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In industrialized countries, 20–40% of T1DM patients younger than 20 years present with diabetic ketoacidosis. After adjusting for age, gender, ethnicity, diabetes type, and family history of diabetes, diabetic ketoacidosis at diagnosis was associated with lower family income, less desirable health insurance coverage, and lower parental education. Younger children present with more severe symptoms at diagnosis, because children younger than 7 years old have lost on average 80% of the islets, compared to 60% in those 7–14 years old and 40% in those older than 14 years.

In part 2 of this Exclusive Interview, Dr. Andy Rhinehart shares the benefit of keeping up with various diabetes guidelines, even from outside of the U.S.

New study shows that taking anti-psychotic medications decreased diabetic complications.

New research shows duration a greater predictor than glycemic control or A1C.

Endothelial dysfunction is the link between ED, DM, and CAD.

Study suggests better coping strategies might have a role to play in prevention.

Last week, our Featured Writer Dr. Sheri Colberg, Ph.D., FACSM invited reader questions on her most recent article. See her responses to your questions here.

Mr. Hernandez is an overweight (BMI 30 kg/m2), 45-year old plumber of Hispanic heritage who arrives at your office for a first-time visit. He has not been to a physician during the last 7 years because he hasn’t always had health insurance and “doesn’t like going to the doctor.” However, he has been noticing lately that his vision seems a little blurry and he’s developed a red, itchy rash in his groin. He is a non-smoker and recalls being told a long time ago that he should eat a low salt diet, but he can’t remember why. On examination, his BP is 154/96 mm/Hg, and his pulse is 72, RR 22. His physical exam is notable for signs of a yeast infection in his groin. You order a CBC and A1C to be drawn that day before he leaves. You advise him how to treat his skin infection. When you receive the results of the chem 12 panel, it shows a random plasma glucose of 162 mg/dL and A1C 7.3%. You call Mr. Hernandez and ask him to return the next morning, before he has eaten, for additional labs. In this individual, you might order all the following labs EXCEPT...follow the link to select your answer!

A teenage type 1 on an insulin pump was seen in our office for follow up. The download on her pump revealed some interesting numbers. First off, her glucose levels were out of target range and secondly her I:CHO ratio and her insulin sensitivity looked more like the numbers of a type 2 diabetic vs a type 1. Her I:CHO was 1:16 and her insulin sensitivity was 1:30. In my experience, I'm used to seeing a lower I:CHO and a higher insulin sensitivity in type 1 vs type 2.

In part 1 of this Exclusive Interview, DIC Publisher Steve Freed talks with Dr. Andy Rhinehart to learn about a new insulin dosing support software that is used in conjunction with doctor intervention.