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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #46: Neuropeptides and Islet Hormone Secretion Part 5 of 5

Summary of present-day knowledge: We know today that the pancreatic islets are innervated by parasympathetic, sympathetic, and sensory nerves. The parasympathetic nerves stimulate insulin and glucagon secretion whereas sympathetic nerves inhibit insulin secretion and stimulate glucagon secretion; the net influence of the sensory nerves is not yet clearly established.

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Reclassifying Diabetes: is it Time for an Expanded Definition?

For those healthcare providers who treat diabetes with any kind of regularity, it has become increasingly obvious that several of our patients fall outside the current diabetes classification system. With individualization of patient care being the new focus, it can be challenging to accomplish this, when certain diabetic individuals don’t “conform” to the current definitions.

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Artificial Pancreas Recommendations

The FDA-approved artificial pancreas will probably be available the first quarter of 2017 from Medtronic. Will you recommend it now or will you wait for at least 1-2 years? Follow the link to share your response!

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Question 855

Test Your Knowledge

Please select the drug class that best fits the description. This oral drug class slows the intestinal digestion and absorption of carbohydrates: 1. Sulfonylureas 2. DPP-4 Inhibitors 3. Alpha-glucosidase inhibitors 4. Bile Acid sequestrates Did you get it right? Follow the link to find out!

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Denial: Numbers Don’t Lie

Woman, 64 years of age. History of Class II Obesity and hyperlipidemia. While she had obesity, her glucose levels were elevated. A1C 8.2%. She followed a lower carb meal plan, was active, took metformin and a GLP-1, a statin and an ACE-I. She lost 22% total body weight. A1C then remained in the 6-6.5% range for 3 years on this treatment plan. Over the past 8 months, due to insurance and her statement of denial that she ever really had diabetes, she stopped taking her glucose-lowering medication, statin, and ACE-I, wasn’t as strict with meal plan or activity, and stopped checking her glucose, but did not gain back her weight.

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