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Insulin Journal
VOLUME 3, NUMBER 1
| Editorial |
Editorial
Steven V. Edelman, MD, and Derek LeRoith, MD, PhD
This issue of Insulin truly highlights both the importance of insulin in the treatment of type 2 diabetes mellitus (DM) and the number of factors that can influence a patient’s success in terms of metabolic control and quality of life. The other important message offered in this issue is that there are many ways to design an insulin regimen for patients with type 2 DM.
One of the largest and most comprehensive comparison studies, the Treating to Target in Type 2 Diabetes (4T) trial, which examined different insulin strategies for type 2 DM, is analyzed and discussed in practical terms to help all of us in the trenches who see these tough-to-treat people with insulin-requiring type 2 DM. If you think about it, managing type 2 DM over time can be quite difficult because we are trying to treat a moving target. As β-cell function declines, a patient’s response to treatment changes; this is especially true with the different insulin regimens. In many ways, treating type 2 DM may be more difficult than treating type 1 DM, where treatment regimens, especially insulin requirements, do not change dramatically over time.
Finding a successful individualized insulin regimen for each of our type 2 DM patients is one thing, but there are so many other factors to consider that may influence our success. The ever-changing and variable factors such as diet, exercise, concomitant illnesses, pregnancy, and stress all play a huge role in day-to-day glucose control. In addition, home glucose monitoring, which plays a vital role in treating patients on insulin, may provide inaccurate results due to patient technique, differences in meter accuracy, and other factors.
Treating patients who require insulin is not a simple task and our success can be influenced by many variables. Professional education such as that provided by this journal and other information portals is vitally important in helping us deal with the complexities of managing our patients successfully. To that end, this issue offers 0.5 continuing medical education credit for an article written by Bruce W. Bode, MD, on incorporating postprandial glucose (PPG) and fasting plasma glucose (FPG) into clinical management strategies. Traditionally, FPG has been the focus for diagnosis and treatment of type 1 and type 2 DM. Recently, however, the focus has been expanded to include the contribution of both FPG and PPG to overall glycemic control. In fact, changes in PPG levels are typically the first signs of abnormal glucose metabolism associated with type 2 DM, and they are a useful measure of glycemic control in patients with near-normal FPG and high glycosylated hemoglobin (A1C) levels. Knowing the contributions of FPG and PPG to overall A1C concentrations in patients with type 2 DM will help us make better decisions when developing or changing our patients’ treatment regimens. |
| Articles in This Issue |
Physicians' Corner: Afloat in a Rising Sea of Type 2 Diabetes: Looking for Lighthouses in the 4-T Trial
Charles F. Shaefer, Jr., MD, FACP, FCCP
It is important to know where you are and where you are going with the treatment of your type 2 diabetes patient. A specific pathway for diabetic treatment, such as the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) consensus algorithm for the treatment of type 2 diabetes, may be relatively easy to follow once that "safe passage" has been identified. However, the fact that there are so many treatment choices out there, so many different ways to turn and become lost, makes it imperative to search for evidence-based markers that give some sense of direction or confirmation that we are moving along the right pathway.
Evaluating the Accuracy of Modern Glucose Meters
Richard M. Bergenstal, MD
Self-monitoring of blood glucose (SMBG) is important for all patients with diabetes, as it provides valuable feedback on the effects of diet, exercise, and medications. To maximize the potential benefits of SMBG, clinicians must have confidence in the accuracy of their patients' glucose meters. The aim of this article is to review several issues related to glucose meter accuracy and ways that accuracy can be enhanced.
 Incorporating Postprandial and Fasting Plasma Glucose into Clinical Management Strategies
Bruce W. Bode, MD
Targeting plasma glucose is a widely accepted practice in the treatment of both type 1 and type 2 diabetes mellitus (DM). Although clinicians have traditionally relied on fasting plasma glucose (FPG) levels for diagnosis and as a target for therapy, the focus has expanded to include the contribution of postprandial glucose (PPG) to glycosylated hemoglobin (A1C) levels. This article examines the contributions of FPG and PPG to A1C levels in patients with diabetes and discusses the impact of these findings on insulin treatment strategies for patients who fail to achieve recommended A1C goals.
Quality of Life and Insulin Therapy in Type 2 Diabetes Mellitus
Martha M. Funnell, MS, RN, CDE
A frequently cited barrier to insulin use in type 2 diabetes mellitus (DM) is concern about the adverse effects on quality of life. Results of studies in this area have been mixed, with insulin use showing decreased, enhanced, or no impact on quality of life.
Variability of Insulin Action: Does It Matter?
Lutz Heinemann, PhD
The metabolic effects induced by injection of identical doses of insulin into the SC depot varies considerably both intraindividually and interindividually. Clearly, it is the intraindividual variability of insulin action that is of relevance for the treatment of patients with diabetes.
Response to Previous Case Study
Derek LeRoith, MD, PhD
The patient was a 16-year-old, obese black male who presented to the local emergency department where he was described as being in "acute distress." Two weeks before admission, the patient had noted polyuria, nocturia, weight loss (despite being constantly hungry), and little energy. Two days before admission, he developed headaches, generalized abdominal pain, nausea, and vomiting.
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| Patient Handouts |
Lifestyle Factors Affect Insulin Requirements
Susan Renda, MS, CRNP, CDE
The goal of insulin therapy is to imitate what would normally happen in your body if you did not have diabetes. Many factors can influence how much insulin your body needs to keep your glucose levels in control.
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All articles have been reviewed by members of our Editorial Board or independent referees.
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