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Production Assistant, Diabetes In Control

Treatment Changes

Test Your Knowledge

A 42-year-old patient was diagnosed with type 2 diabetes approximately one year ago and is currently taking metformin, a DPP-4 inhibitor, and a basal insulin dose (current daily dose .9 U/kg/day). Despite good compliance with her diet, exercise, and medication regimen, she reports postprandial glucose measurements of usually about 190 mg/dL. Her current A1C is 7.6%. Which of the following changes in her management do you consider most important? A. Add a sulfonylurea to her regimen B. Increase her basal insulin dose C. Add a pre-meal rapid-acting insulin D. Discontinue her basal insulin dose and add a prandial insulin dose Follow the link to see the answer.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #90: Lipid and Lipoprotein Metabolism, Hypolipidemic Agents, and Therapeutic Goals Part 2

Lipoprotein metabolism in normal individuals and in type 2 diabetes mellitus: Triglyceride levels in blood are regulated by the size and number of VLDL secreted from the liver and the efficiency with which triglycerides are cleared from the plasma by lipoprotein lipases. In T2DM, greater numbers of larger, more triglyceride-enriched VLDL are secreted from the liver and lipoprotein lipase activity may be modestly reduced; both lead to increased levels of triglyceride in the blood. HDL cholesterol levels are reduced for several reasons, including increased transfer of that cholesterol to very low- and low-density lipoprotein, in exchange for their triglyceride, by cholesterol ester transfer protein. LDL particles lose some of their cholesterol to VLDL via the same exchange mechanism, which generate smaller, denser, LDL.

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