We all know of patients who walk around with glucose levels of 400mg/dl without any problems functioning. Most of our patients are often 100-200 points too high and they don’t even know it. When we start them on insulin, we usually go slow for fear of hypoglycemia, as often it …

Female, 26 years of age, type 1 diabetes for 15 years, well-educated, uses insulin pump. Recent A1C 7.6%; has been rising from 6 to 6.5. Thinks her mealtime insulin is not working fast enough. She does bolus about 20 minutes before eating. Assessed pump, CGM, food intake and activity. Her report seemed to be the case.

Michael Hill explains how the system works when a patient's blood glucose drops.

Dr. Stanley Schwartz asks and begins to answer the question: is insulin beneficial for the vasculature as well as the patient -- or not?

Linking molecular and metabolic regulation of hepatic glucose metabolism: Cross-talk between metabolism and molecular biology is an emerging mechanism of metabolic regulation and is particularly relevant to the control glucose metabolism in liver. Some transcription factors and nuclear receptors are activated in response to metabolites. During fasting lipid metabolites are released that activate PPARα and induce the gene expression of oxidative metabolism.