Free Resource Friday | 2020 (Vision Needed to View) ADA Injectables Algorithm

Happy Friday! As I get older, font sizes seem to be getting smaller. Excited to see the updated Injectables Algorithm, I turned my ADA Book to Standard 9 and quickly realized that in order to read the print, I had to hold the page inches from my nose. And there was no way could I read the footnotes even using my iphone flashlight to illuminate the words.

Thank goodness I collaborate with wonderful staff who boast youthful eyes and 2020 vision.

Robert (our Assistant Director and my high school senior) set to work recreating a draft of the document on Word. Getting the arrows to line up and fitting all the content in little boxes, was challenging, but he persevered. Taryn added the footnotes and I completed the final editing and the creation of the PDF.

We created this readable version because the algorithm is an important document that can be used to promote a collaborative practice.

Coach Beverly

I consider the ADA Standards my clinical “playbook”. The medication algorithms are of particular importance because it provides us with the opportunity to engage in a collaborative practice with our referring providers. “These are the evidence based medication recommendations from the ADA. I use it as a guide to recommend medication additions or changes”.

Enjoy our font enhanced Figure 9.2: Intensifying to Injectable Therapy

Then we can start a conversation exploring if a collaborative practice and medication adjustments using the algorithm is comfortable for the provider and perhaps include into our practice guidelines.

Enjoy this helpful 2 page reference guide, on us!

This Friday, Diabetes Education Services is featuring a new Free Resource to add to our ever-growing catalog. Your swag purchases from DES help us continue to feature new content on Fridays:


Want more Standards of Care updates?

Join Coach Beverly for the 2020 Standards of Care webinar on January 21, 2020 @ 11:30 a.m. PST, where she’ll highlight changes from 2019-2020 and highlight important need-to-know content for CDCES’s!

Join for Level 1 Standards of Care, or buy the full Level 1 bundle to benefit from all the updates this month!


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Multiple studies have examined metformin for its potential tumor and cancer fighting ability. The National Center for Biotechnology Information (NCBI) published such a study in 2016. Researchers found substantial pre-clinical evidence suggesting anti-cancer properties of metformin based on in-vitro and in-vivo analysis. Their analysis suggested metformin could be used as a radiation sensitizer or immunotherapy drug, besides its direct anti-proliferative properties .

In mice with lung cancer, metformin was used and researchers saw a 72% reduction in tumor burden. Tumors are known to exhibit the Warburg effect, but metformin blunts this and consequently downregulates the growth of cancer stem cells.

Several observational studies showed a correlation between metformin use and lessened cancer incidence. The results demonstrated that metformin users have statistically significant reductions in liver, pancreatic, colorectal and breast cancers.

You can read more details on the study and enjoy their infographics and tables of data here.

Coach Beverly reports no conflict of interest for medication postings.


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October Newsletter Now Available!

Our October Newsletter is brimming with medication updates! From Oral GLP-1 to Semaglutide and pre-filled Glucagon, we’re keeping you up to date AND updating our PocketCards. Did you know you can hire Coach Beverly to come speak in your hometown? Read this month’s Newsletter to find out how to request her time. 

October News Topics Include:

  • Oral GLP-1: Easier to Stomach than Injectables?
  • Canagliflozin Slows Kidney Disease and Protects the Heart
  • Diabetes & Breast Cancer
  • 25% Off Live Webinars
  • Updated DiaBingo
  • 7 Strategies to Survive Halloween

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A post analysis of the SAVOR-TIMI 53 trial and a review of 17 different observational studies showed metformin use is associated with decreased all-cause mortality in people with type 2 diabetes and a high risk of cardiovascular events.

The SAVOR-TIMI 53 trial involved 12,156 people who had baseline biomarker samples: 74% had taken metformin, 13% had prior heart failure, and 11% had at least moderate CKD. The trial found the metformin group had a significant decrease in risk of death from any cause.

In a previous systematic review of 17 observational studies published in the Annals of Internal Medicine in 2017, researchers concluded that metformin use is associated with decreased all-cause mortality in patients with CKD, congestive heart failure, or chronic liver disease with hepatic impairment.

Find out more details about the Harvard Medical School study here.


Want more great medication information? Download our Medication PocketCard for free! We also have these great 8-cards-in-1, laminated, accordion fold PocketCards for sale with bulk discounts.

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Xeris Pharmaceuticals new pre-filled glucagon pen, Gvoke, just received FDA’s stamp of approval to treat severely low blood sugar levels in people with diabetes.

The Gvoke glucagon pen is filled with a liquid stable form of glucagon and is approved for use in people with diabetes, age 2 and above. Xeris will have the pre-filled syringe version available in 4-6 weeks and the auto-injector version available in 2020.

The Xeris glucagon pen was created to simplify glucagon injections. This new Gvoke pen does not require any mixing, since it is filled with liquid stable glucagon.

Availability of a glucagon delivery device is critical to treat severe hypoglycemia and prevent serious consequences of untreated severe hypoglycemia such as cardiovascular events, seizure, coma, or even death.

Read more about the Gvoke Glucagon Pen and auto-injector here .


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Continuous glucose monitoring (CGM) uses interstitial fluid to provide real time glucose readings. Some CGMs have a nonadjunctive dosing indication, which means that users can base treatment decisions on the CGM reading.

Most recently, Eversense CGM received the nonadjunctive indication from the FDA. This means that Eversense users will not have to check fingersticks to make treatment decisions in the near future.

Photo 2018 FDA Website

However, users will still need to calibrate the Eversense CGM twice daily and will need to download a new app before they can base treatment on the CGM readings.

The Eversense is the first long-term implantable CGM device that can be used for up to 90 days before replacing. The sensor is inserted via an in-office procedure in the upper arm by a trained physician. A fluorescent chemical coating on the outside of the sensor generates a small amount of light in response to the amount of sugar that is present in fluid under the skin (interstitial glucose). This light signal is converted into a glucose reading and transmitted wirelessly every five minutes to a compatible mobile device.

Read more in Endrocrine Today – FDA approves nonadjunctive indication for Eversense CGM.

For more information visit the Eversense Website


Want more practice for the exam? Try our new Technology Toolkit, meant to assist with studying based on the updated CDCES content outline!

Earn 3 CEs and join coach Beverly for her second airing of the Toolkit Live on September 11 and 13, 2019. Purchase includes On-Demand viewing now and the ability to join live later.

Two Online Courses are included in this Technology Toolkit:

  • Tech 101 – Pumps and Sensors Update and Overview and 
  • Tech 102 – Insulin Pump Calculations: From Basal to Square Bolus 

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In a randomized phase 3a study published in Diabetes Care, those taking oral semaglutide monotherapy experienced superior and clinically significant improvements in A1c and weight loss compared to those taking a placebo.

Semaglutide (Ozempic) is currently only available as a once a week injectable, belonging to the GLP-1 Receptor Agonists classification. This class of medications is referred to as “Incretin Mimetics” since they imitate the action of gut hormones, causing satiation, post prandial glucose lowering and slowed gastric emptying. They have the added benefit of associated weight loss.

One drawback for people starting on semaglutide and all GLP-1 RAs, is that they currently can only be administered via injection.

Download FREE Diabetes Injectables PocketCard for more info on GLP-1 RAs.

The findings, based on the Peptide Innovation for Early Diabetes Treatment, or PIONEER, study, found that those who took either oral semaglutide 3 mg, 7 mg or 14 mg once a day for 26 weeks had significantly lower A1C and improved body weight, compared with those on placebo.

This phase 3a trial involving 703 people with type 2 diabetes provides hope that this medication class may be effective when administered orally.

The findings also showed that mild to moderate transient gastrointestinal incidents were the most common adverse events with the oral form of this GLP-1 receptor agonist.

Download FREE Diabetes Injectables PocketCard for more info on GLP-1 RAs. Join our Diabetes Educator Course for a 3 Day Review of Medications and More!


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August Newsletter Now Available!

In our August Newsletter, we highlight several exciting new releases! Nasal Glucagon has been approved, generic Dapagliflozin has been released, and Cleveland Clinic has synthesized a chart of supplements and their efficacy for people with diabetes!

Come to the San Diego Live Seminar for 39 CEs and NEW Networking Night!

Read this month’s newsletter before August 16 to see how you could get a $50 discount.

August Newsletter Topics Include:

  • Nasal Glucagon Approved
  • Nutritional Supplement Chart for People With Diabetes
  • 5 Steps to Stop Sitting & Increase Longevity
  • Diabetes Educator Conference “Making a Difference” Scholarship Awarded
  • Generic SGLT-2 Inhibitor Approved
  • New Technology Course & Networking Mixer at San Diego Live Seminar
  • Women Leaders Conference Save the Date – December 6
  • CDCES Coach App® Rated by DANA | $50 Discount for App Survey

Click here to read our newsletter


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The marketing application for a generic version of Farxiga, or dapagliflozin has received tentative approval from the US Food and Drug Administration (USFDA). Alembic Pharmaceuticals received a nod for its abbreviated new drug application for Dapagliflozin Tablets in 5 mg and 10 mg strength.

The approved product is therapeutically equivalent to the reference listed drug product Farxiga Tablets.

No information on pricing has been posted yet, but the hope is that as patents expire, more affordable generic diabetes medications will be made available.

Dapagliflozin belongs to the SGLT-2 Inhibitor class of diabetes medications. To read more, download our FREE Diabetes Medication Pocket Cards.


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The FDA just approved Baqsimi, a nasal glucagon powder to treat severe hypoglycemia in people with diabetes ages four and older. This first non-injectable form of glucagon should be available by the end of August. The U.S. list price for a Baqsimi one-pack is $280.80 and for a two-pack is $561.60.* This priceing is comparable to injected glucagon.

For people with diabetes and their loved ones, witnessing and treating severe hypoglycemia is scary. This new nasal treatment offers a fast and effective intervention for people at risk for severe hypoglycemia.

“This new way to administer glucagon may simplify the process, which can be critical during an episode, especially since the patient may have lost consciousness or may be having a seizure. In those situations, we want the process to treat the suffering person to be as simple as possible.”

said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research.

The safety and efficacy of Baqsimi was evaluated in three studies; two with adults and one with pediatrics over the age of four with type 1 diabetes. The participant’s glucose levels increased sufficiently after the powdered glucagon was nasally administered.

Baqsimi comes in a single-use dispenser and does not need to be inhaled, which means it can be effectively administered to a person who is unconscious due to severe hypoglycemia.

Precautions
Baqsimi is not indicated in people with pheochromocytoma, a rare tumor of adrenal gland tissue, or by patients who have insulinoma, a tumor of the pancreas.
Baqsimi also carries a warning that it should be used with caution by those who have been fasting for long periods, have adrenal insufficiency or have chronic hypoglycemia because these conditions result in low levels of releasable glucose in the liver.
The most common adverse reactions associated with Baqsimi are nausea, vomiting, headache, upper respiratory tract irritation, watery eyes, redness of eyes and itchiness. Side effects of Baqsimi are similar to injectable glucagon, with the addition of nasal and eye-related symptoms, such as watery eyes and nasal congestion, because of the way the drug is administered.

*Eligible commercially insured people with diabetes can pay $25 for up to two BAQSIMI devices (1 two-pack or 2 one-packs) with a savings card. This prescription is generally filled on an annual basis.  Lilly may also be able to help people who don’t have commercial insurance coverage. Interested persons and healthcare professionals with questions about BAQSIMI can visit www.BAQSIMI.com or call The Lilly Answers Center at 1-800-LillyRx (1-800-545-5979).

More info on Baqsimi approval at FDA Website – Click here


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