responding to glucose. Lysy P, et al. “RNA-based MAFA over-expression is sufficient to drive human pancreatic duct-derived cells toward a b-cell-like phenotype.” Presented at: 54th Annual European Society for Pediatric Endocrinology Meeting; Oct. 1-Oct. 3, 2015; Barcelona.

Liraglutide use led to less alcohol intake and suppressed dopamine effects in rodents.

New results published about usefulness of artificial beta cell technology in type 1 diabetes patients.

Finding a new pathway to manage insulin production is a large step towards improving outcomes for patients with diabetes.

Adults aware of their prediabetes status may be more likely to exercise and lose weight.

Increased risk due to level of duration and degree of weight gain

Overnight hypoglycemia in adults with type 2 diabetes leads to a decreased awakening response in the hours after the event, affecting the ability to respond with an adequate intake of carbohydrates, according to recent study findings. Forty-two adults with type 2 diabetes were screened for the study. Twenty completed two overnight sleep sessions in a lab setting. During one overnight visit, researchers induced hypoglycemia with a hyperinsulinemic clamp; after participants reached sleep stage N2, researchers turned off glucose infusion until the plasma glucose target of 48mg/dL.(2.7 mmol/L) to 50mg/dL.( 2.8 mmol/L )was reached and maintained for 15 minutes. The participants were then brought back into normal glycemic range for the remainder of the night. During a separate visit, plasma glucose was maintained in the normoglycemic range for the duration of the session; participants were assigned to the two sessions in random order. When compared with the normoglycemic night, the rate of awakenings fell 27% between hours 4 and 8 on the hypoglycemic night; awakenings were 20% fewer during hours 0 to 8. Researchers measured significantly higher hormonal responses to hypoglycemia (adrenaline, growth hormone and cortisol) on the hypoglycemic night. The study adds further understanding of the problems with sleep-related hypoglycemia and its relation to daytime impairment and comorbidity. P. Jennum MD, DMSc.Diabetes Care 10-2015

Short and long sleep duration have negative effect on insulin sensitivity in men, increase in beta-cell function in women

Insulin sensitivity found only in the animal-protein diet group

Quote of the Week!

“One of the things I learned the hard way was that it doesn’t pay to get discouraged. Keeping busy and making optimism a way of life can restore your faith in yourself.“

…Lucille Ball

Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletter:

Ashley Garringer, USF College of Pharmacy
Shawn Vahabzadeh, USF College of Pharmacy
Kristie Huynh, LECOM College of Pharmacy
Jaydeep Patel, USF College of Pharmacy
Yasmien  Ibrahim, FAMU College of Pharmacy
Tyler Fritsch, LECOM College of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
810 Bear Tavern Road Suite 102
Ewing, NJ, 08628
USA
www.diabetesincontrol.com