What is insulin resistance? Broadly, insulin resistance can be defined as an abnormal biologic response to insulin; insulin, whether endogenous or exogenous in origin, has limited ability to reverse a hyperglycemic metabolic state.Thus a person with insulin resistance is, almost inevitably, progressing towards developing frank type 2 diabetes (T2DM) if an intervention (usually lifestyle) is not implemented. Due to the very close link between diabetes and insulin resistance, no formal clinical definition of insulin resistance has emerged.We will discuss the potential clinical use of the insulin resistance syndrome and the metabolic syndrome later in the chapter. For now, we focus on investigation of insulin resistance as a useful entity for research concepts, and in particular discuss its biologic consequences by describing its associated risk factor perturbations.

Additional conditions more likely in those diagnosed later in life.

Canagliflozin is found to have reduced risk of cardiovascular death or hospitalization due to heart failure in type 2 diabetes patients.

Use of high temperature, open flame for cooking both red meat and chicken associated with increased risk.

Study shows greater than 20% weight decrease, especially in men, can significantly increase risk of fragility fractures.

Mortality rates increased in adults with diabetes, low estimated glomerular filtration rate in absence of albuminuria.

Which lifestyle change do you feel is most important in controlling blood sugars and lowering A1c values -- Nutrition, Physical activity, or both? Follow the link to share your opinion.

Mr. Hernandez is a 45-year-old plumber of Hispanic heritage who has excessive weight (BMI 30 kg/m2). He arrives at your office for a first-time visit. He has not been to a physician during the last 7 years because he hasn’t always had health insurance and “doesn’t like going to the doctor.” However, he has been noticing lately that his vision seems a little blurry and he’s developed a red, itchy rash in his groin. He is a non-smoker and recalls being told a long time ago that he should eat a low salt diet, but he can’t remember why. On examination, his BP is 154/96 mm/Hg, and his pulse is 72, RR 22. His physical exam is notable for signs of a yeast infection in his groin. You order a CBC and A1C to be drawn that day before he leaves. You advise him how to treat his skin infection. When you receive the results of the blood test, it shows a random plasma glucose of 162 mg/dL and A1C 7.3%. You call Mr. Hernandez and ask him to return the next morning, before he has eaten, for additional labs. In this individual, you might order all the following labs EXCEPT: A. A1C B. chem 12 panel C. fasting lipid profile D. urine ketones Follow the link for the answer.

Available through the Samsung Health service*, the DWP is powered by WellDoc’s platform that is used in its BlueStar® product. This consumer version, for people with type 2 diabetes, provides personalized information for users, such as interactive quizzes and videos, and the ability to conveniently monitor food intake, exercise, sleep, medication, and blood glucose readings for better diabetes self-management.

As I am working with patients, I have so many thoughts about how different each patient is. I also have thoughts about how in this day and age, with all we have available, some people who have had diabetes for oh so many years still have no clue how to manage their diabetes.