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Adding Prandial Insulin

Your patient has been systematically titrating his basal insulin dose for the last 6 months. His daily dose is NPH .90 U/kg/day. Despite his good efforts, you decide it would be prudent to add a prandial insulin dose to his treatment regimen. Which of the following scenarios might lead you to this conclusion?

A. A1C=7.4%, FPG less than 130 mg/dl, PPG greater than 180 mg/dl
B. A1C=7.0%, FPG less than 130 mg/dl, PPG less than 180 mg/dl
C. A1C=7.0%, FPG less than 120mg/dl, PPG less than 160mg/dl
D. A1C=6.8%, FPG less than 120 mg/dl, PPG less than 160 mg/dl

Follow the link for the answer.

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Summer Camp Rejuvenation: Hitting the Reset Button

This summer I had the opportunity as a student pharmacist to attend a camp for youth with type 1 diabetes (T1D) and assist as a member of the medical staff. We spent the first few days setting up, going over camp procedures and policies, and preparing for arrival of the campers. This was my first time helping at such an event, and my expectations of how deeply the camp experience would impact the lives of the campers (and myself included!) were greatly exceeded.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #136: Pathogenesis of Type 2 Diabetes Mellitus Part 7

Cellular mechanisms of insulin resistance: The cellular events via which insulin initiates its stimulatory effect on glucose metabolism start with binding of the hormone to specific receptors that are present on the cell surface of all insulin target tissues. After insulin has bound to and activated its receptor, “second messengers” are generated and these second messengers activate a cascade of phosphorylation-dephosphorylation reactions that result in stimulation of intracellular glucose metabolism. The first step in glucose utilization involves activation of the glucose transport system, leading to glucose influx into insulin target tissues, primarily muscle. The free glucose, which has entered the cell, subsequently is metabolized by a series of enzymatic steps that are under the control of insulin. Of these, the most important are glucose phosphorylation (catalyzed by hexokinase), glycogen synthase (which controls glycogen synthesis), and phosphofructokinase (PFK) and PDH (which regulate glycolysis and glucose oxidation, respectively).

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Kathleen Wyne 2018 Transcript

In this Exclusive Interview transcript, Kathleen Wyne talks with Diabetes in Control Medical Editor Joy Pape during the AACE 2018 convention in Boston, MA about adult onset type 1 diabetes and its misdiagnosis, and how to determine whether a patient has type 1 or type 2 diabetes.

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