Clinical Gems

Richard S. Beaser, MD Michael Johnstone, MD   This week’s excerpt answers the following questions:  What are the three disorders of coagulation and fibrinolysis that increase the risk of developing macrovascular disease When and who should be on aspirin therapy How to reduce macrovascular risks Which ACE inhibitor reduces the …

  Konstantinos Makrilakis, MD, PhD Nikolaos Katsilambros, MD, PhD.     Hyperosmolar non-ketotic hyperglycemia (also called hyperosmolar hyperglycemic state [HHS]) is one of the most serious acute complications of diabetes, with significant morbidity and mortality.

Richard S. Beaser, MD Michael Johnstone, MD The week’s excerpt answers the following questions:  What is the relationship between triglyceride levels and the degree of insulin resistance? Which lipid abnormalities are markers of coronary artery disease (CAD)? What are the current goals for lipids for diabetic patients? Can improved glucose …

            This week we have a short quiz. If you’ like to review the topic a little more before taking the quiz, just follow this link to our previous excerpt at Diabetic Emergencies – Diagnosis and Clinical Management: Diabetic Ketoacidosis in Adults.  

Richard S. Beaser, MD Michael Johnstone, MD  This week’s excerpt answers the following questions: What are the risk factors for the premenopausal female? What is the likelihood of macrovascular disease among those with diabetes?  While diabetes is a result of a metabolic dysfunction resulting in hyperglycemia complications make diabetes mellitus …

Konstantinos Makrilakis, Nikolaos Katsilambros A 28-year-old man with Type 1 diabetes for 12 years is under treatment with long-lasting insulin (e.g., insulin glargine) 26 IU at bedtime and a rapid-acting insulin analog (e.g., insulin lispro) three times a day before each meal (the dose determined depending on the carbohydrate content …

Richard S. Beaser, MD, Edward S. Horton, MD and Catherine A. Mullooly, MS, RCEP, CDE   The weeks excerpt answers the following questions: How to adjust insulin for activity What is the "lag effect" Which snack foods are best for exercise

Konstantinos Makrilakis, Nikolaos Katsilambros In patients taking insulin — either basal only ( ± pills) or a more intensified regimen (insulin mixtures two or three times daily or a basal-bolus regimen) — the “sick-day rules” should be taught and the patient should be provided with urine strips to test for …

Richard S. Beaser, MD, Edward S. Horton, MD and Catherine A. Mullooly, MS, RCEP, CDE  The week’s excerpt answers the following questions:  How much resistance training is needed to improve insulin sensitivity Frequency, duration and intensity levels required Self-care skills applied to physical exertion Individualized physical activity for type 2 …

Konstantinos Makrilakis, Nikolaos Katsilambros During an acute illness, blood sugar levels usually rise. Illness causes a greater than normal demand for insulin due to the release of stress hormones such as adrenaline (epinephrine), cortisone, and growth hormone. These hormones can be triggered by any kind of stressful condition such as …