Step up your diabetes game! We answer your questions from #MedTwitter with help from returning guest, Jeff Colburn MD, FACP, FACE (USU) Topics include: the pitfalls of A1C testing, the A1C target controversy, lifestyle interventions, continuous glucose monitoring, pathophysiology of T2DM, use of SGLT2 inhibitors, GLP1 agonists, and how to initiate and titrate insulin therapy. ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Writer (including CME Questions) and Producer: Matthew Watto MD, FACP Cover Art and Infographic: Bryan Brown MD Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP; Emi Okamoto MD Guest: Jeff Colburn MD, FACP, FACE Time Stamps 00:00 Pun, Intro, disclaimer, and guest bio 03:55 Guest one liner 05:45 Picks of the week*: Illusions (book) by Richard Bach, Industrial Accident: The Story of Wax Track Records (Documentary), Free Solo (Documentary), Peter Attia’s The Drive (Podcast) -episode with Jason Fung MD 12:28 A case of Type 2 Diabetes (T2DM); Four potential pitfalls when checking A1C  19:58 Does tight glucose control improve outcomes? 24:05 Continuous glucose monitoring 29:08 Pathophysiology of diabetes and the metabolic syndrome 33:13 Beta cell regeneration 35:10 Can intensive lifestyle changes and T2DM; DIRECT trial  37:50 Next steps for patients uncontrolled on metformin; SGLT2 inhibitors - considerations for use, risk and benefits, how to counsel patients 42:40 SGLT inhibitors and degree of hyperglycemia; How real are concerns about amputations and Fournier’s gangrene?; How does eGFR affect their use and efficacy?; Euglycemic DKA 49:51 GLP1 agonists. Now available as oral agents. 53:40 2019 ADA guidelines for the management of hyperglycemia 54:51  How to manage the use of both insulin and oral hypoglycemic agents in combination 56:48 Insulin therapy. Choice of agent. How to start it. How to titrate. 60:40 Can patients with T2DM ever stop insulin? 62:00 Adding GLP1 and SGLT2 agents on top of insulin therapy 65:30 Using loop diuretics with SGLT2 inhibitors 66:30 Take home points 69:06 Outro