Last week, I had a new patient referred to me with adult onset type 1 diabetes. The patient was 63 years old and — although she had been losing weight over the past year — it was a 16 pound loss over the previous 2 weeks that got the physician concerned. An A1c test came in at 13.1 and the C-peptide was 0.89, so they placed the patient on 40 units of Lantus every morning. My goal was to help the patient learn how to eat and exercise better, and of course the number of carbs that she was eating needed to be reduced. When we told her that she should keep the carbs below 100, she decided that if below 100 was good, below 50 would be better. Her levels improved, and in 7 days we were down to 24 units every morning.
She was still getting a rise in post-meal glucose even when consuming no carbs, only protein and fat, and was becoming frustrated. I called her back in and we sat down and talked about how non-glucose secretagogues can cause an increase in glucose levels. Although she had no idea of what a secretagogue was, by the time we were done she understood how her mix of protein and fat was possibly causing an increase. If you want to understand this confusing process you would be well served by reading this week’s clinical text. Dave Joffe Editor-in-chief