Insulin adjustment with Symlin and adherence at insertion site

I have been wondering about people's experience with Symlin. Does a % reduction of mealtime bolus (i.e. 30%) work best when administering Symlin vs. same dose but different bolus type (i.e. dual-wave instead of normal)?

Also, what is the best way to keep insertion site secure? IV-3000? Has anyone discovered anything cheaper that works?

Is "pre-diabetes" a good thing?

Saying that 57 million Americans have pre-diabetes sounds impressive, but does it further the cause of improving diabetes care. There is some concern that telling a patient they have pre-diabetes, or "a little sugar" may be falsely reassuring. They may show up years later with complications of diabetes saying, "I thought I was O.K. because they told me it was only pre-diabetes".

This, like everything else, underscores the importance of patient education.

Diabetes is a big(ger) problem

The U.S. Center for Disease Control and Prevention has released new data regarding the prevalence of diabetes in the U.S.
It turns out the prevalence is high and increasing.
As of 2007:

• 24 million people with diabetes
• - 25 percent do not know they have diabetes ---> down from 30 percent
• Almost 25 percent of the population 60 years and older had diabetes
• 57 million people have per-diabetes

Wouldn't it be good if someone would attack this growing epidemic head-on?

Diabetes and OSA, OSA and Diabetes

The following is an exerpt from a recent Nationa Sleep Foundation alert. Is this a condition you consider in your patients?

The International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention has published a consensus statement in the journal Diabetes Research and Clinical Practice on the close link between type 2 diabetes and obstructive sleep apnea (OSA). According to the statement:
Up to 40 percent of people with OSA will have diabetes.
Among diabetes patients, the prevalence of some form of sleep disordered breathing (e.g., snoring) may be as high as 58 percent.
The link between OSA and diabetes may be independent of overweight/obese status.

HIMSS talk: The Library of the Future

The HIMSS-SCT June talk looks to be quite interesting - abstract below. Just in the time I've been practicing, the "best" ways to educate ourselves about the latest science have changed radically. The Texas Medical Library has had to adapt their resources correspondingly.

Abstract: The Library of the Future In the 2007 film Starting Out in the Evening, Leonard Schiller, an aging writer, whose novels are out-of-print and who is doggedly trying to finish writing his last book, is asked by a young graduate student: “Aren’t you afraid that, in 100 years, no one will be reading your books?” His answer: “My dear, I’m afraid that, in 100 years, no one will be reading at all.”

This presentation will look at the role of libraries in the future, how they will continue to maintain the traditions of reading, scholarly publishing, and the preservation of knowledge, and how they will use technology to enhance research, education, and communication. Current issues will be noted and future trends will be identified. The library’s role as an agent for change will also be addressed.

Presenter: Leah Krevit, MLIS, has been a librarian in the Texas Medical Center since 1986. She is currently Associate Director for Collection Management at the Houston Academy of Medicine –Texas Medical Center Library. Her primary responsibilities include collection development, electronic resources licensing, institutional repository development, web presence and portal development, and traditional technical services oversight. Prior experience includes 12 years as the Director of Information Resources and Technology at The University of Texas Dental Branch at Houston. She obtained her M.L.I.S. from The University of Texas at Austin School of Information. Computer Science from the University of Houston (1990) and a Bachelors degree in Computer Science from Texas A&M (1985).

When: Friday June 27^th 11am

Where: M. D. Anderson Cancer Center, Faculty Center conference room FC 1.2002 street address: 1400 Holcombe Blvd. Houston 77030

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Let's talk about...CGM(S)

One significant finding in the recent VA Diabetes Trial was that recent severe hypoglycemia was a pwerful predictor of cardiovascular events. During the recent ADA meetings, one member of the expert panel discussing the results of the ACCORD trial suggested that the excess mortality in the intensive glycemic control group was likely due, at least in part, to hypoglycemia. The authors were not able to demonstrate this by analyzing their data. Another member of the panel pointed out that significant hypoglycemia found on CGM is often asymptomatic.

What is your experience with CGM? In which clinical scenarios have you found it to be useful? Maybe you have decided that it has no role in your practice. Let's discuss this.