Objectives: To determine the effects of a guideline-derived resident educational program on inpatient glycemic control and length of hospital stay (LOS). Methods: We compared the following variables before and after resident education: percentage of patients on basal-plus-bolus regimens, mean fingerstick glucose (FSG), LOS, and rates of hypoglycemia (FSG
Comprehensive glycemic control, as demonstrated by desirable glycated hemoglobin A1c (HbA1c), postprandial glucose (PPG), and fasting plasma glucose (FPG) levels, is imperative for managing patients with type 2 diabetes mellitus (T2DM). It is important to minimize fluctuations in blood glucose levels, as they are thought to contribute to both the…
Abstract:A 61-year-old male with a chronic history of renal insufficiency treated with peritoneal dialysis (PD) was discovered to be asymptomatic for an occult insulinoma after peripheral revascularization. The patient's near continuous provision of glucose in the PD fluid acted to conceal symptoms of an insulinoma which was revealed when PD…
Abstract:An 18-year-old male with a history of diabetes presented with hemiparesis. His serum glucose was low, but did not fit the numerical criteria for hypoglycemia. His symptoms rapidly reversed after glucose infusion. This case illustrates crucial features of hypoglycemia. Symptoms may be atypical in the young adult population and may…
Abstract:Homeostatic mechanisms that maintain blood glucose concentration within a narrow physiologic range are complex and redundant. Elaborate feedback loops involving insulin, glucagon, sympathoadrenal mediators, growth hormone, amylin, and incretins normally operate synchronously to keep blood glucose within a narrow set point. Individuals with diabetes have defects in glucose homeostatic pathways,…
Iatrogenic hypoglycemia is the main factor limiting aggressive and optimal diabetes management. Rather than being an inevitable consequence of optimal glycemic control, however, hypoglycemia is avoidable and generally straightforward to manage when it occurs. Professional caregivers, patients, and their families are often fearful of hypoglycemia, even though most episodes are…
A 64-year-old nondiabetic woman presented with spells of lightheadedness and diaphoresis associated with lethargy and hunger of 2 weeks’ duration. Physical examination was unremarkable; however, her fasting plasma glucose was 66 mg/dl, with concurrent plasma insulin of 171 μIU/ml (normal, 5–27 μIU/ml). Her C-peptide and proinsulin levels were elevated, with…
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