Resources

In this week's Homerun Slides, understanding the development and progression of type 2 diabetes.

Sympathetic effects and mediation: Sympathetic nerves inhibit insulin and stimulate glucagon secretion. Their activation may help mediate stress-induced changes in islet hormone secretion including the glucagon counterregulatory response to hypoglycemia.These effects may be mediated by the combination of the classical neurotransmitter noradrenaline and the sympathetic neuropeptides (galanin and NPY). All three neurotransmitters can inhibit insulin and stimulate glucagon secretion, thus mimicking the effects of sympathetic activation on islet hormone secretion. In addition, galanin and NPY meet several other of the criteria needed to be classified as a physiologic neurotransmitter.

I am a neuroendocrinologist by training, having received my Bachelor’s degree in biochemistry and molecular biology from the University of California, Santa Barbara and Master’s and Doctorate degrees from Louisiana State University (LSU) in physiology under the mentorship of Dr. Albert H. Meier. It was at LSU that my interest in the biological clock system and its role in the regulation of metabolic physiology was sparked by the revolutionary discoveries and elucidations made by Dr. Meier’s lab concerning biological clock mechanisms regulating physiology. He and his group in the early 1960s were the very first to demonstrate the existence in any organism of circadian rhythms of physiological responses to neuroendocrine factors. At LSU, I began investigating the possibility that modern human pathology of the metabolic syndrome (and several other progressive pathologies) was not a result of any “genetic defect” but of an environmentally induced (e.g., diet, stress, sleep-wake architecture) alteration of circadian neuroendocrine information presented to the clock system that then responded to direct the body to the obese/insulin resistant state as a survival response to such information.

A single, once-daily injection to lower both fasting and postprandial blood glucose

Are clinicians intensifying treatment before it is too late?

Initiation of glucagon like peptide-1 agonists may increase risk of gallbladder or bile duct disease and cholecystectomy; no increased risk associated with DPP-4 inhibitor therapy.

In part 2 of this exclusive interview from AACE 2016, Dr. Garvey discusses the available tools -- medication, surgery, lifestyle interventions - to combat obesity, and which strategies are most effective.

In part 1 of this exclusive interview from AACE 2016, Dr. Timothy Garvey discusses the new comprehensive clinical practice guidelines for patients with obesity.

Please select the drug class that best fits the description. This shorter-acting insulin secretagogue may be associated with less hypoglycemia than the other secretagogues. 1. Biguanides 2. Sulfonylureas 3. Meglitinides 4. Thiazolidinediones Did you get it right? Follow the link to check your answer.

Should we be more aggressive for people with prediabetes and use more of the drugs we have available, rather than waiting until they progress to diabetes? Follow the link to share your opinion!