October 16, 2015 : Issue #803

• Personal Diabetes Data via MiniMed Connect
• Usefulness of the Chronic Disease Registries
• Factors That May Reduce Exercise-Induced Hypoglycemia
• DSME Programs are Not Enough
• Management of Diabetes by Prescribing vs. Non-Prescribing Nurses
• Metformin Effect on Height in Children and Adolescents
• Second Trial for Type 1 Diabetes Vaccine
• Lactobacillus reuteri Improves Incretin and Insulin Secretion
• Metformin May Lower the Risk of Colorectal Cancer
• Artificial Pancreas for Type 1 Diabetes

Last Friday, I had my six interns gather at a local restaurant for an insulin sit-down. We ran some scenarios for converting patients from basal insulin to mixed insulins, and for adding mealtime insulins. As they were offering their answers, it became very apparent that they were not well-versed in the duration, peaks and effects of the 11 different insulins currently available.

As a result of their collective knowledge deficit, we had them go back and build a comprehensive list with all the details you would need to make the right insulin dosing decisions. Click here to become an insulin expert. (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.)

Another way to help manage glucose would be increasing natural hormones that control glucose levels. There is new evidence that using a certain probiotic will increase insulin and GLP-1 levels, thereby reducing glucose levels. Read Item #8 to see which probiotic it is.

Announcements:

There’s Still Time to Enter to Win a $100 Gift Card!

Submit your best advice on how to prevent insulin errors at home, at pharmacies, and in the hospital. Enter before November 1st for a chance to win.

dLifeTV.com: Sunday, October 18, 7PM ET

From dLife.com: “dLife visits journalist Bob Schieffer to find out how he ‘faces the nation’ each week with diabetes. And a high flying airline employee shows us what it’s like to stay healthy at 20,000 feet. Plus, amazing triathletes with diabetes and Jim Turner on the fears we face.” 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

Will you begin using the new insulins or take a wait and see approach? Follow the link to respond!

Boehringer Ingelheim Pharmaceuticals, and Eli Lilly and Company announced Synjardy® (empagliflozin/metformin) tablets are now available by prescription in pharmacies across the United States.

Medtronic’s MiniMed Connect device got approved faster than expected and has started shipping in the U.S., enabling smartphone viewing and remote monitoring of pump and CGM data. The $199 keychain device receives data from a nearby MiniMed 530G or Revel pump and sends it via Bluetooth to a nearby Apple iPhone or iPod Touch app (Android is in development). Data is then uploaded to Medtronic’s web-based CareLink software, where it can also be viewed in near real-time from any device with an Internet connection. Up to three caregivers can receive text message notifications, alerting them to out-of-range glucose values and pump alarms. The $199 device is unfortunately not covered by insurance.  (Item #1)

The most up to date comprehensive insulin list available, including all the new insulins, providing you with the Onset, Peak, Duration, and Role in glucose management. It also includes Indications, Pharmacology, How supplied, Dosage and administration, Drug interactions, Adverse effects, Precautions and contraindications, plus key advice to give to patients. Click here to get the PDF.

I recently was included in a discussion on a Facebook group for athletes with diabetes about how hard it can be to lose weight through exercise. While I would never claim to have all the answers on this topic, here are some ideas about what can make you gain weight or keep you from losing weight with diabetes, based on my decades of professional and personal experience with diabetes and weight management, and what you can do about it.

A 47 year-old patient has done an excellent job with lifestyle modifications and medication adherence, however she has not been able to yet achieve her individualized A1C goal. Her current regimen consists of a metformin, sitagliptin and insulin detemir (insulin started 4 months prior). However, over the past month as she has titrated her basal insulin towards her A1C goal, her self-glucose blood monitoring log shows large drops in her overnight glucose levels. After consulting with the treatment team, you decide to add rapid-acting prandial insulin to her regimen. How would you implement this strategy? Follow the link to take the quiz!

Premature ejaculation is the most common male sexual dysfunction, with a prevalence of up to 20% among all men. However, it is often ignored due to both poor treatment efficacy and compliance. In this meta-analysis, the authors from China present compelling data that a combination of selective serotonin reuptake inhibitors (SSRIs) and phosphodiesterase-5 (PDE-5) inhibitors is more efficacious than monotherapy for the treatment of premature ejaculation. Men with premature ejaculation could have an underlying erectile dysfunction that will extend the duration of erection with PDE5i, which is probably why dual therapy is more efficacious. The combined use of SSRIs and PDE-5 inhibitors provided additive favorable effects in men with PE compared with SSRIs or PDE-5 inhibitors monotherapy and was generally well tolerated. Urology: October 2015 Volume 86, Issue 4, Pages 758–765

Convenient smartphone access to diabetes information.

Registry improvements better track progresses meeting performance indicators.

Prandial and basal insulin reduction with carbohydrate feeding can help reduce risk of lows.

Behavioral programs for patients with diabetes provide benefit for glycemic control.

Findings show longer relationships and longer consultations between prescribing nurses and diabetic patients.

In a cohort of 224 diabetic patients, those who had a glass of red wine with their Mediterranean dinner were found to have higher HDL levels and a lower risk for heart attacks. The risks and benefits of alcohol use among people with diabetes have been controversial. While studies suggest possible benefits to moderate alcohol use, both with diabetes and without it, it’s questionable whether doctors should tell their diabetes patients to drink. Ann Intern Med. Published online 13 October 2015 doi:10.7326/M14-1650

Higher doses of medication may lead to a mean increase of approximately 1 cm height.

Oral insulin vaccine may protect beta-cells from autoimmune destruction.

Probiotic does not change insulin sensitivity in glucose-tolerant individuals.

Treatment found to reduce incidence of adenomas in patients with seemingly dose-dependent effect.

Closed-loop system at home over 12 weeks feasible in type 1 patients.

That figure increases to 30 percent among parents with children under 18 and jumps to 43 percent among millennials (adults age 18-34). The survey of more than 2,000 U.S. adults conducted online by Harris Poll on behalf of Merck Manuals also uncovered that 40 percent of Americans are not at all, or not very, confident that the information found on for-profit health websites is credible. Despite this, 1 in 3 Americans (33 percent) admit they don’t look to confirm the credibility of an online health site before searching for information. To help consumers confirm if a website is credible, The Manuals have developed the STANDS method – an easy-to-remember solution using six essential elements: Source – Does the resource cite recognized authorities and provide their credentials? Transparent – Is it open and obvious whether the site’s mission is educational or commercial? Accessible – Is the site available without registration and is there a way for users to contact someone with questions or concerns? Neutral – Is the information available purely as a resource, or does the site benefit financially from what its users do (such as buying products or visiting advertised websites)? Documented – Is the site updated when needed by recognized medical experts? Secure – Can users access content without forfeiting personal information? MerckManuals.com and MSDManuals.com are authored by 350 independent medical experts from around the world. It is available at no cost, requires no registration and the user experience is not compromised

Gender-driven “risk window” found to mostly occur around menopausal age.

Treatment showed statistically significant improvements in pain relief and sleep quality.

Quote of the Week!

“Life is like riding a bicycle – in order to keep your balance, you must keep moving.”

…Albert Einstein

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