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Letter from the Editor #490

Oct 14, 2009

This past weekend I was in California to serve on a panel discussing insulin protocols in both the hospital and long term care settings. There was a lot of great information on what different hospitals did. It was interesting to hear how the choice of pens or vials was made and whether a hospital had a single brand formulary or open formulary.

There was also discussion as to the differences between patients in the hospital for diabetes related problems or diabetes patients who were there for another illness or problem. At one point the leader of the discussion talked about adding prandial insulin rather than using only a sliding scale to fix elevated glucose levels. The recommendation he made was to give 4 units of rapid insulin at the start of the largest meal and control carbohydrates for the patient. As he went around the room of some 30 medical professionals, there was almost unanimous agreement. When another practitioner and I recommended that we take 3 or 4 meals and do pre and post prandial readings and then decide which meal and how much to give, there was silence in the room.


They all assumed that the largest meal would be the one that affected glucose the most, but often that is not true. Often supper is the biggest meal but breakfast has the most carbohydrates with the least amount of digestion slowing protein or fat. Some of the hospitals were actually doing pre and post checking but were not using it this way.

Maybe we can learn something from this for our patients not in the hospital. On my way to the airport Sunday night it came as no surprise that my limo driver — who was overweight — had diabetes. Conversation ensued and he had been give a meter and told to eat healthy and lose weight. But his clinician never mentioned the connection between his glucose going up and his choices for food affecting this.

You can guess that we had an education class on the way to the airport.

If you want to check out the new data on carbohydrate’s effect on glucose control and why this limo driver had a greater risk of getting diabetes than his daytime co-workers be sure to read Items #4 and #15.



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The life and legacy of the man who shattered baseball records and racial barriers, but struggled against diabetes – Jackie Robinson. Also, the “All Stars” of diabetes on and off the field; a look at the language of diabetes; and the facts on an important women’s health issue that could be affecting you. Sundays on CNBC at 7 PM ET, 6 PM CT, and 4 PM PT.


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CGM, weight management, carb counting, insulin use in Type 2’s, advanced pumping techniques, motivation, foot screening, health insurance, tai chi, Type 3 issues, grocery store pitfalls and gems, empowerment, keeping your kidneys kicking, cooking demos, zumba dancing, laughter, integrative medicine, Type 1 research update, cutting edge treatments for neuropathy, sexual health and diabetes, the list goes on and on and on.  Register today! Just go to www.TCOYD.com.



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Check out this week’s “Test Your Diabetes Knowledge” question.

Dave Joffe, Editor-in-chief