Patient with poorly controlled diabetes | Figure 1

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Patient with Poorly Controlled Diabetes

A 47 year old male patient sees me for the first time for NIDDM. He is currently on metformin 1g twice daily and glipizide 20mg twice daily dosage. His latest HbA1C result is 9.2%. He claims to be compliant to current medication. I have decided to start him on insulin therapy. Which of the following is the LEAST APPROPRIATE strategy?

A. Add basal insulin to current DM medications
B. Maintain current dosage of metformin, reduce glipizide dosage by half , and add on pre-meal bolus insulin
C. Discontinue metformin and glipizide , and replace with pre-meal bolus insulin
D. Discontinue metformin and glipizide , and add basal-bolus insulin
E. Maintain metformin, discontinue glipizide , and add on pre-mixed insulin

Update on Diabetic with Hypothyroid

Update on Diabetic with Hypothyroid: Here are the child's growth charts (weight on top & BMI on bottom). The sharp drop occurred in under 2 months. Insulin and thyroid antibodies are on the second slide. Remember the original labs were: HgbA1c >14; Glucose 339; Insulin 7.8. Currently doing well on insulin therapy. The endocrinologist is now controlling medications.

Approval of Tresiba®

On December 19, 2016, Novo Nordisk announced that the FDA approved an expanded indication for Tresiba® (insulin degludec injection 100 U/mL, 200 U/mL), a long-acting basal insulin, to be used in children and adolescents with diabetes. This insulin, first approved by the FDA in September 2015, is now indicated to improve glycemic control in patients with type 1 and type 2 diabetes from age one through adulthood, making it the only basal insulin approved for both types in patients as young as 1 year old. Tresiba® is released over time, has a 25-hour half-life and a consistently flat and stable profile. Todd Hobbs, MD, US Chief Medical Officer of Novo Nordisk stated that there is a rising number of children and adolescents with diabetes in the US, especially those with type 2. The challenge is managing blood sugar levels and keeping up with multiple injections throughout an already busy day. This approval provides another option of long-acting insulin that is dosed once daily.

Patient Case

A 52-year-old man, treated for type 2 diabetes, uses metformin 850 mg twice daily. At the pharmaceutical appointment, he asked why he uses metformin even when his glycemia is normal (92 mg/dl). Based on this data, I answered the following questions:

  1. Importance of non-pharmacological measures for diabetes treatment?
  2. Why use metformin twice a day despite normal glucose?
  3. Significance of achieving glycated hemoglobin?

Another Patient Case

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She cares for around eight rescued dogs. Physical examination revealed multiple small vesicles, clustered and scattered, predominantly in the lumbar and left gluteal area.