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Insulin Journal
VOLUME 1, NUMBER 4
| Editorial |
Editorial
Steven V. Edelman, MD, and Derek LeRoith, MD, PhD
Self-monitoring of blood glucose (SMBG) and insulin therapy are 2 crucial components that must be used together to achieve glycemic goals. SMBG is an important self-care tool that can motivate patients to take a more active role in managing their diabetes. It can provide the information needed to make rational and safe clinical decisions regarding insulin adjustments, as well as the patient’s overall diabetes care. This issue of Insulin focuses on SMBG and insulin therapy, with continued emphasis on both the fasting and postprandial values.
SMBG is one of the cornerstones of insulin therapy, and patients should be taught the value of SMBG early on in their treatment. Its continued successful use, however, is based to a major degree on how comfortable patients are with using their blood glucose meters. If a patient feels that he is a “failure” because his blood glucose levels are elevated, he may not be motivated to do the required testing, or he will “forget” his blood glucose diary when coming for office visits, or he will just make up the values in the waiting room. To a large extent, the onus is on the health care providers in this country to develop a strong and nonaccusatory relationship with our patients so that they can still feel comfortable coming to us when their numbers are too high or if they did not do the required daily testing as prescribed. The true usefulness of SMBG, however, lies in what is done with the results of such testing. These results should be interpreted by the patient and/or the health care provider, and then decisions made regarding adjustments to care.
The glucose value is just a number, however, and we should avoid negatively judging our patients. We should focus instead on the barriers these individuals face on a day-to-day basis as they try to comply with the demands that we caregivers put on them, including testing their blood glucose levels, exercising on a consistent schedule every day with the same duration and intensity, and adhering to a routine of meals and snacks at regular times each day. We believe that SMBG is our patients’ own personal laboratory in the palm of their hands, and if presented correctly, it can empower people with diabetes mellitus into appropriate self-care.
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| Articles in This Issue |
A Practical Look at Self-Monitoring of Blood Glucose
Susan M. Renda, MS, CRNP, CDE
Being able to check their own blood glucose levels can enable individuals with diabetes mellitus (DM) to better understand and manage their illness. Intensive glycemic control has been shown to reduce the long-term microvascular complications of DM.
Contributions of Fasting and Postprandial Plasma Glucose Levels to Glycosylated Hemoglobin and Diabetes Mellitus-Related Complications: Treating Hyperglycemia with Insulin
George E. Dailey, MD
The goal of this article was to define A1C and address the contributions of FPG and PPG levels to overall A1C. Elevated A1C levels correlate with an increased risk of cardiovascular disease and other complications, which are also reviewed here. Available therapies and therapeutic strategies are discussed, including the use of insulin when oral therapy alone has not maintained glycemic control.
Insulin Therapy in Patients with Type 2 Diabetes Mellitus: Treatment to Target Fasting and Postprandial Blood Glucose Levels
Denis Raccah, MD, PhD
A basal-bolus regimen can be tailored to the glycemic needs of each individual patient; the simplicity and flexibility of dosing may result in greater patient compliance and, thus, improved glycemic control.
Tight Control of Hyperglycemia in Type 2 Diabetes Mellitus
Thomas W. Donner, MD
The goal of this article was to review the options available for obtaining glycemic control in patients with type 2 DM.
Insulin Therapy: The Question This Issue
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?
Response to Previous Case Study
Derek LeRoith, MD, PhD
A 36-year-old white man with diabetes mellitus (DM) for 4 years presents with persistent hyperglycemia while taking multiple oral agents.
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| Patient Handouts |
Blood Glucose Monitoring: Getting a Clear View of Your Diabetes
Susan M. Renda, MS, CRNP, CDE
When you clean the windshield of your car, you can then get a clear view of where you are going. You are better able to see the road ahead and more likely to reach your destination without hitting any obstacles.
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All articles have been reviewed by members of our Editorial Board or independent referees.
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