Our expert is Diana McNeil, MD, FACP, Professor of Medicine, Division of Endocrinology and Metabolism, Duke University School of Medicine

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Mitzi Perdue

MPerdue@LiebertPub.com

THE BIONIC PANCREAS OFFERS NEW HOPE FOR TYPE 1 DIABETES

There’s good news for those with type 1 diabetes.  The FDA has just approved a device (Medtronic MiniMed 670G) that automates keeping their blood sugar at healthy levels.  It will be available by Spring 2017. Referred to as a bionic pancreas, the system includes a glucose meter in the form of an electrode under the skin, an insulin pump strapped to the body, and an infusion patch connected to the pump.  A tiny catheter delivers insulin as needed. The system measures a patient's glucose levels every five minutes and either administers or withholds insulin. The bionic pancreas does a far better job of maintaining the individual’s glucose levels within the normal range than previous therapies for those with type 1 diabetes.

Future versions will not only administer insulin to lower blood sugar, but can also   provide glucagon to raise blood sugar. This technology means keeping individuals with Type 1 diabetes safe from the complications of diabetes that come when their blood sugar is out of the normal range.

SODIUM-GLUCOSE TRANSPORT INHIBITORS ARE USEFUL, BUT HAVE A SERIOUS DRAWBACK

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new class of diabetic medications that are highly useful for the treatment of type 2 diabetes. In the past, we tried to limit the amount of sugar excreted, and we gauged the effectiveness of diabetic control by whether a tablet added to urine showed color changes that revealed the presence of sugar. However, sodium-glucose inhibitors take the opposite approach; their goal is for people to pee out excess sugar. In addition to enabling people to get rid of excess sugar, sodium-glucose inhibitors can lower blood pressure and they can also have a modest impact on weight loss.  However, increased sugar in urine means an environment where yeasts can flourish  these kinds of medications increase the likelihood of yeast infections.  This in turn limits the usefulness of the medication.

MENOPAUSE AND CARDIOVASCULAR DISEASE

We recommend an aggressive approach in managing cardiac risk for women who are over 45 and have type 2 diabetes.   Type 2 diabetes is a cardiac risk equivalent disease, and in most cases such women should be put on some version of statins.  Not everyone needs statins, but after menopause women lose much of their protection against heart disease, and statins are important for decreasing the inflammation that puts them at greater risk for cardiovascular disease.

MENOPAUSE AND DIABETES

Menopause can be challenging for a woman with type 2 diabetes because hormonal fluctuations may influence blood glucose levels.  Menopause may occur earlier for her than it would with a non-diabetic woman. She may experience sexual issues, such as lack of desire or vaginal dryness.  She also may experience mood swings. A menopausal woman with diabetes is likely to need more aggressive bone density testing.  She may have sleep issues, and getting this right is important because getting good sleep is essential for diabetes management. Type 2 diabetes also has a relationship with sleep apnea and if this is the case, the sleep apnea needs to be addressed.  In addition to treating specific symptoms, make sure that she exercises and that she gets her sleep.

BEFORE PRESCRIBING A NEW MEDICATION, MAKE SURE THE PATIENT CAN AFFORD IT

A recent patient in her 60s had a great response to one of the new medications.
She was given a prescription and a card to get her first month’s medication free, but then found that the new medication costs $1,000 a month.  She made too much money to get it free, but she didn’t make enough to be able to afford it. We now teach all our residents and young doctors to make sure that the patient can afford the medications they are prescribing.