Clinical Gems

Anne Peters, MD, and Lori Laffel, MD, MPH, Editors Jane Lee Chiang, MD, Managing Editor Jeremy Hodson Pettus, MD, and Steven Edelman, MD  GLP-1 AGONISTS The incretin effect was discovered after experiments found that administration of oral glucose resulted in an increased insulin secretion compared to the same amount of …

Elizabeth Blair, MSN, PARN, BC, CDE The week’s excerpt answers the following questions: How do you determine the patient’s knowledge and skill base? What is the emotional component? How can you negotiate goals with a patient? What are the important survival skills that every patient needs to know? What are …

Anne Peters, MD, and Lori Laffel, MD, MPH, editors Jane Lee Chiang, MD, managing editor Jeremy Hodson Pettus, MD, and Steven Edelman, MD Weight Loss Weight gain is associated with intensive insulin regimens. During the first year of the DCCT, subjects assigned to intensive insulin therapy gained twice as much …

Konstantinos Makrilakis, MD, PhD Nikolaos Katsilambros, MD, PhD.  Avoidance of complications Hypoglycemia and hypokalemia are the two most common complications of treatment of hyperglycemic crises with insulin. They have both been reduced significantly, however, with the administration of low-dose insulin and careful monitoring and replacement of serum potassium. 27,28 Frequent …

Anne Peters, MD, and Lori Laffel, MD, MPH, editors Jane Lee Chiang, MD, managing editor   Introduction Jeremy Hodson Pettus, MD, and Steven Edelman, MD   The discovery of insulin over 90 years ago remains one of the greatest success stories in the history of medicine.

Konstantinos Makrilakis, MD, PhD Nikolaos Katsilambros, MD, PhD.  Clinical management The management of HHS is similar to that of DKA. It includes correction of the fluid and electrolyte abnormalities that are typically present and administration of insulin. 1,3,15 Therapy should also aim at simultaneous identification and treatment of the precipitating …

Anne Peters, MD, and Lori Laffel, MD, MPH, editors Jane Lee Chiang, MD, managing editor   Diagnosing Diabetes  Michael J. Haller, MD Standards of care endorsed by the American Diabetes Association (ADA) and the World Health Organization (WHO) provide a number of overlapping criteria for the diagnosis of diabetes. Based …

Richard S. Beaser, MD Michael Johnstone, MD   The weeks excerpt answers the following questions: What are "anginal equivalents"? When is cardiac testing indicated in patients with diabetes who have underlying CAD? When is stress perfusion imaging or a stress echo an appropriate initial choice? When is Doppler testing of …

Konstantinos Makrilakis, MD, PhD Nikolaos Katsilambros, MD, PhD. The earliest symptoms of marked hyperglycemia are polyuria, polydipsia, and weight loss. Unlike DKA, which usually evolves rapidly over a 24-hour period, symptoms in HHS develop more insidiously, often persisting for several days or even weeks before people seek medical attention and …

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 …