Physicians' Corner-Shopping for Basal Insulin on the Coffee Aisle: Lots of Choices for Lots of Tastes
Charles F. Shaefer, Jr., MD, FACP, FCCP
I think most clinicians would agree that there has been widespread acceptance of the use of basal insulin in the primary care community. In recent months, I have rarely encountered primary care practitioners who are uncomfortable with initiation and titration of basal insulin. Most practitioners understand and accept its utility in the diabetes treatment paradigm. When I do find confusion relating to basal insulin, I have been impressed that it relates most often to uncertainty about which product to use.
 Inpatient Insulin Therapy
Dawn Smiley, MD, and Guillermo E. Umpierrez, MD
This article reviews the risks associated with hyperglycemia in hospitalized patients, the biologic rationale for using insulin to prevent increases in glucose levels, and strategies for managing hyperglycemia in the hospital setting.
Pregnancy Loss and Neonatal Death in Women with Type 1 or Type 2 Diabetes Mellitus
Tim Cundy, MD
In women with type 1 DM, the perinatal mortality rate decreased substantially in most western countries by the early 1980s and has remained stable over the past 25 years. The decrease in perinatal mortality was achieved predominantly by a reduction in the number of late intrauterine deaths and stillbirths. Currently, the major causes of pregnancy loss in type 1 DM are major congenital anomalies and complications of prematurity. Pregnancy in type 2 DM has been recognized as a problem in developing countries since the late 1980s, but is now emerging as a significant problem in western countries, particularly in disadvantaged communities.
Reducing Oxidative Stress in Patients with Type 2 Diabetes Mellitus: A Primary Care Call to Action
Jeff Unger, MD
The effects of chronic hyperglycemia, hyperlipidemia, and hypertension in patients with diabetes mellitus places these individuals at high risk for microvascular and macrovascular complications. Approximately 80% of patients with type 2 DM will succumb to cardiovascular complications such as stroke, peripheral arterial disease, and heart disease. Given the important role of oxidative stress in the development of complications of type 2 DM, physicians should consider methods to reduce oxidative stress that may occur during both acute (postprandial) and chronic hyperglycemia.
Insulin and Endothelial Function: A Brief Review
Intekhab Ahmed, MD, and Barry J. Goldstein, MD, PhD
Since its discovery, insulin has maintained a key position for its principal effects on glucose metabolism. Within the past several decades, we have witnessed a major surge in our ability to decipher insulin's actions beyond glucose metabolism. One of the key effects of insulin in the vasculature has been its interaction with the endothelium; epidemiologic evidence indicates a potential link between insulin and cardiovascular morbidity and mortality. The prevailing dogma holds that insulin and the endothelium maintain a delicate relationship that is essential for normal functioning of the organ lining the blood vessels of the body. Dysfunction of the endothelium is observed in insulin-resistant states, including obesity, glucose intolerance, and type 2 diabetes mellitus.
Insulin Therapy: The Question This Issue
Anuj Bhargava, MD, MBA, CDE, FACP, FACE
What is a good formula for initiating insulin therapy in a newly diagnosed type 1 diabetic?
"Diabetes Tactics" Case Studies
Lois Jovanovic, MD, FACE, on behalf of CADRE
This month's "Diabetes Tactics" case discusses achieving optimal glycemic control in a pregnant woman with type 2 diabetes and polycystic ovary syndrome.
Responses to April 2008 Case Study
Derek LeRoith, MD, PhD
This was the case of a 58-year-old, obese man with type 2 diabetes mellitus, uncontrolled cardiovascular risk factors, and recently diagnosed, nonobstructive coronary disease.
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