Clinical Gems

Combination Therapy, Chapter 9 – Part 4 Steve V. Edelman, MD Robert R. Henry, MD Combination therapy usually refers to the use of oral antidiabetic agents (daytime) together with a single injection of intermediate-acting or long-acting insulin at bedtime. The rationale for using an evening-insulin strategy is based on the …

Multiple-Injection Regimens, Chapter 9 – Part 5 Steve V. Edelman, MD Robert R. Henry, MD One of the more common insulin regimens utilized in Type 2 diabetes mellitus is a split-mixed regimen consisting of a prebreakfast and predinner dose of an intermediate- and a fast-acting insulin. This split-mixed regimen of …

Insulin-Pump Therapy + New Types of Insulin Preparations + Complications of Insulin Therapy, Chapter 9 – Part 6 Steve V. Edelman, MD Robert R. Henry, MD Insulin-Pump Therapy Insulin-pump therapy has been traditionally used for people with Type 1 diabetes. People with Type 1 diabetes usually do not have insulin …

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…