Management of Symptomatic Hypoglycemia in Patients on Insulin Therapy

Diabetology
Curriculum:
Intensification of Insulin Therapy and Appropriate Management of Symptomatic Hypolgycemia in Patients on Insulin Therapy
Credits:
0.5 AMA PRA Category 1 Credit(s)™
Launch Date:
November 20, 2014
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Primary Care Physicians

Relevant Terms:

Type 2 diabetes mellitus, Hypoglycemia, Basal insulin titration, Prandial insulin titration

Anne L. Peters, MD, FACP, CDE

Anne L. Peters, MD, FACP, CDE
Professor at the Keck School of Medicine
University of Southern California
Director, USC Clinical Diabetes Programs
Los Angeles, California

Dr. Peters is currently a professor at the Keck School of Medicine at the University of Southern California (USC) and the Director of the USC Clinical Diabetes Program. She runs diabetes centers in Beverly Hills and in underserved East Los Angeles and works with the L.A. County Department of Health Services on a county-wide diabetes program.
 
Dr. Peters has been a principal investigator on multiple clinical trials focusing on diabetes and diabetes prevention. She established the Community Diabetes Initiatives Research Center in collaboration with Children’s Hospital Los Angeles with funding from the Keck Foundation, the JDRF, ADA, Rose Hills Foundation, California Nutrition Network, and the Helmsley Trust. Dr. Peters is a principal investigator for the NIH Look AHEAD Study and the UCLA/USC NIH P50 program project, “Family and Neighborhood Interventions to Reduce Heart Disease Risk in East L.A.” 
 
She has been an invited speaker at many local, national, and international medical conferences. Dr. Peters has authored 3 books on diabetes and over 100 articles appearing in peer-reviewed medical journals including The Journal of the American Medical Association, Annals of Internal Medicine, Archives of Internal Medicine, Diabetes Care, and the American Journal of Medicine.  She serves on the ABIM Endocrine Board and the Board of the ADA. Dr. Peters received the ADA Outstanding Physician Clinician Award in 2008 and the 2010 Bernardo Houssay Award from the National Minority Quality Forum for her work with the underserved. She is an author of the “ADA/EASD Position Statement on the Management of Hyperglycemia in Type 2 Diabetes” and co-chair of the ADA Working Group on the Treatment of Type 1 Diabetes.

Louis Kuritzky, MD

Louis Kuritzky, MD
Family Physician
Emeritus Clinical Assistant Professor
Department of Community Health and Family Medicine
University of Florida
Gainesville, Florida

Dr. Kuritzky is a family physician and Emeritus Clinical Assistant Professor at the Department of Community Health and Family Medicine at University of Florida in Gainesville. He received his medical degree from the Medical College of Virginia in Richmond and completed his internship at Miami Valley Hospital in Dayton, Ohio.
 
Prior to joining the faculty at the University of Florida in 1983, Dr. Kuritzky was a member of the University of California, Los Angeles (UCLA) Family Medicine Clinical Faculty. His current professional society participation includes the American Society of Hypertension (ASH), the American Diabetes Association (ADA), and the American Association of Family Physicians (AAFP). In addition to being board-certified in family medicine by the American Board of Family Medicine, he has received certification as a Specialist in Hypertension by the ASH.
 
Dr. Kuritzky has given hundreds of presentations nationally and internationally at professional societies. He is on the editorial board of Internal Medicine Alert and the International Journal of Impotence Research. He has authored over 100 articles in journals including the New England Journal of Medicine, Journal of the American Medical Association, Comprehensive Therapy, Hospital Practice, and Patient Care. 
1. Minimize symptomatic hypoglycemia by modifying or titrating insulin therapy appropriately

Program Overview
One of the many barriers that clinicians who manage patients with type 2 diabetes mellitus (T2DM) who may be appropriate for insulin therapy is to overcome the misguided fear that patients have regarding their potential risk for hypoglycemia. Although newer insulin therapies have been shown to reduce risk of hypoglycemia, the hypoglycemic episodes, if and when they occur, can be frightening for the patient and can result in devastating consequences, including discontinuation of therapy. Hence, it is critical that physicians investigate the causes of these episodes and educate the patients to document the blood glucose values prior to, and at the time of, these hypoglycemic episodes. Using the information collected, physicians should then identify the cause, and if needed, modify or titrate insulin therapy appropriately thereby effectively eliminating subsequent hypoglycemic events. In this activity, we will discuss a case of a patient on insulin therapy experiencing a hypoglycemic episode and review the appropriate steps involved in investigating and managing hypoglycemia.

Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Elsevier Office of Continuing Medical Education (EOCME) and ACCELMED. The EOCME is accredited by the ACCME to provide continuing medical education for physicians.
 
Credit Designation Statement
The Elsevier Office of Continuing Medical Education designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 
Disclosure Statement
It is the policy of the Elsevier Office of Continuing Medical Education that all faculty, instructors, and planners disclose real or apparent conflicts of interest relating to the topics of this educational activity.
 
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
 
Dr. Kuritzky receives consultant/advisor fees from Boehringer Ingelheim; Eli Lilly and Company; Janssen Pharmaceuticals, Inc.; Novo Nordisk; and sanofi-aventis.
 
Dr. Peters serves on the speakers' bureaus for Bristol-Myers Squibb Company/AstraZeneca Partnership; and Novo Nordisk. She receives consultant fees from Abbott Diabetes Care, Inc.; Becton, Dickinson and Company; Bristol-Myers Squibb Company/AstraZeneca Partnership; Eli Lilly and Company; Janssen Pharmaceuticals, Inc.; Medtronics, Inc.; Novo Nordisk; and sanofi-aventis. She has received a research grant from Medtronics, Inc.
 
Non-faculty: Jason LeDune, MS; Tara Frate; Jennifer Hughes; Sandy Breslow; and Brynne Hunter hereby state that they or their spouse/life partner do not have any financial relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

Peer Review
This enduring material has been peer-reviewed by The American Journal of Medicine.
 
Financial Support
This activity is supported by independent educational grants from Novo Nordisk and Lilly.  For further information concerning Lilly grant funding visit www.lillygrantoffice.com. 
 
CME Inquiries/Special Needs
For all CME inquiries or special needs, please contact elsevierCME@elsevier.com.
 
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Elsevier Office of Continuing Medical Education, ACCELMED, Novo Nordisk, and Lilly USA, LLC, do not recommend the use of any agent outside of the labeled indications.
 
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients' conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.
 
How to Receive Credit
There are no fees for participating in and receiving credit for this activity. The participant must read the learning objectives and enduring material and must answer the multiple-choice online post-test. Please complete the evaluation form, which provides each participant with the opportunity to comment on the quality of the instructional process, the perception of enhanced professional effectiveness, the perception of commercial bias, and his/her views on future educational needs. A score of at least 75% is required to successfully complete this activity. Credit is available through November 19, 2015.
 


Course Viewing Requirements
Supported Browsers:
Internet Explorer 8.0+ for Windows 2000, 2003, Vista, XP, Windows 7, Windows 8
Google Chrome 28.0+ for Windows, Mac OS, or Linux
Mozilla Firefox 23.0+ for Windows, Mac OS, or Linux
Safari 6+ for Mac OSX 10.7 and above

For video playback, install the latest version of Flash or Quicktime.
Supported Phones & Tablets:
Android 4.0.3 and above
iPhone/iPad with iOS 6.1 or above