3) First, a case study: 52M, 25 Y h/o T1DM. Married, self-employed landscape professional working outside 10 h/day 6 d/week. On 70/30 insulin 20 units BID (breakfast and dinner). Also on atorvastatin 20 mg/day and losartan 50 mg day. BMI 28 kg/m2.— cardio-met (@cardiomet_CE) April 6, 2021
5) The patient has long standing T1D and has early manifestations of microvascular disease (background retinopathy and peripheral neuropathy). A target HbA1c of 7% or lower would be ideal to help prevent progression of microvascular disease.— cardio-met (@cardiomet_CE) April 6, 2021
7) What else should you ask?— cardio-met (@cardiomet_CE) April 6, 2021
a. Does he eat regularly?
b. Does he check SMBG when he feels low?
c. Does he skip insulin doses or self-adjust his dose?
d. All of the above?
9) When he does eat lunch, it is usually a sandwich from a fast-food restaurant. He eats dinner with his family regularly and this is usually a healthy meal.— cardio-met (@cardiomet_CE) April 6, 2021
His symptoms of hypoglycemia usually occur at work – he doesn’t have time to check his SMBG.
11) He doesn’t usually adjust his insulin dose, unless his pre-meal SMBG is low, in which case he decreases the dose to 10 units.— cardio-met (@cardiomet_CE) April 6, 2021
13) Select your best answer and return tomorrow for results and more education! @MedTweetorials Shout outs to @TheAACE @American_Heart @AmDiabetesAssn @DiabetesTimes @MarkHarmel @DrE_TCOYD @joslinDiabetes @adventHealthCFL— cardio-met (@cardiomet_CE) April 6, 2021
15) As to yesterday’s poll. All of these are reasonable choices.— cardio-met (@cardiomet_CE) April 7, 2021
You place a CGM on patient with instructions to return 2 weeks later for review, at which time, the patient reports that the CGM fell off after 2 days because of perspiration and activity.
17) He tried setting reminders, which were somewhat helpful, but still skips meals and occasional insulin injections because he is so busy.— cardio-met (@cardiomet_CE) April 7, 2021
23) You initiate the patient on insulin glargine U100 25 units once daily and insulin aspart 5 units with each meal.— cardio-met (@cardiomet_CE) April 8, 2021
The patient reports taking the insulin glargine every evening at dinnertime.
25) He has fewer episodes during the daytime, but has now awakened several times around 2-3 am sweating and anxious. On one occasion, his SMBG was 45.— cardio-met (@cardiomet_CE) April 8, 2021
You are concerned that the insulin glargine U100 may be causing the nocturnal hypoglycemia and may not be lasting the full 24h.
28) The patient returns 3 months later. He has titrated the insulin degludec to 30 units a day. He reports significantly less hypoglycemic episodes and none at night. His SMBG in the morning is 110 mg/dL on average and 120-130 before dinner. His most recent HbA1c was 7.0%.— cardio-met (@cardiomet_CE) April 8, 2021
30) Overall, this results in improved glycemic control.— cardio-met (@cardiomet_CE) April 8, 2021
When considering treatment options for patients with type 1 diabetes, it is important to personalize therapy. Do you think this patient’s quality of life has improved on this new regimen? In what way?
31) That's it! You made it! Free CE/#CME! Physicians, nurses, pharmacists: go to https://t.co/Mm2dcPD1bD and claim your credit! I am @RpratleyMD. Follow @cardiomet_CE for more tweetorials! #Endotwitter #MedEd @ENDOUNO @endojorm— cardio-met (@cardiomet_CE) April 8, 2021