NEW Meds Management for Type 2 webinar!

Updated and now available On Demand in the Online University

This course is included in: Level 2 – Beyond Fundamentals. Purchase this course individually for $29 or the entire bundle and save 70%. 

Diabetes Education Services Online University Courses are an excellent way to study for your exam anytime and anywhere that is convenient for you. You will have immediate access to your courses  for 1 year after your purchase date. Each individual online course includes a: 90 minute video presentation, podcast, practice test and additional resources.

This advanced level course is designed to help participants determine the best medication choice based on the patient’s unique characteristics. The content incorporates the management guidelines published by the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) Algorithms. We will discuss the role of lifestyle changes and review the pros and cons of available diabetes medications using a patient centered approach. In addition, we discuss the medication algorithms in detail. Participants not familiar with the basics of diabetes medication, may benefit from first enrolling in our “Meds for Type 2” and “Insulin 101 Course.”  90-minute course.


Topics include:

  • The importance of patient assessment in determining a realistic meds management plan.
  • Gain insights into developing an individualized plan to treat hyperglycemia in collaboration with the person with diabetes
  • Strategies on adjusting meds plus lifestyle to achieve glucose targets

Intended Audience:  A great course for health care professionals seeking to enhance their knowledge of hyperglycemia management for those living with type 2 diabetes.

Instructor: Beverly Thomassian RN, MPH, CDE, BC-ADM is a working educator and a nationally recognized diabetes expert.

Fee: $29.00 (Group Discounts Available)

Course Level: 2 (included in Level 2 – Beyond Fundamentals)

All hours earned count toward your CDE Accreditation Information

Earn 1.5 CEs

Video presentation and podcast available now On Demand.

*Certified Diabetes Educator® and CDE® are registered marks owned by NCBDE. The use of DES products do not guarantee successful passage of the CDE® exam. NCBDE does not endorse any preparatory or review materials for the CDE® exam, except for those published by NCBDE.”

Standards of Care Section 8 – Approaches to Glycemic Treatment

Insulin Therapy for Type 1
This updated version of Meds Management includes more detailed information on insulin therapy for Type 1s. They note that sensor-augmented insulin pump therapy with the threshold suspend feature reduced nocturnal hypoglycemia without increasing A1c (for type 1s in a 3 month randomized trial). The FDA approved the first hybrid closed-loop pump system, since the literature supports its safety and efficacy.

Investigational Agents for Type 1s

  • Add on Metformin for Type 1 – In several trials, adding metformin to insulin for type 1s, reduced insulin requirements 6.6 units a day and led to small reductions in weight and LDL cholesterol. However, it did not significantly reduce A1c. Metformin in not FDA Approved for use in patients with type 1 diabetes.
  • SGLT-2 Inhibitors – these “glucoretics” lower glucose by decreasing renal reabsorption of glucose in the proximal tubules. Since this class works independent of endogenous insulin, SGLT-2 Inhibitors may benefit patients with type 1 or type 2 (not FDA Approved for use in patients with type 1 diabetes).  However, the FDA has issued a warning of the risk of ketoacidosis occurring in the absence of significant hyperglycemia. There are many reported cases of euglycemic ketoacidosis in patients with type 1 or type 2 diabetes. If patients are experiencing signs of ketosis, instruct them to immediately stop taking the SGLT-2 and seek immediate care.

Type 2 Management Strategies – Stepwise Approach to Pharmacologic Management of Type 2 Diabetes – 2018

Pharmacologic Approaches to Glycemic Treatment 2018.  This hyperglycemia road map details strategies to achieve glucose control for both Type 1 and Type 2 Diabetes. Section 8 of Standards of Care, Dec 2018.

Step 1

According to the ADA 2018 Standards, section 8, Metformin therapy should be started along with lifestyle Management at diagnosis of type 2 Diabetes (unless contraindicated). Metformin is effective, safe, inexpensive and may reduce risk of CV events and death.

Step 2

If A1c target is not achieved after 3 months, consider metformin and any one of the six preferred treatment options based on drug specific effects and patient factors.

If A1c target is still not achieved after 3 months on metformin, and the patient has CV Disease, consider adding a second agent with evidence of cardiovascular risk reduction (based on drug specific effects and patient factors).

These include:

  • SGLT-2 Inhibitors – empalgliflozin (Jardiance) and canagliflozin (Invokana)
  • GLP-1 Receptor Agonist – liraglutide (Victoza)

Step 3

If A1c target is still not achieved after 3 months, combine metformin plus two other agents for a three-drug combination.

Step 4  

If A1c target is still not achieved after 3 months, add combination injectable therapy to the three-drug combination.

For all steps, consider including medications with evidence of CV risk reduction, based on drug specific effects and patient factors.

Medication Therapy Based on A1c

  • If A1c is less than 9%, consider monotherapy
  • If A1c is greater than or equal to 9% consider dual therapy
  • If A1c is greater or equal to 10%, or if BG 300 or more, or pt is markedly symptomatic, consider insulin and injectable therapy.

Want to learn more about this topic?

 


 

 

New SGLT-2 Inhibitor – Ertugliflozin

The Food and Drug Administration (FDA) has approved Ertugliflozin (Steglatro), a new SGLT-2 Inhibitor to treat adults with type 2 diabetes. Also approved are two new combination medications with ertugliflozin.  These include Segluromet (ertugliflozin plus metformin) and Steglujan (ertugliflozin plus sitagliptin). See box below for available combination doses (in mgs).

Dosing range: 5 -15 mg daily.  Monitor GFR before starting. Don’t start med if GFR is less than 60 and stop if GFR is less than 30.

Considerations: Ertugliflozin has the same warnings as other SGLT-2s: Watch for hypotension, UTI’s, increased urination, genital infections, ketoacidosis.

Benefits: no hypoglyecmia or weight gain.
Lowers A1c 1.0% – 2.0%. Lowers wt 1-3 lbs.

Download our FREE Updated Insulin PocketCard


Medication Update Webinar – Feb 19, 2018 11:30 to 1pm (PST)

Feeling overwhelmed by all the new recently approved diabetes medications? Two bio-similiar insulins are now available and another GLP-1 RA was just approved. Plus, 2 new combo oral meds are now available.

Are you wondering how to apply the new 2018 ADA and AACE Medication Management Guidelines into practice?

We are here to help out!

This webinar will discuss how to integrate these new medications into our practice. We will discuss the benefits and limitations and critical information to share with our patients and providers.

If you want cutting edge information on the latest pharmacology and how to incorporate the new ADA Guidelines into practice, we highly recommend this Meds Update.

To Join Us and earn CEs you have 2 options: 

med3

diabetesed-buynow2-150x28-1

Or Purchase our Meds Update Toolkit

Earn 3.5 CE’s – 2 Courses for Only $49

This toolkit includes:

  • Meds Update Course 2018 – cutting edge information on the latest pharmacology and how to incorporate the new ADA Guidelines into practice.
  • Basal-bolus Insulin in the Hospital Setting Course – A comprehensive program which explores the effective use of basal bolus insulin in the hospital setting through case studies and examples.

If you want cutting edge information on the latest pharmacology and hospital glucose management, we highly recommend this Meds Update Toolkit.

diabetesed-buynow2-150x28-1

 


 

New Copycat Bolus Insulin

The Food and Drug Administration (FDA) has approved Admelog (Sanofi-Adventis US), the first copycat version of short-acting insulin lispro (Humalog, Eli Lilly)  to treat individuals aged 3 years and older with type 1 diabetes and adults with type 2 diabetes.

Download our FREE Updated Insulin PocketCard

Features:

Approved for use as an injection, via pump, or intravenously.

It will be available both in vials and as a prefilled pen (Admelog SoloStar).

The FDA approved Admelog through an abbreviated approval pathway under which companies can rely on the FDA’s previous approval of a drug as safe and effective or on previously published literature supporting safety and/or effectiveness. This process is meant to reduce drug development costs in order to reduce the drug’s price on the market.

 


Medication Update Webinar – Feb 19, 2018 11:30 to 1pm (PST)

Feeling overwhelmed by all the new recently approved diabetes medications? Two bio-similiar insulins are now available and another GLP-1 RA was just approved. Plus, 2 new combo oral meds are now available.

Are you wondering how to apply the new 2018 ADA and AACE Medication Management Guidelines into practice?

We are here to help out!

This webinar will discuss how to integrate these new medications into our practice. We will discuss the benefits and limitations and critical information to share with our patients and providers.

If you want cutting edge information on the latest pharmacology, we highly recommend this Meds Update.

To Join Us and earn CEs you have 2 options: 

med3

diabetesed-buynow2-150x28-1

Or Purchase our Meds Update Toolkit

Earn 3.5 CE’s – 2 Courses for Only $49

This toolkit includes:

  • Meds Update Course 2018 – cutting edge information on the latest pharmacology and how to incorporate the new ADA Guidelines into practice.
  • Basal-bolus Insulin in the Hospital Setting Course – A comprehensive program which explores the effective use of basal bolus insulin in the hospital setting through case studies and examples.

If you want cutting edge information on the latest pharmacology and hospital glucose management, we highly recommend this Meds Update Toolkit.

diabetesed-buynow2-150x28-1

 


 

New GLP-1; Semaglutide (Ozempic)

The US Food and Drug Administration (FDA) has approved semaglutide (Ozempic, Novo Nordisk) as an adjunct to diet and exercise for the treatment of type 2 diabetes in adults.

This once weekly injection of (GLP-1) receptor agonist will be available in 0.5-mg and 1.0-mg doses, via a dedicated prefilled pen device. 

Semaglutide is the seventh GLP-1 receptor agonist on the US market and the third dosed once weekly.
And the data suggests it might be more effective than some of its competitors. 

Download our updated FREE Injectables PocketCard

Features:

The company’s eight phase 3a trials involved over 8000 adults with type 2 diabetes, including individuals at high cardiovascular risk and those with renal disease. One of the studies, SUSTAIN-6, was a 2-year FDA-mandated cardiovascular-outcomes trial involving 3297 patients.

  • In the five SUSTAIN efficacy trials, semaglutide reduced hemoglobin A1c by 1.5 to 1.8 percentage points.
  • Semaglutide was also associated with a 4.5- to 6.4-kg weight loss. The most common side effect was mild to moderate nausea, which diminished over time.

 

After approval, Novo Nordisk is required to conduct a pediatric trial in adolescents younger than 18 years of age and to add semaglutide to a 15-year medullary thyroid carcinoma registry that includes all of the long-acting GLP-1 products.  

Semaglutide will be priced similarly to current weekly GLP-1 receptor agonists and will be offered with a savings card program to reduce copays for eligible commercially insured patients.


Medication Update Webinar – Feb 19, 2018 11:30 to 1pm (PST)

Feeling overwhelmed by all the new recently approved diabetes medications? Two bio-similiar insulins are now available and another GLP-1 RA was just approved. Plus, 2 new combo oral meds are now available.

Are you wondering how to apply the new 2018 ADA and AACE Medication Management Guidelines into practice?

We are here to help out!

This webinar will discuss how to integrate these new medications into our practice. We will discuss the benefits and limitations and critical information to share with our patients and providers.

If you want cutting edge information on the latest pharmacology and hospital glucose management, we highly recommend this Meds Update.

To Join Us and earn CEs you have 2 options: 

med3

diabetesed-buynow2-150x28-1

Or Purchase our Meds Update Toolkit

Earn 3.5 CE’s – 2 Courses for Only $49

This toolkit includes:

  • Meds Update Course 2018 – cutting edge information on the latest pharmacology and how to incorporate the new ADA Guidelines into practice.
  • Basal-bolus Insulin in the Hospital Setting Course – A comprehensive program which explores the effective use of basal bolus insulin in the hospital setting through case studies and examples.

If you want cutting edge information on the latest pharmacology and hospital glucose management, we highly recommend this Meds Update Toolkit.

diabetesed-buynow2-150x28-1

 


 

Bydureon BCise Injector

The once weekly GLP-1 Receptor Agonist, Bydureon, is a dual chambered pen that requires mixing and assembly that was challenging for some patients.

Download our FREE Updated Insulin PocketCard

To improve the patient experience, a new extended release pre-filled delivery device, Bydureon BCise – has been approved by the FDA. for adults with type 2 diabetes. The new autoinjector features a simpler mixing process, a hidden needle, and a viewing window for users to confirm that they’ve received the medication.

Features of Bydureon BCise (rhymes with “precise”) is expected to launch in early 2018.

  • Easier mixing: To prep the BCise pen for injection, the user simply has to shake it for 15 seconds. By comparison, the older dual-chambered pen instructed users to tap it “80 times or more.”

  • Pre-attached needle: With the dual-chambered pen, users had to screw on the needle cap. Bydureon BCise comes with a hidden needle.

  • Easier injection: To administer Bydureon BCise, users are directed to push the pen against the skin and hold for 15 seconds, removing the hassle of needle insertion and holding down the plunger.

To get the new autoinjector, healthcare professionals must write a prescription specifically for Bydureon BCise. AstraZeneca has not specified what the price of Bydureon BCise beyond suggesting that it will be comparable to the dual-chambered pen pricing.


Medication Update Webinar – Feb 19, 2018 11:30 to 1pm (PST)

Feeling overwhelmed by all the new recently approved diabetes medications? Two bio-similiar insulins are now available and another GLP-1 RA was just approved. Plus, 2 new combo oral meds are now available.

Are you wondering how to apply the new 2018 ADA and AACE Medication Management Guidelines into practice?

We are here to help out!

This webinar will discuss how to integrate these new medications into our practice. We will discuss the benefits and limitations and critical information to share with our patients and providers.

If you want cutting edge information on the latest pharmacology and hospital glucose management, we highly recommend this Meds Update.

To Join Us and earn CEs you have 2 options: 

med3

diabetesed-buynow2-150x28-1

Or Purchase our Meds Update Toolkit

Earn 3.5 CE’s – 2 Courses for Only $49

This toolkit includes:

  • Meds Update Course 2018 – cutting edge information on the latest pharmacology and how to incorporate the new ADA Guidelines into practice.
  • Basal-bolus Insulin in the Hospital Setting Course – A comprehensive program which explores the effective use of basal bolus insulin in the hospital setting through case studies and examples.

If you want cutting edge information on the latest pharmacology and hospital glucose management, we highly recommend this Meds Update Toolkit.

diabetesed-buynow2-150x28-1

 


 

World Diabetes Day Celebrates Dr. Banting and the Discovery of Insulin

During a hot summer in 1921, Dr.Banting secured space to test out his theory in the University of Toronto. Along with his colleague, Charles Best, and a bare bones lab, they conducted dozens of experiments on dogs, which ultimately led to the discovery of insulin. 

Dr. Banting and Charles Best began their experiments ligating the pancreases of dogs, thinking this would prevent destruction by the digestive pancreatic juices, and then isolating the extract from the islet cells. They then processed the extract from the islet cells and injected this extract they called “insulin” into diabetic dogs.  According to an audio Interview with Dr. Best, by July 1921, they had 75 positive examples of insulin lowering blood glucose levels in dogs. 

In February 1922, doctor Frederick Banting and biochemist John Macleod published their paper on the successful use of a alcohol based pancreatic extract for normalizing blood glucose levels in a human patient.

Here are some photos of the first insulin bottles produced by the University of Toronto and Eli Lilly.

Soon, word of their discovery got out and the race was on to produce enough insulin to treat the flood of type 1 patients arriving in Toronto to receive this miracle injection.

But, as with any amazing discovery, there is always more to the story. 

One of the biggest barriers to Banting was the simple fact that he was not involved in the field of diabetes research. The idea leading to the discovery of insulin came to him after preparing a lecture on the pancreas and diabetes, a subject he knew little about. He wasn’t a trained researcher and thus securing support for the project was initially difficult.

First Patients to Receive Insulin

The first patient to receive insulin was a ‘welfare’ case at Toronto General Hospital – no clinical trial structure to say the least. People from Canada/US flooded into Toronto to receive treatment. Banting struggled with the lack of accessibility of insulin – volume needed, issues of purification.

The earliest patients were “selected”, some youths from Canada/US, some soldiers with diabetes (probably because of Banting’s service in the First World War) and then later some select private patients. During this time they were working hard to increase the volume and continue to improve the purification process. Insulin was available for testing in US, namely through Dr. Elliot Joslin in the late summer 1922.

Takes a Team

While Best played a critical and important role, credit must also go to Professor Macleod, from the University of Toronto, who provided the lab space, showed Dr. Banting how to operate on dogs, provided his student Best and suggested they switch from a saline to alcohol to purify the ‘extract’.  Dr. Macleod also secured the support of JB Collip, the 4th man on the team and the fist person to purify insulin for human use. Best is also known for pushing Banting to return to the research during a particular dark period of failure.

Dr. Banting – Fun and Interesting Facts

  • Sold insulin patent for $1
  • Was wounded during the First World War and received the Military Cross
  • Youngest Nobel Laureate in Medicine
  • First Canadian on the cover of Time Magazine
  • Among the last Canadians to receive a knighthood and have the title Sir Frederick Banting
  • One of only two “non-Americans” to have a Second World War Liberty Ship named after him (USS Frederick Banting)
  • Has as a crater on the Moon named after him (between Apollo 15 & 17 landing sites).

Want to Learn More About the Dr. Banting?

  Visit Banting House FaceBook Page

 


 

Faster Aspart Insulin, Fiasp, Approved

A faster-acting injected mealtime insulin, Fiasp (“fast-acting insulin aspart”) is now FDA approved and expected to be available at the end of 2017 or early in 2018.

Fiasp is a new formulation of NovoLog, which includes the addition of niacinamide (vitamin B3) to increase the speed of the initial insulin absorption, resulting in an onset of appearance in the blood in approximately 2.5 minutes.

Fiasp is approved for adults with type 1 and type 2 diabetes and will launch at the same price as NovoLog. The newly-approved insulin has a faster onset and offset. On the front end, Fiasp starts working within minutes of injection and it can be taken as much as 20 minutes after starting a meal. While taking it at the beginning of the meal is strongly recommended, this dosing flexibility may be beneficial for some patients.

“The intention of rapid acting insulin therapy is to mimic, as much as possible, the natural physiological insulin response that occurs after meals, a process that is important for optimal A1C management.” said Bruce Bode, MD FACE, President of Atlanta Diabetes Associates and Associate Professor at Emory University School of Medicine.

Fiasp will be packaged in Flex Touch Pens and 10mL vials.

Download FREE Updated Insulin PocketCard which includes Fiasp

Novo Nordisk Press Release

Aspart (Fiasp) Package Insert


 

Metformin Particularly Effective in Those With History of GDM – check out this article written in Medscape for more information. 

Women with a history of GDM who developed prediabetes that were started on Metformin decreased risk of developing type 2 diabetes by 41% at the 15 year mark. Wow.

 


 

Interested in learning more about women and diabetes? Check out our Online University course:

Level 2 – Women and Diabetes 1.0 CEs – $19.00

Women with diabetes are confronted with a variety of issues that require special attention, education and understanding. This course reviews those special needs while focusing on Gestational Diabetes and Pre-Existing Diabetes.

 

Canagliflozin Amputation Warning!
The FDA is warning that Canagliflozin puts patients at higher risk of amputation.

Patients at higher risk of amputation include those with a history of prior amputation, peripheral vascular disease, neuropathy, and diabetic foot ulcers. Monitor patients on canagliflozin for any signs of extremity sores, ulcers or pain and discontinue canagliflozin.

The FDA urges health care professionals and patients to report side effects involving canagliflozin and other medicines to the FDA MedWatch program, using the information in the Contact FDA box at the bottom of the page.

This is based on results from two clinical trials – the CANVAS (Canagliflozin Cardiovascular Assessment Study) and CANVAS-R (A Study of the Effects of Canagliflozin on Renal Endpoints in Adult Participants With Type 2 Diabetes Mellitus) – showed that
leg and foot amputations occurred about twice as often in patients treated with canagliflozin compared to patients treated with placebo, which is an inactive treatment.

Amputations of the toe and middle of the foot were the most common; however, amputations involving the leg, below and above the knee, also occurred. Some patients had more than one amputation, some involving both limbs.

The CANVAS trial showed that over a year’s time, the risk of amputation for patients in the trial were equivalent to:

  • 5.9 out of every 1,000 patients treated with canagliflozin
  • 2.8 out of every 1,000 patients treated with placebo

The CANVAS-R trial showed that over a year’s time, the risk of amputation for patients in the trial were equivalent to:

  • 7.5 out of every 1,000 patients treated with canagliflozin
  • 4.2 out of every 1,000 patients treated with placebo