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Vicious Circle(s) of Hyperinsulinemia- Result in Weight Gain and Hypoglycemia

Vicious Circle(s) of Hyperinsulinemia- Result in Weight Gain and Hypoglycemia. Undue. Or bolus. Hypoglycemia Symptomatic or not!. Consequences of Hypoglycemia. Prolonged QT- intervals- Diabetologia 52:42,2009 Can be of pronged duration IJCP Sup 129, 7/02

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Vicious Circle(s) of Hyperinsulinemia- Result in Weight Gain and Hypoglycemia

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  1. Vicious Circle(s) of Hyperinsulinemia-Result in Weight Gain and Hypoglycemia Undue Or bolus Hypoglycemia Symptomatic or not!

  2. Consequences of Hypoglycemia • Prolonged QT- intervals- Diabetologia 52:42,2009 • Can be of pronged duration IJCP Sup 129, 7/02 • Greater with higher catecholamine levels Europace 10,860 • Associated with Angina Diabetes Care 26, 1485, 2003 / Ischemic EKG changes Porcellati, ADA2010 • Associated with Arrhythmias • Associated with Sudden Death Endocrine Practice 16,¾ 2010 • Increased Variabilty- explains highest mortality in intensive group had highest HgA1c in ACCORD ( increases inflammation, ICU mortality Hirsch ADA2010)

  3. So given epidemiologic data, CV risk/glucose data and now ADVANCE, VADT, ACCORD, implications of weight gain and hypogycemia, what are/ should be goals (SSS) • 1. ADA- stayed at <7.0 • AACE – stayed at < 6.5 • Lowest possible as long as no undue risk of • hypoglycemia and visceral weight gain • 2. ADA and AACE- • Start early in DM - • implications for prevention- • lifestyle and drug therapy of metabolic syndrome and IGT • b. do not aim for aggressive control in those • with significant pre-existing CV disease • Disagree- lowest possible without hypoglycemia, weight gain • Modify goals for ‘elderly’ • Disagree- lowest possible without hypoglycemia, weight gain

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