Write your question in the box below. Please include your name and your email address. Questions may be edited for clarity. Because of the sizeable number of queries received, we cannot reply to individuals. Rather, the most interesting exchanges will be posted on this site.

Could a woman with type 1 diabetes mellitus (DM) begin to produce insulin after pregnancy? Are thiazolidinediones (TZDs) only effective when a patient with type 1 DM is still producing insulin, and not when any type of injectable insulin is required? Apart from clinical findings, how can you tell with certainty whether a patient has type 1 DM? How long can an insulin-resistant patient take high-dose steroids and insulin without loss of glycemic control?
Dina E. Green, MD

What is the evidence supporting early "insulinization" therapy in type 2 diabetes mellitus (DM)?

Anuj Bhargava, MD, MBA, CDE, FACP, FACE

How can I tell my patient with certainty that he has type 1 diabetes mellitus (DM)? Would the addition of an oral diabetes medication be effective in a patient with type 1 DM?
Anuj Bhargava, MD, MBA, CDE, FACP, FACE

What is a good formula for initiating insulin therapy in a newly diagnosed type 1 diabetic?
Anuj Bhargava, MD, MBA, CDE, FACP, FACE

What choices do my patients have for insulin administration other than syringes and vials? What kinds of insulin pens are currently available? Why should my patients use insulin pens? If insulin pens have such advantages, why are they not used more commonly? Are there any special instructions for using pens compared with using syringes? What is the role of insulin pens in hospitals?
Anuj Bhargava, MD, MBA, CDE, FACP, FACE

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?
Anuj Bhargava, MD, MBA, CDE, FACP, FACE

How and when do I start a patient on insulin therapy? What choices of insulin regimen do I have? How do I decide which regimen to start with? Do I need to make any changes in oral medications with initiation of insulin? How should I convince a patient to start insulin?
Anuj Bhargava, MD, MBA, CDE, FACP, FACE

Why is the use of sliding-scale insulin so controversial? How do I write a correction scale?
Anuj Bhargava, MD, MBA, CDE, FACP, FACE