Insulin Journal
VOLUME 2, NUMBER 1
Editorial
This issue of Insulin develops the theme of insulin therapy for both hospitalized and ambulatory patients. Recent evidencestrongly suggests that intensive insulin therapy for hospitalized patients with hyperglycemia, whether or not they have diabetes
mellitus (DM), significantly reduces morbidity and mortality. The excitement following these studies has led to major
changes in DM management in hospitals worldwide. In most intensive care units, protocols have been developed and instituted
to follow the guidelines suggested by the latest studies. We all eagerly await outcomes data from our own institutions,
but early indications are positive.
New paradigms for instituting insulin therapy in ambulatory patients with type 2 DM who are taking oral antidiabetic
agents have also become standard practice. The vast majority of patients with type 2 DM are overweight. Insulin therapy,
when applied in an effective manner, is often associated with weight gain. However, although the weight increase is noticeable,
it apparently does not increase cardiovascular complications in these patients and is more likely to reduce acute and
chronic complications of hyperglycemia.
One of the concerns with intensive insulin therapy has been the early increase in retinopathy seen in several studies such
as the Diabetes Control and Complications Trial. This early increase in retinopathy may be related to insulin’s induction of
vascular endothelial growth factor, an angiogenic agent. However, long-term insulin therapy protects against worsening of
retinopathy by reducing oxidant stress and proinflammatory cytokines. The long-term benefits of intensive insulin treatment
in delaying or preventing retinopathy may thus outweigh insulin’s potential to cause an early increase in retinopathy.
The studies presented further support the use of intensive insulin therapy under multiple circumstances. Each patient must
be approached individually to achieve as close to normal glycemic control as possible while avoiding hypoglycemia.
Physicians' Corner: The Good Old Days Were Not So Good for Inpatient Care
In the good old days, we didn't routinely pay a lot of attention to inpatient blood glucose levels as long as the patient wasn't experiencing diabetic ketoacidosis or suffering from such a degree of polyuria that the nurse called us in the middle of the night.
Diabetic Retinopathy: Unraveling the Paradoxical Effects of Intensive Insulin Treatment
The goal of this article was to review developments in understanding both the pathophysiologic pathways involved in diabetic retinopathy and the biologic effects of insulin to provide a possible explanation why insulin treatment may have deleterious short-term effects yet provide long-term benefits.
Intriguing evidence from randomized controlled trials suggests that tight glycemic control in the hospitalized patient improves mortality and morbidity, although the above-recommended glucose target values have not been met in some studies.
The Impact of Diabetes Education on Improving Patient Outcomes
With morbidity, mortality, and medical costs of increasing concern, diabetes educators must provide patients and primary caregivers with the tools to improve their DM and the motivation and understanding to help them meet their goals. The goal of this article was to determine the effectiveness of education provided by CDEs in an American Diabetes Association-recognized outpatient program for adults.
Weight Gain and Management Concerns in Patients on Insulin Therapy
Intensive insulin therapy is often associated with weight gain. Although there is concern that weight gain in patients with type 2 DM may have adverse effects on risk factors for cardiovascular disease, unfavorable changes in blood pressure and lipid levels have not been consistently observed in clinical trials.
Insulin Therapy: The Question This Issue
I hear about the basal-bolus concept of insulin therapy all the time. What is this concept, and why should my patients use it? Please explain. Why should a patient agree to inject insulin 4 or 5 times a day? What is carbohydrate (carb) counting, and why should my patient with DM do it? How do I determine the ratio (compensation factor) that the patient should use?
Staying Healthy to Avoid Illness
When you have diabetes, managing your blood glucose and taking care of your health may help you avoid serious illness and a trip to the hospital. Staying as healthy as you can requires regular planning and maintenance.
The patient is a 30-year-old Hispanic man who was admitted to the surgical intensive care unit (ICU) with abdominal pain, vomiting, and a blood glucose level of 426 mg/dL.
This was the case of a 48-year-old Hispanic male with type 2 diabetes mellitus (DM) who presented with elevated levels of glycosylated hemoglobin (A1C). He had presented 2 years prior for treatment and was currently taking metformin 1000 mg BID, insulin glargine 30 U QHS, and other medications. His diet was high in carbohydrates.
