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Production Assistant, Diabetes In Control

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #84: Measuring Insulin Action In Vivo

The glucose clamp: Rather than using exogenous agents that suppress beta-cell insulin secretion, the glucose clamp uses external feedback control to “open the loop” between insulin secretion and sensitivity. The glucose clamp is a powerful and widely used method to attain a quantitative measure of insulin sensitivity, and has been applied in many hundreds of experimental studies.

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National Treatment Targets

What percent of your patients with diabetes fail to meet national treatment targets for glycemic, blood pressure, or cholesterol control? a) >50% b) >75% c) < 50% d) 25% Follow the link to see how you and your colleagues compare.

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Prandial Insulin Administration

Test Your Knowledge

Your patient has been systematically titrating his basal insulin dose for the last 6 months; his daily dose is NPH .90 U/kg/day. Despite his good efforts, you decide it would be prudent to add a prandial insulin dose to his treatment regimen. Which of the following scenarios might lead you to this conclusion? A) A1C=7.4%, FPG<130 mg/dl, PPG>180 mg/dl B) A1C=7.0%, FPG<130 mg/dl, PPG<180 mg/dl C) A1C=7.0%, FPG<120mg/dl, PPG<160mg/dl D) A1C=6.8%, FPG<120 mg/dl, PPG<160 mg/dl Follow the link to see if you got it right.

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Helping Patients to Achieve Behavior Change

Man, 76 years of age, type 2 diabetes, obesity, SP right total hip replacement one year out. When preparing for hip surgery, was on basal and bolus insulin, metformin. Had been on a GLP-1 but had diarrhea so he stopped. Was able to, for the most part, follow a lower carbohydrate meal plan but was not active. When he first started coming to us for weight loss to prepare for his surgery, his weight was 304 pounds, BMI 45, A1c 9.9%, Cr 1.87, eGFR 34. We decreased his metformin from 2,000mg/day to 1,000mg day and referred to nephrology. With this change and being motivated for surgery, he lost weight and in 6 months went into surgery having lost 25 pounds with an A1c of 6.9%. Note, due to eating less carbs, he could take less insulin, which seemed to help his appetite. Surgery was performed and he did well.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #83: Measuring Insulin Action In Vivo

The heralded isolation of insulin in Toronto in 1921 was followed immediately by treatment of diabetes. It soon became clear that while insulin was effective in regulating the blood glucose levels in most patients, there were some subjects in whom insulin appeared to be ineffective. This lack of insulin effect was termed “insulin resistance” as early as 1925.

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