Physicians' Corner: The Good Old Days Were Not So Good for Inpatient Care
Charles F. Shaefer, Jr., MD, FACP, FCCP
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
Jorge L. Jacot, PhD, Aaron I. Vinik, MD, PhD
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.
Acute Glycemic Control in Hospitalized Patients: Evidence Published Since the American College of Endocrinology Position Statement
Zachary Bloomgarden, MD, Jeffrey I. Mechanick, MD
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
Lisa Kiblinger, RN, MS, CDE, Norbert L. Braza, MS
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
Sydney A. Westphal, MD, Pasquale J. Palumbo, MD, MACP, MACE
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
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?
Response to Previous Case Study
Derek LeRoith, MD, PhD
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.
|
