INSULIN INITIATION AND INTENSIFICATION WITH A FOCUS ON HYPOGLYCEMIA REDUCTION
|
|
- Robyn Willis
- 5 years ago
- Views:
Transcription
1 INSULIN INITIATION AND INTENSIFICATION WITH A FOCUS ON HYPOGLYCEMIA REDUCTION Jaiwant Rangi, MD, FACE Nov 10 th 2018
2 DISCLOSURES Speaker Novo Nordisk Sanofi-Aventis Boheringer Ingleheim Merck Abbvie Abbott
3 T1DM: DESTRUCTION OF THE PANCREAS Type 1 Diabetes is caused by the autoimmune destruction of insulin producing ß-cells Antigen TCR T Cell T Cell ß-cells T-cells mediated killing of ß-cells
4 T2DM: RESISTANCE TO INSULIN Food Intake Fat cells Muscle cells Liver Carbohydrate absorbed Insulin Elevated Blood Glucose Pancreas
5 INSULIN ACTION Glucose uptake Lipolysis Fat storage Fat cells Muscle cells Liver Glucose production Glucose storage Carbohydrate absorbed Insulin Elevated Blood Glucose Pancreas
6 INSULIN RESISTANCE Fat cells Muscle cells Liver Carbohydrate absorbed Insulin Elevated Blood Glucose Pancreas
7
8 CASE #1 48 year old man with Type 2 DM x 12 years. Current DM meds Metformin 1000 mg BID Sitagliptin 100 mg QD Glipizide 10 mg BID On ACE-I for Hypertension and Statin for elevated Cholesterol
9 CASE #1 PE: Obese, 5 10, 245 lbs. BMI PE otherwise unremarkable HbA1C 8.7 % Fasting BG levels between What is the next step for DM management?
10
11
12 BARRIERS TO STARTING INSULIN Fear of needles Fear of hypoglycemia No time to learn about insulin Concerns about side effects of insulin History of family member that was on insulin and then Feeling like failure in terms of diabetes
13 INSULIN DELIVERY DEVICES
14 STARTING BASAL INSULIN AACE Guidelines: Pick a starting dose for basal insulin A1c < 8 % units A1c > 8 % units I often start at either 10 or 20 units or based on weight for morbidly obese patients otherwise it takes long to titrate
15 STARTING BASAL INSULIN Titration: Increase insulin by 2 units 2 x per week (pick days) until fasting blood glucose levels are to goal Decrease by 2 units if hypoglycemia Goal Blood Sugar: Generally mg/dl Higher risk of hypoglycemia mg/dl Max dose insulin: 40 units is a reasonable start Allows patients to be comfortable increasing dose
16 STARTING BASAL INSULIN Start insulin Glargine 20 units between 9-11 PM Check FSBG levels every morning Goal fasting BG: mg/dl Every Wed and Sat review your blood glucose levels and if not to goal, increase Glargine dose by 2 units (example increase from 20 to 22 units daily) Once you reach Glargine 40 units please contact provider
17 CASE #1 CONT. Started on Glargine 20 units Goal fasting BG mg/dl Titrate 2 x per week Follow up appointment in 1 month Glargine increased to 32 units Fasting BG usually around mg/dl Had one episode of low BG with symptoms, checked FSBG and it was 82 mg/dl Stopped increasing his dose after that low
18 CASE #2 82 year old man with Type 2 Diabetes for 30 years. He lives by himself and is very worried about low blood glucose levels Current DM meds: Metformin 1000 mg BID Degludec 24 units at night Empagliflozin 10 mg QD HbA1c of 8.4 % at appointment today. Checks FSBG once per day. Fasting range mg/dl What are your options for next steps?
19
20 CASE #2 Options include: GLP1-RA SU Prandial Insulin DPP4 inhibitor TZD If hypoglycemia is his main concern, what options would you consider?
21 CASE #2 CONT. Decided to start on a GLP1 RA Options: Once daily injection (Liraglutide/Victoza) Once weekly injection (Duglaglutide / Trulicity, Exenatide/Bydureon, Semaglutide / Ozempic) Combination (Soliqua 100/33 Glargine and Lixisenatide or Xultrophy 100/3.6 Degludec and Liraglutide)
22 CASE #3 62 year old woman with a history type 2 DM for 14 years She struggles with her diet and finds the higher carbohydrate options easiest while at work Current DM meds: Toujeo (U300 Glargine) 56 units Dulaglitide/Trulicity 1.5 mg weekly Canagliflozin / Invokana 300 mg QD Repaglinide / Prandin 1 mg 1-2 tabs before meals
23 Case #3 cont. HbA1c 10.0 %!! Forgot her BG meter, but does try to check her FSBG 1-2 times per week fasting Reports good BG levels, usually around mg/dl in the morning Admits, she does miss the Repaglinide / Prandin several times per week
24 Case #3 cont. CGM placed and she returns in 2 weeks with data
25 INSULIN OPTIONS
26 BASAL / BOLUS INSULIN
27 BASAL/BOLUS INSULIN Basal Insulin Long acting insulin to help lower fasting and between meal BG levels Bolus Insulin Prandial Insulin (meal time) Short acting insulin taken before a meal to prevent a post prandial spike Correctional Insulin Short acting insulin, extra insulin taken to correct a high BG level
28 CASE #3 CONT. Will start short acting insulin prior to each meal Current Basal insulin dose is 54 units. But her BG is dropping mg/dl overnight Decrease Basal Insulin to 40 units Start prandial insulin with meal(s)
29 CASE #3 Basal plus one: Start 10 % of basal or 5 units with one meals Basal / Bolus: Start 50 % basal and 50 % bolus Total daily insulin dose: units/kg
30 CASE #3 CONT Decrease Toujeo dose to 40 units Start Lispro 10 units with each meal Encouraged her to keep CHO consistent around gm. per meal Add correction insulin if BG above 150 per sliding scale
31 CASE #3 CONT. Blood Sugar: Insulin Dose: <70 No insulin, 15 gm of CHO and repeat units units units units > units
32 CASE #3 She does not like carrying her Sliding Scale around, how else can she determine her insulin doses? CHO counting working with a dietician, patient learns to count CHO and determine insulin dose based on CHO content of the meal example: 1 unit of insulin per 5 gm. of CHO Correction or sensitivity factor determine decrease in BG per unit of insulin example: 1 unit per 25 mg/dl above target of 150 mg/dl
33 CASE #4 67 year old man with Type 2 DM x 22 years presents to your office. His complications include nephropathy and neuropathy Rx History: He has been on insulin for over 15 years. No oral agents due to renal disease and intolerance Current RX: Glargine 80 units Lispro 25 units with meals
34 CONCENTRATED INSULIN Is he a good candidate for a concentrated insulin? What options are available for concentrated Insulin's?
35 CONCENTRATED INSULIN Candidates: Insulin resistance: on medications such as steroids Genetic forms of insulin resistance On more than 100 units per day of insulin Presence of insulin antibodies Type 1 DM with obesity or overweight
36 CONCENTRATED INSULIN OPTIONS U500 syringe and vial remember dose is 5 X amount seen on the insulin syringe U500 Pen dose is in units U300 Glargine (Toujeo) Solostar pen U200 Degludec (Tresiba) - Flexpen U200 Lispro (Humalog) Kwik pen
37 INTEGRATED PUMP/CGM SYSTEMS Minimum 670G is the first hybrid closed loop system Data from the CGM is transmitted to the pump and the basal rate is adjusted Patient must still enter CHO and corrections More integrated systems to come in the next 1-2 years
38 CASE #4 CONT. Started on U-300 Glargine and U-200 Humalog with meals Advantages: Smaller injection volume (more comfortable) Pens last longer (and less waste) Potentially less risk of hypoglycemia (especially overnight) Less time dependent (any time of day dosing)
39 CASE #5 24 year old woman with Type 1 Diabetes working at a start up just moved to the area DM diagnosed at age 9. No complications HbA1c 8.2 % Current insulin doses: Degludec: 12 units AM, 8 units PM Lispro: 1 unit per 14 gm of carbohydrate 1 unit per 20 mg/dl above target of 120 mg/dl She is interested in learning more about technology for Diabetes what are her options?
40 TECHNOLOGY Insulin Delivery Systems Blood glucose monitoring Meters Continuous Glucose Sensors
41 CONTINUOUS SUBCUTANEOUS INSULIN INFUSION (CSII) Catheter is placed subcutaneously and connected to an electronic pump. Pump delivers low levels of basal rate short acting insulin (rates can vary during the day). Patient can give boluses for meals and corrections for high blood glucose levels.
42 REAL TIME CONTINUOUS GLUCOSE SENSORS Subcutaneous catheter inserted every 7-10 days. Interstitial fluid BG measurement every 5 minutes. Alarms can be set for highs and lows. Currently available CGMs: Medtronic Minimed Dexcom G5 (G6 any day now) Abbott Freestyle Libre
43 REAL TIME CONTINUOUS GLUCOSE SENSORS
44 CASE #5 CONT. Patients decides to start on a CGM to help warn her about hypoglycemia Finds that she was having nocturnal hypoglycemia and rebound fasting high BG levels Decreased her Basal Insulin Discovered a lot of after meal highs, needs to adjust the timing of her meal time insulin She is considering her options for a closed loop system in the future
45 Thank you! Contact information: Office:
Insulin Initiation and Intensification. Disclosure. Objectives
Insulin Initiation and Intensification Neil Skolnik, M.D. Associate Director Family Medicine Residency Program Abington Memorial Hospital Professor of Family and Community Medicine Temple University School
More informationLearning Objectives. Are you ready for more insulin formulations?
Are you ready for more insulin formulations? Shara Elrod, PharmD, BCACP, BCGP Learning Objectives Review pharmacology and dosing of new insulin formulations Compare and contrast new insulin formulations
More informationNew Therapies for Diabetes Management: Hope or Headache?
New Therapies for Diabetes Management: Hope or Headache? Elizabeth Stephens, MD, FACP PMG- Endocrinology Elizabeth.Stephens@providence.org November 2018 Disclosures None 1 Objectives Discussion of 3 rd
More informationIndividualizing Care for Patients with Type 2 Diabetes
Individualizing Care for Patients with Type 2 Diabetes Disclosures Speaker: AstraZeneca, Novo Nordisk, BI/Lilly, Valeritas, Takeda Advisor: Tandem Diabetes, Sanofi Objectives Develop individualized approaches
More informationThe Management of Diabetes in Primary Care Kelly Krawtz, PharmD, BCPS, BCACP
The Management of Diabetes in Primary Care Kelly Krawtz, PharmD, BCPS, BCACP Objectives Explain the current pharmacologic options for the management of diabetes Describe the latest technologies available
More informationINSULIN 101: When, How and What
INSULIN 101: When, How and What Alice YY Cheng @AliceYYCheng Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form
More informationMixed Insulins Pick Me
Mixed Insulins Pick Me Alvin Goo, PharmD Clinical Associate Professor University of Washington School of Pharmacy and Department of Family Medicine Objectives Critically evaluate the evidence comparing
More informationUpdate on Therapies for Type 2 Diabetes: Angela D. Mazza, DO July 31, 2015
Update on Therapies for Type 2 Diabetes: 2015 Angela D. Mazza, DO July 31, 2015 Objectives To present the newer available therapies for the management of T2D To discuss the advantages and disadvantages
More informationIntensification of Diabetic Therapy. Case studies
Intensification of Diabetic Therapy Case studies Patient #1 1 st visit: 64 year old male, H/O prediabetes, lost weight 280 lbs. to 240 lbs. ER for dental abscess, glucose >300 A1C 11.4%, no diabetic medication,
More informationType 2 Diabetes Mellitus Insulin Therapy 2012
Type 2 Diabetes Mellitus Therapy 2012 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Preparations Onset Peak Duration
More informationLet s not sugarcoat it! Update on Pharmacologic Management of Type II DM
Let s not sugarcoat it! Update on Pharmacologic Management of Type II DM Gregory Castelli, PharmD, BCPS, BC-ADM Clinical Pharmacist UPMC St. Margaret Objectives By the end of this presentation, participants
More informationINSULIN IN THE OBESE PATIENT JACQUELINE THOMPSON RN, MAS, CDE SYSTEM DIRECTOR, DIABETES SERVICE LINE SHARP HEALTHCARE
INSULIN IN THE OBESE PATIENT JACQUELINE THOMPSON RN, MAS, CDE SYSTEM DIRECTOR, DIABETES SERVICE LINE SHARP HEALTHCARE OBJECTIVES DESCRIBE INSULIN, INCLUDING WHERE IT COMES FROM AND WHAT IT DOES STATE THAT
More informationClinical Cases in Diabetes Management. Joseph Cook D.O.
Clinical Cases in Diabetes Management Joseph Cook D.O. Objectives State the prevalence of Diabetes Mellitus in Ohio State the percentage of diabetic patients in the U.S. treated by Primary Care Physicians
More informationAdvances in Diabetes Care Technologies
1979 Advances in Diabetes Care Technologies 2015 Introduction Insulin pump use: ~ 20% - 30% of patients with T1DM < 1% of insulin-treated patients with T2DM 2007 FDA estimates ~375,000 insulin pumps for
More informationPhysiology of Normoglycemia
Case 1 45 year-old male patient seen at the clinic (Medicine). Workplace stress (financial analyst); occasionally goes jogging. Two-year duration of T2DM. No previous cardiovascular events. Coexisting
More informationUpdate on New Basal Insulins and Combinations: Starting, Titrating and Adding to Therapy
Update on New Basal Insulins and Combinations: Starting, Titrating and Adding to Therapy Jerry Meece, BPharm, CDE, FACA, FAADE Director of Clinical Services Plaza Pharmacy and Wellness Center Gainesville,
More informationDiabetes and Technology. Saturday, September 9, 2017 Aimee G sell, APRN, ANP-C, CDE
Diabetes and Technology Saturday, September 9, 2017 Aimee G sell, APRN, ANP-C, CDE Disclosure Speaker s Bureau: Janssan Pharmaceuticals Current Technology V-Go by Valeritas Continuous Sensors (personal
More informationDiabetes Update Bryan Heart Conference September 5, 2015 Shannon Wakeley, MD. Disclosures. Objectives 9/1/2015
Diabetes Update Bryan Heart Conference September 5, 2015 Shannon Wakeley, MD Disclosures I speak on behalf of the following companies: Astra Zeneca, Boehringer Ingelheim, Johnson & Johnson, Sanofi and
More informationManagement of Type 2 Diabetes Mellitus. Heather Corn, MD, MS Endocrinology, Diabetes, and Metabolism
Management of Type 2 Diabetes Mellitus Heather Corn, MD, MS Endocrinology, Diabetes, and Metabolism Disclosures Working for Intermountain Healthcare Some of the views represented are the opinion of ABIM-certified
More informationImages have been removed from the PowerPoint slides in this handout due to copyright restrictions. Insulins. Rapid Short Intermediate Long Mix
Diabetes Medications Diabetes Medications Type 1 Insulin is needed Type 2 Oral Diabetes Medications Or Oral Diabetes Medications plus Insulin Or Insulin Alone Diabetes Medications Secretagogues Glipizide
More informationIncorporating CGM Into Clinical Decision Making. Etie Moghissi, MD, FACE Clinical Associate Professor, David Geffen School of Medicine UCLA
Incorporating CGM Into Clinical Decision Making Etie Moghissi, MD, FACE Clinical Associate Professor, David Geffen School of Medicine UCLA 1 Limitations of Current Glucose Monitoring Methods A1c Standard
More informationTips and Tricks for Starting and Adjusting Insulin. MC MacSween The Moncton Hospital
Tips and Tricks for Starting and Adjusting Insulin MC MacSween The Moncton Hospital Progression of type 2 diabetes Beta cell apoptosis Natural History of Type 2 Diabetes The Burden of Treatment Failure
More informationHow they work and when to take them. Diabetes Medications
How they work and when to take them Diabetes Medications BIGUANIDES Metformin Actions Slows down the release of glucose from the liver. Helps the bodies cells become more sensitive to insulin. Pros Weight
More informationInpatient Glycemic Management:
Disclosure to Participants Conflict of Interest (COI) and Financial Relationship Disclosures: Dr. Seley attended Advisory Board Meeting: Alliance (Boehringer-Ingelheim/Lilly) Bayer Diabetes Care Sanofi
More informationWhat s New in Type 2 Diabetes? 2018 Diabetes Updates
What s New in Type 2 Diabetes? 2018 Diabetes Updates Gretchen Ray, PharmD, PhC, BCACP, CDE Associate Professor, UNM College of Pharmacy January 28, 2018 gray@salud.unm.edu OBJECTIVES Describe the most
More informationUsing Insulin in the Primary Care Setting: Interactive Cases
Using Insulin in the Primary Care Setting: Interactive Cases Irl B. Hirsch, MD University of Washington School of Medicine Dualities (Nov, 2011) Research Grants: sanofi-aventis, Novo Nordisk, Halozyme,
More informationRebecca Newberry APRN MS CDE
Current Diabetes Medications Nursing Implications and Applications Rebecca Newberry APRN MS CDE Methodist Center for Diabetes and Nutritional Health Disclosures Objectives Speakers Bureaus/Consulting Board
More information7/8/2016. Sol Jacobs MD, FACE Division of Endocrinology Emory University School of Medicine
Sol Jacobs MD, FACE Division of Endocrinology Emory University School of Medicine Participation in investigator initiated clinical research supported by: Merck Boehringer Ingelheim Novo Nordisk Astra Zeneca
More informationMaking Sense of New DM Therapies and Technologies
Making Sense of New DM Therapies and Technologies Sandra Indacochea Sobel, MD Clinical Assistant Professor of Medicine Clinical Chief of Endocrinology, UPMC Mercy Division of Endocrinology, Diabetes, and
More informationBeyond Basal Insulin: Intensification of Therapy Jennifer D Souza, PharmD, CDE, BC-ADM
Beyond Basal Insulin: Intensification of Therapy Jennifer D Souza, PharmD, CDE, BC-ADM Disclosures Jennifer D Souza has no conflicts of interest to disclose. 2 When Basal Insulin Is Not Enough Learning
More informationWhat the Pill Looks Like. How it Works. Slows carbohydrate absorption. Reduces amount of sugar made by the liver. Increases release of insulin
Diabetes s Oral s - Pills These are some of the pills that are currently available in Canada to treat diabetes. Each medication has benefits and side effects you should be aware of. Your diabetes team
More informationInitiation and Titration of Insulin in Diabetes Mellitus Type 2
Initiation and Titration of Insulin in Diabetes Mellitus Type 2 Greg Doelle MD, MS April 6, 2016 Disclosure I have no actual or potential conflicts of interest in relation to the content of this lecture.
More informationDisclosure 1/16/2017. Michael R. Brennan D.O., M.S., F.A.C.E Director Beaumont Endocrine Center Chief of Endocrine Beaumont Grosse Pointe 1/16/2017 2
Therapy For Diabetes Michigan Association of Osteopathic Family Physicians Mid-Winter Family Medicine Update Shanty Creek Resort, MI January 19-22nd 2017 Michael R. Brennan D.O., M.S., F.A.C.E Director
More informationGLP-1 receptor agonists for type 2 diabetes currently available in the U.S.
GLP-1 receptor agonists for type 2 diabetes currently available in the U.S. GLP-1 agonists are a class of antidiabetic agents that mimic the actions of the glucagon-like peptide. GLP-1 is one of several
More informationLearning Objectives. Impact of Diabetes II UPDATES IN TYPE 2 DIABETES. David Doriguzzi, PA-C
UPDATES IN TYPE 2 DIABETES David Doriguzzi, PA-C Learning Objectives Upon completion of this educational activity, the participant should be able to: Overcome barriers and attitudes that limit Clinician/Patient
More informationWhat s New in Type 2 Diabetes? 2018 Diabetes Updates
What s New in Type 2 Diabetes? 2018 Diabetes Updates Jessica Conklin, PharmD, PhC, BCACP, CDE, AAHIP Associate Professor, UNM College of Phar macy jeconklin@salud.unm.edu Luis Gonzales, PharmD, PhC UNM
More informationBEST 4 Diabetes. Optimisation of insulin module
BEST 4 Diabetes Optimisation of insulin module Confidence and competence Where would you rate yourself? Why do all of our patient not achieve optimal blood glucose control? Insulin Therapy Goals and Purpose
More informationPharmacology Updates. Quang T Nguyen, FACP, FACE, FTOS 11/18/17
Pharmacology Updates Quang T Nguyen, FACP, FACE, FTOS 11/18/17 14 Classes of Drugs Available for the Treatment of Type 2 DM in the USA ### Class A1c Reduction Hypoglycemia Weight Change Dosing (times/day)
More informationBEST 4 Diabetes. Optimisation of insulin module
BEST 4 Diabetes Optimisation of insulin module Confidence and competence Where would you rate yourself? Why do all of our patient not achieve optimal blood glucose control? Insulin Therapy Goals and Purpose
More information2018 Diabetes Summit Managing Diabetes: An Art and a Science
2018 Diabetes Summit Managing Diabetes: An Art and a Science Natasha Petry, PharmD, BCACP NDSU College of Health Professions, School of Pharmacy, Department of Pharmacy Practice Patient-Centered Medical
More informationAdvances in Diabetes Care Technologies
1979 Advances in Diabetes Care Technologies 2015 Introduction Roughly 20% - 30% of patients with T1DM and fewer than 1% of insulin-treated patients with T2DM use an insulin pump In 2007, the US FDA estimated
More informationObjectives. Recognize all available medical treatment options for diabetes. Individualize treatment and glycemic target based on patient factors
No disclosure Objectives Recognize all available medical treatment options for diabetes Individualize treatment and glycemic target based on patient factors Should be able to switch to more affordable
More informationGlucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol
Glucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed
More informationAdvances in Technology in the Treatment of Diabetes Mellitus 2017 How far have we come-how far are we going? Is there a final frontier?
Advances in Technology in the Treatment of Diabetes Mellitus 2017 How far have we come-how far are we going? Is there a final frontier? Alan B Schorr DO FAAIM FACE www.sugardoc.com abs@sugardoc.com Disclosures
More informationInsulin Prior Authorization with optional Quantity Limit Program Summary
Insulin Prior Authorization with optional Quantity Limit Program Summary 1-13,16-19, 20 FDA LABELED INDICATIONS Rapid-Acting Insulins Humalog (insulin lispro) NovoLog (insulin aspart) Apidra (insulin glulisine)
More information1. Continuous Glucose Monitoring
1. Continuous Glucose Monitoring 1. Physiology of interstitial fluid glucose 2. Comparison of CGM and self-monitored blood glucose (SMBG) data 3. Insulin dosing indication in BGM vs. CGM & the FDA 4. Protection
More informationCGM Use in Pregnancy & Unique Populations ELIZABETH O. BUSCHUR, MD THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER
CGM Use in Pregnancy & Unique Populations ELIZABETH O. BUSCHUR, MD THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER Case 1: CGM use during pregnancy 29 yo G1P0000 at 10 5/7 weeks gestation presents to set
More informationToday s Goals 10/6/2017. New Frontiers in Diabetes Technology. Disclosures
New Frontiers in Diabetes Technology Marie E. McDonnell, MD Director, Brigham and Women's Diabetes Program Division of Endocrinology, Diabetes and Hypertension Brigham and Women s Hospital Today s Goals
More informationDiabetes Management: A diagnostic perspective
Diabetes Management: A diagnostic perspective Images: http://www.engadget.com/2009/09/23/bayer-introduces-countour-usb-glucose-meter/ http://www.medtronicdiabetes.com/treatment-and-products/minimed-530g-diabetes-system-with-enlite
More informationApplication of the Diabetes Algorithm to a Patient
Application of the Diabetes Algorithm to a Patient Apply knowledge gained from this activity to improve disease management and outcomes for patients with T2DM and obesity Note: The cases in this deck represent
More informationDiabetes Technology Continuous Subcutaneous Insulin Infusion Therapy And Continuous Glucose Monitoring In Adults: An Endocrine Society Clinical
Diabetes Technology Continuous Subcutaneous Insulin Infusion Therapy And Continuous Glucose Monitoring In Adults: An Endocrine Society Clinical Practice Guideline Task Force Members Anne Peters, MD (Chair)
More informationDiabetes Meds Update Disclaimer and Important Info. Objectives. Page 1. Copyright , Diabetes Education Services
Diabetes Meds Update 2016 Beverly Dyck Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Disclaimer and Important Info This content is for educational purposes only. Please see Package
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationDiabetes II Insulin pumps; Continuous glucose monitoring system (CGMS) Ernest Asamoah, MD FACE FACP FRCP (Lond)
Diabetes II Insulin pumps; Continuous glucose monitoring system (CGMS) Ernest Asamoah, MD FACE FACP FRCP (Lond) 9501366-011 20110401 Objectives Understand the need for insulin pumps and CGMS in managing
More informationBasal-Bolus Insulin Therapy. Veronica Brady, PhD, FNP-BC, BC-ADM, CDE ECHO January
Basal-Bolus Insulin Therapy Veronica Brady, PhD, FNP-BC, BC-ADM, CDE ECHO January 18 2018 Terminology No longer using the term diabetic. Diabetes does not define people. People with diabetes are individuals
More informationThis program applies to Commercial, GenPlus and Health Insurance Marketplace formularies.
OBJECTIVE The intent of the GLP-1 (glucagon-like peptide-1) Agonists [Adlyxin (lixisenatide), Byetta (exenatide), Bydureon (exenatide extended-release), Tanzeum (albiglutide), Trulicity (dulaglutide),
More informationTechnology in Diabetes Care: Emerging Level
Technology in Diabetes Care: Emerging Level Charlotte Parsons ARNP, CDE Christine Fisher, RD, CD, CDE, CPT WADE April 26, 2019 Disclosures to Participants Notice of Requirements for Successful Completion:
More informationInitiating Injectables in Type 2 Diabetes. Tara Kadis Team Leader Diabetes Nurse Specialist York Teaching Hospital
Initiating Injectables in Type 2 Diabetes Tara Kadis Team Leader Diabetes Nurse Specialist York Teaching Hospital Increasing levels in delivery of diabetes care Complex Care support 3 3.1 People with diabetes
More informationNewer Therapies for Type 2 Diabetes
Newer Therapies for Type 2 Diabetes Sandra Indacochea Sobel, MD Clinical Assistant Professor of Medicine Clinical Chief of Endocrinology, UPMC Mercy Division of Endocrinology, Diabetes, and Metabolism
More informationDiabetes: We ve Come a Long Way, Baby! Amy Wachter, MD Christiana Care Endocrinology March 22, 2018
Diabetes: We ve Come a Long Way, Baby! Amy Wachter, MD Christiana Care Endocrinology March 22, 2018 Title of My Talk Ancient Times Diabetes has been affecting lives for thousands of years. Egyptians in
More informationCASE A2 Managing Between-meal Hypoglycemia
Managing Between-meal Hypoglycemia 1 I would like to discuss this case of a patient who, overall, was doing well on her therapy until she made an important lifestyle change to lose weight. This is a common
More informationMaking the Most of Continuous Glucose Monitoring
Making the Most of Continuous Glucose Monitoring Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC Wynnewood, PA AADE 2014 Diabetes Educator of the Year gary@integrateddiabetes.com
More informationNEW TECHNOLOGIES FOR MANAGING DIABETES ANGELA THOMPSON DNP, FNP-C, BC-ADM, CDE, FAANP
NEW TECHNOLOGIES FOR MANAGING DIABETES ANGELA THOMPSON DNP, FNP-C, BC-ADM, CDE, FAANP No commercial support or sponsorship was received for this project I have nothing to disclose OBJECTIVES Identify at
More informationInsulin Management. By Susan Henry Diabetes Specialist Nurse
Insulin Management By Susan Henry Diabetes Specialist Nurse The Discovery of Insulin - 1921 - Banting & Best University Of Toronto Discovered hormone insulin in pancreatic extract of dog - Marjorie the
More informationHow I use the latest technology to investigate and treat a person with Type 1 Diabetes. Dr Pratik Choudhary
How I use the latest technology to investigate and treat a person with Type 1 Diabetes Dr Pratik Choudhary Disclosures Advisory board and speaker fees from Medtronic, Roche, Abbott and Johnson and Johnson,
More informationThe York Diabetes Care Model
This Session The York Diabetes Care Model The annual review what s it for and how to do it How to make the diagnosis of diabetes and who to test Categorisation of diabetes at diagnosis Basics of Insulin
More informationLET S TALK INSULIN THE BASICS
LET S TALK INSULIN THE BASICS AUTHOR S DISCLOSURES Contracted for program development for Lifescan Canada Speaker for Lifescan, Lilly, BI, Consultant for Lilly, Janssen, Novo Nordisk, Lifescan Canada OBJECTIVES
More informationHot Topics: The Future of Diabetes Management Cutting Edge Medication and Technology-Based Care
Hot Topics: The Future of Diabetes Management Cutting Edge Medication and Technology-Based Care Mary Jean Christian, MA, MBA, RD, CDE Diabetes Program Coordinator UC Irvine Health Hot Topics: Diabetes
More informationNewer Insulins. Boca Raton Regional Hospital 15th Annual Internal Medicine Conference
Newer Insulins Boca Raton Regional Hospital 15th Annual Internal Medicine Conference Luigi F. Meneghini, MD, MBA Professor of Internal Medicine, UT Southwestern Medical Center Executive Director, Global
More informationA Practical Approach to the Use of Diabetes Medications
A Practical Approach to the Use of Diabetes Medications Juan Pablo Frias, M.D., FACE President, National Research Institute, Los Angles, CA Clinical Faculty, University of California, San Diego, CA OUTLINE
More informationClinical Practice Guidelines
Clinical Practice Guidelines Diabetes Objective The purpose is to guide the appropriate diagnosis and management of Diabetes. This guideline is designed to assist the clinician by providing a framework
More informationSTEP THERAPY CRITERIA
CATEGORY DRUG CLASS BRAND NAME (generic) STEP THERAPY CRITERIA AMYLIN ANALOG: SYMLIN/SYMLINPEN (pramlintide acetate) ANTIDIABETIC AGENTS GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST (GLP-1): ADLYXIN (lixisenatide)
More information8/21/2017 UNRAVELING THE CROWED INSULIN SCENE. A Practical Overview of Insulin Focusing on New Insulin Preparations
UNRAVELING THE CROWED INSULIN SCENE A Practical Overview of Insulin Focusing on New Insulin Preparations Patricia Garnica MS, ANP-BC, CDE, CDTC North Shore University Hospital, Manhasset, N.Y. October
More informationUpdates in Diabetes Technology
Updates in Diabetes Technology Jessica Kirk, MSN, RN, CPN, CDE Nurse Manager, Endo ECHO No disclosures Disclosures 1 Objectives Distinguish patients appropriate for continuous glucose monitoring and insulin
More informationDiabetes Update 10/12/2017. Section #1 OBJECTIVE. Lab features to consider:
Section #1 OBJECTIVE Diabetes Update Fall 2017 Lyle Myers BE ABLE TO DIFFERENTIATE TYPE 1 FROM TYPE 2 DIABETES Clinical features: - age at onset - body weight/bmi - family history - treatment history -
More informationNEW DIABETES CARE MEDICATIONS
NEW DIABETES CARE MEDICATIONS James Bonucchi DO, ECNU, FACE Adult Medicine and Endocrinology Specialists Disclosures Speakers bureau Sanofi AZ BI Diabetes Diabetes cost ADA 2017 data Ever increasing disorder.
More information!"#$%&%'(!)*+'(,(&)%-!'(.#!%('"./0%(( /1#).!(&2()!(((
!"#%&%'(!)*+'(,(&)%-!'(.#!%('"./0%(( /1#).!(&2()!((( 26%5&"7%'( At the end of this presentation, participants should be able to: Evaluate the emerging role of GLP-1 Agonists for weight loss Understand
More informationThe Alphabet Soup of Diabetes. Egils Bogdanovics M.D. Hungerford Diabetes Center
The Alphabet Soup of Diabetes Egils Bogdanovics M.D. Hungerford Diabetes Center Insulin: January 11, 1922 12 year old Leonard Thompson, on a starvation diet for 2 years received his first insulin injection
More informationObjectives. Navigating New Insulins. Disclosures. Diabetes: The Stats. Normal Insulin Release Individuals without diabetes. History of Insulin 5/23/17
Objectives Compare and contrast currently available products. Navigating New s Diana Isaacs, PharmD, BCPS, BC-ADM, CDE Clinical Pharmacy Specialist Cleveland Clinic Diabetes Center Determine the factors
More informationComplete this CE activity online at ProCE.com/InsulinPart2
Complete this CE activity online at ProCE.com/InsulinPart2 Case 1: A 67 year old male with T2DM History and Presentation John is a 67 year old retiree who has been visiting your pharmacy/clinic for over
More informationVery Practical Tips for Managing Type 2 Diabetes
Very Practical Tips for Managing Type 2 Diabetes Jean-François Yale, MD, FRCPC McGill University Health Centre, Montreal, Canada Jean-francois.yale@mcgill.ca www.dryale.ca OBJECTIVES DISCLOSURES The participant
More informationRhonda Eustice, PharmD, CDE. Will Power lasts about two weeks and is soluble in alcohol. Mark Twain
Rhonda Eustice, PharmD, CDE Will Power lasts about two weeks and is soluble in alcohol. Mark Twain Diabetes Management: The Three Legged Stool Diet Medication Exercise Objectives Know the treatment goals
More informationThe ABCs of MDI: Gaining a working knowledge of Multiple Daily Injection insulin therapy. Today s Presenter
FD Title Slide The ABCs of MDI: Gaining a working knowledge of Multiple Daily Injection insulin therapy learn.extension.org/events/3369 3 This material is based upon work supported by the National Institute
More informationPediatric Diabetes Update Fran R. Cogen, MD, CDE Professor of Pediatrics Director, Diabetes Services
1.19.18 Pediatric Diabetes Update Fran R. Cogen, MD, CDE Professor of Pediatrics Director, Diabetes Services DISCLOSURES 1. No financial incentives 2. Volunteer Positions 1. National Certification Board
More informationDIABETES & ENDOCRINE DIABETES TECHNOLOGY: HOW TO STAY CURRENT WITH ONGOING TECHNOLOGY ADVANCEMENT
DIABETES TECHNOLOGY: HOW TO STAY CURRENT WITH ONGOING TECHNOLOGY ADVANCEMENT Min-Jye Chen, MD Endocrinology Diabetes Management of the School-Aged Child Provided by Texas Children s Hospital Provider #18-267764-A
More informationUpdate on Insulin-based Agents for T2D
Update on Insulin-based Agents for T2D Injectable Therapies for Type 2 Diabetes Mellitus (T2DM) and Obesity This presentation will: Describe established and newly available insulin therapies for treatment
More informationAchieving and maintaining good glycemic control is an
Glycemic Efficacy, Weight Effects, and Safety of Once-Weekly Glucagon-Like Peptide-1 Receptor Agonists Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE; Kathleen Wyne, MD, PhD, FACE, FNLA; Anthony Cannon,
More informationTechnology in Diabetes Management Irl B. Hirsch, MD University of Washington
Technology in Diabetes Management 2016 Irl B. Hirsch, MD University of Washington Dualities Research: Helmsley Charitable Trust, JDRF, ADA, NIDDK, CDC Consulting: Abbott, Roche, Intarcia Raise Your Hand
More informationErtugliflozin (Steglatro ) 5 mg daily. May increase to 15 mg daily. Take in the morning +/- food. < 60: Do not initiate; discontinue therapy
Sodium-glucose Cotransporter-2 (SGLT2) s Inhibit SGLT in proximal renal tubules, reducing reabsorption of filtered glucose from tubular lumen Lowers renal threshold for glucose à increase urinary excretion
More informationType 2 Diabetes Mellitus: Update on Pharmacotherapy 04/04/18
Type 2 Diabetes Mellitus: Update on Pharmacotherapy 04/04/18 No conflicts of interest Objectives for this talk Update on non-insulin drug therapy fro type 2 DM Appropriate use of insulin in type 2 DM ADA
More informationSoliqua (insulin glargine and lixisenatide), Xultophy (insulin degludec and liraglutide)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.48 Subject: Insulin GLP-1 Combinations Page: 1 of 5 Last Review Date: September 15, 2017 Insulin GLP-1
More informationThere have been important changes in diabetes care which may not be covered in undergraduate textbooks.
Diabetes Clinical update There have been important changes in diabetes care which may not be covered in undergraduate textbooks. Changes in the diagnosis of diabetes a) HbA1C Since 2011, World Health Organisation
More informationThe Realities of Technology in Type 1 Diabetes
The Realities of Technology in Type 1 Diabetes May 6, 2017 Rosanna Fiallo-scharer, MD Margaret Frederick, RN Disclosures I have no conflicts of interest to disclose I will discuss some unapproved treatments
More informationInsulin Pump Therapy in children. Prof. Abdulmoein Al-Agha, FRCPCH(UK)
Insulin Pump Therapy in children Prof. Abdulmoein Al-Agha, FRCPCH(UK) aagha@kau.edu.sa Highlights Evolution of insulin pump Pumps mimics Pancreas Goals of diabetes care What lowers HbA1c Criteria for selection
More informationFARXIGA (dapagliflozin) Jardiance (empagliflozin) tablets. Synjardy (empagliflozin and metformin hydrochloride) tablets. GLUCOPHAGE* (metformin)
Type 2 Medications Drug Class How It Works Brand and Generic Names Manufacturers Usual Starting Dose The kidneys filter sugar and either absorb it back into your body for energy or remove it through your
More informationDiabetes Management: Current High Tech Innovations
Diabetes Management: Current High Tech Innovations How Far We ve Come in the Last 40 Years William V. Tamborlane, MD Department of Pediatrics Yale School of Medicine Disclosures I am a consultant for:
More informationStarting and Helping People with Type 2 Diabetes on Insulin
Starting and Helping People with Type 2 Diabetes on Insulin Elaine Cooke, BSc(Pharm), RPh, CDE Pharmacist and Certified Diabetes Educator Maple Ridge, BC Objectives After attending this session, participants
More informationDIABETES (1 of 5) Generic. Generic $0 $5 $5-10 $0 $0 $0. Generic $0 $5 $5-10. Generic. Generic $0 $5 $5-10 $0 $0 $0. Generic $0 $5 $5-10 $0 $0 $0
Metformin DIABETES (1 of 5) Glucophage Glucophage XR ER $7 (500mg) $7 (500mg) $5 $5 500mg, 750mg only 500mg, 750mg only Sulfonylurea/Combinations Amaryl Glucotrol glimepiride glipizide $5 $5 Glucotrol
More informationAntihyperglycemic Agents in Diabetes. Jamie Messenger, PharmD, CPP Department of Family Medicine East Carolina University August 18, 2014
Antihyperglycemic Agents in Diabetes Jamie Messenger, PharmD, CPP Department of Family Medicine East Carolina University August 18, 2014 Objectives Review 2014 ADA Standards of Medical Care in DM as they
More informationNew Drug Evaluation: Insulin degludec/aspart, subcutaneous injection
New Drug Evaluation: Insulin degludec/aspart, subcutaneous injection Date of Review: March 2016 End Date of Literature Search: November 11, 2015 Generic Name: Insulin degludec and insulin aspart Brand
More information