August 6, 2016 : Issue #845

• Probiotics for the Management of Diabetes
• Is Liraglutide A Wonder Drug Against Cardiovascular Death?
• Sleep Pattern and Diabetes Risk
• Obesity and Its Effects on Mortality Rate
• Diabetes and Its Effect on Cancer
• Head Scratching Days with Insulin Action Changes
  • by Featured Writer: Dr. Sheri Colberg, Ph.D., FACSM

This past week, one of my favorite patients came back from a visit to Mississippi and was distraught. This patient was diagnosed with diabetes 6 years ago, and after significant weight loss he had to be placed on insulin. Being one of those people who believed he could “cure” his diabetes and get off of insulin, he started eating very clean and lean and became an avid runner and triathlon participant. His A1c that had been 13.1 is now consistently below 5.6.

He was upset that on this 7 day trip he had suddenly lost all control of his diabetes, even while using more insulin on the trip than he had in many years. My first thought was that the insulin got too hot in the car and had lost its effectiveness, but he had already thought of that and bought new insulin on the trip. As we talked, I found out that they had gone by car and the drive was 13 hours each way. On top of that, they went to visit some family members, and that was another 7 hour drive. We were starting to go over all of his food and activity and when and where he ate, and to save time we decided that he would go home and list all of his foods and then return to see me the next day.

On Thursday he came back with the information and was ready to hear a lecture about what he had done on the trip, but instead I handed him a copy of this month’s feature from Dr Sheri Colberg, and told him to read it and be prepared next time. If you want to find out what Dr. Colberg shared that saved my patient from a scolding, then click here.

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We can make a difference!

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Dave Joffe, Editor-in-chief

August is Gastroparesis Awareness Month:  About Gastroparesis 

Would you like to see the FDA approve more treatments for prediabetes, rather than just diet and exercise? Follow the link to share your opinion!

Do you know what the new food label will look like when it goes into effect? Learn about the new features and new design of the new food label. How will the new label reflect updated information about nutrition science? Then learn about the new recommended serving sizes and other requirements for certain package sizes.  Be able to answer your patient’s questions.

Food Label Tool (PDF)

The American Diabetes Association recommends many non-pregnant adults with type 2 diabetes work to achieve an A1C = 7%. Which one of the following glycemic patterns would support this goal?

A) Fasting glucose less than 70, postprandial glucose less than 140, mean plasma glucose less than 120-140
B) Fasting glucose less than 126, postprandial glucose less than 200, mean plasma glucose less than 180
C) Fasting glucose less than 130, postprandial glucose less than 180, mean plasma glucose less than 150 -160
D) Fasting glucose less than 130, postprandial glucose less than 200, mean plasma glucose less than 150 -160

Did you get it right? Follow the link to find out!

Per the new guidelines: You can use metformin in anyone whose estimated glomerular filtration rate (eGFR) is less than 30 mL/minute/1.73 m2 and you do not have to stop metformin in someone undergoing a dye study unless their EGFR is less than 60 mL/minute/1.73 m2.

We used to use serum creatinine cut-points to determine when we should prescribe metformin in patients with any degree of renal insufficiency. Now the FDA has done away with that guideline and really expanded the number of patients that we can safely keep on metformin. These are the rules:

•        Test the eGFR in any patient before you start metformin. If it’s greater than 45 mL/minute/1.73 m2, you are fine. That patient is fully eligible to be on metformin.
•        For the most part, the FDA does not recommend starting metformin in patients with an eGFR between 30 and 45 mL/minute/1.73 m2. But they still consider metformin safe if your patient is on metformin already and seems to be deriving some benefit. So, patients down to an eGFR of 30 mL/minute/1.73 m2 can remain on their metformin.
•        Patients with an eGFR < 30 mL/minute/1.73 m2 should not be on metformin.

The specific guidelines are as follows:

•        If the eGFR is greater than 60 mL/minute/1.73 m2, don’t worry about it. They can continue taking their metformin throughout, unless it’s an intra-arterial dye study. In that case, you are going to need to hold the metformin and make sure that the renal function stays stable.
•        If the eGFR is less than 60 mL/minute/1.73 m2—meaning between 30 and 60—then, as we did before, you stop the metformin before the patient undergoes the dye study and recheck in 48 hours to make sure that the eGFR is still in a safe range.

References: New FDA Guidelines  https://www.regulations.gov/#!documentDetail;D=FDA-2013-P-0298-0002. Published April 3, 2013. Accessed March 30, 2016. A copy of the response is available at www.regulations.gov under Docket No. FDA-2013-P-0298.

Regulations.gov. James Flory MD, MSCE, et al (New York Presbyterian Hospital, Weill Cornell) Citizen Petition. https://www.regulations.gov/#!documentDetail;D=FDA-2012-P-1052-0001. Published October 11, 2012. Accessed March 30, 2016. A copy of the response is available at www.regulations.gov under Docket No. FDA-2012-P-1052.

Can probiotics improve A1c’s, plus much more?

LEADER showed liraglutide reduces risk of cardiovascular death, but latest study shows no benefit to high-risk patients.

Does sleep matter when it comes to diabetes?

Does obesity increase or decrease death rate?

Does diabetes cause cancer, or vice versa?

The topic of insulin action (resistance and sensitivity) has come up multiple times over the years in my articles, but it is admittedly much more complex than I often make it out to be. In a DIC article last summer, you can find a short list of all the factors that can potentially improve insulin action (basically insulin sensitivity). In reality, though, sometimes it is impossible to know exactly what is causing your reduced insulin action from day to day and how to easily and consistently manage it.

Quote of the Week!

“No matter how old you are, no matter how much you weigh, you can still control the health of your body.”

…Mehmet Oz

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