Clinical Gems

Pramlintide Therapy, Chapter 11 – Part 1 Steve V. Edelman, MD Robert R. Henry, MD The discovery of insulin over 80 years ago is one of the great success stories in the history of modern medicine.  Although insulin remains the mainstay of therapy for many patients with diabetes, the greatest …

Pramlintide Therapy Steve V. Edelman, MD Robert R. Henry, MD Mechanisms of Action: Gastric Emptying In healthy individuals, amylin modulates the rate of gastric emptying, most likely via the vagus nerve, to regulate the inflow of nutrients into the small intestine and thereby reduce the postprandial rise in glucose.

Pramlintide Therapy Steve V. Edelman, MD Robert R. Henry, MD Clinical Practice Study In order to assess the efficacy and safety of pramlintide in a typical clinical practice setting, an open-label study was performed in 166 insulin-using patients with Type 2 diabetes who were not able to achieve glycemic control …

Treatment Algorithm Steve V. Edelman, MD Robert R. Henry, MD The primary treatment goals of managing Type 2 diabetes are to: • Eliminate symptoms of hyperglycemia • Recognize the symptoms of hypoglycemia….

Assessment of the Treatment Regimen Steve V. Edelman, MD Robert R. Henry, MD   Certain key clinical and metabolic parameters should be monitored during office visits:

Assessment of the Treatment Regimen, Part 2 Steve V. Edelman, MD Robert R. Henry, MD Measuring Other Glycated Proteins Enhanced glycation of other proteins occurs in diabetes and has been proposed as another method of assessing average glucose control. Because of….  

Assessment of the Treatment Regimen, Part 3 Steve V. Edelman, MD Robert R. Henry, MD Self-Monitoring of Blood Glucose (SMBG) Systems A combination of factors affect the overall performance of SMBG systems…

Assessment of the Treatment Regimen, Part 4 Steve V. Edelman, MD Robert R. Henry, MD Applying SMBG Results to Adjust Insulin Doses Patients can be taught how to analyze and use SMBG data to effectively make adjustments in their insulin doses so that they can maintain and improve glycemic control…. …

Acute Complications: Metabolic – DKA Steve V. Edelman, MD Robert R. Henry, MD The most common acute complications of diabetes are metabolic problems (DKA, HHNS, hypoglycemia) and infection. In addition, the quality of life of patients with chronic and severe hypoglycemia is adversely affected. Characteristic symptoms of tiredness and lethargy …

Insulin Therapy, Chapter 9 – Part 1 Steve V. Edelman, MD, Professor of Medicine, Division of Endocrinology and Metabolism, University of California, San Diego Robert R. Henry, MD, Professor of Medicine, Division of Endocrinology and Metabolism, University of California, San Diego   Insulin therapy most commonly is reserved for patients …