InsulinPub Date : 2008-07-01DOI: 10.1016/S1557-0843(08)80033-4
Charles F. Shaefer Jr. MD, FACP, FCCP
{"title":"Shopping for basal insulin on the coffee aisle: Lots of choices for lots of tastes","authors":"Charles F. Shaefer Jr. MD, FACP, FCCP","doi":"10.1016/S1557-0843(08)80033-4","DOIUrl":"10.1016/S1557-0843(08)80033-4","url":null,"abstract":"<div><p>Summary</p><p>Even the finest coffee bean in the world, if used in the wrong proportion to water, yields a substandard cup of java. The coffee must be used in the right mixture to yield a really satisfying brew. The same principle is true for insulin. Too little produces a weak, ineffective result that doesn't get the job done; too much causes a different set of problems (hypoglycemia and weight gain). It's good when it's balanced. Regardless of the basal insulin chosen, the clinician should be committed to using enough to produce a pleasing result (fasting blood glucose of 100–110 mg/dL) without overdoing it (inducing hypoglycemia or excessive weight gain). A commitment to conscientiously address one of the major components of broken physiology (underproduction of basal insulin in a setting of increased need because of insulin resistance) by adequately replacing what's missing (basal insulin) likely is of greater impact than the actual agent chosen to fill that basal insulin gap. It's all about finding a comfortable and effective therapeutic tool and then routinely and systematically using that tool for the benefit of your patients. And with that thought, I think I'll wander into the kitchen and use my very predictable old coffeemaker to make myself a satisfying cup of joe.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 3","pages":"Pages 146-149"},"PeriodicalIF":0.0,"publicationDate":"2008-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80033-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87448630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
InsulinPub Date : 2008-07-01DOI: 10.1016/S1557-0843(08)80044-9
Steven V. Edelman MD
{"title":"Cómo controlar la diabetes tipo 1 durante el embarazo","authors":"Steven V. Edelman MD","doi":"10.1016/S1557-0843(08)80044-9","DOIUrl":"10.1016/S1557-0843(08)80044-9","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 3","pages":"Pages 201-202"},"PeriodicalIF":0.0,"publicationDate":"2008-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80044-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77817194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
InsulinPub Date : 2008-07-01DOI: 10.1016/S1557-0843(08)80036-X
Tim Cundy MD
{"title":"Pregnancy loss and neonatal death in women with type 1 or type 2 diabetes mellitus","authors":"Tim Cundy MD","doi":"10.1016/S1557-0843(08)80036-X","DOIUrl":"10.1016/S1557-0843(08)80036-X","url":null,"abstract":"<div><p><strong>Background:</strong> Diabetes mellitus (DM) is known to be a significant risk factor for pregnancy loss, either through still-birth or late intrauterine death or as the result of severe congenital malformation. Improved glycemic control and other advances in care substantially reduced the incidence of pregnancy loss in women with type 1 DM in most countries by the 1970s. However, because of a greater prevalence of obesity since the 1980s, the emergence of type 2 DM in pregnancy has become a significant problem. Although more pregnancies now occur in women with type 2 DM than in those with type 1 DM in many locations, relatively little information has been published about pregnancy loss in type 2 DM.</p><p><strong>Objectives:</strong> This article examines the prevalence and causes of pregnancy loss in type 1 and type 2 DM and identifies factors in addition to glycemic control that may influence pregnancy outcome.</p><p><strong>Methods:</strong> A MEDLINE search was conducted for recent literature on pregnancy loss in DM. Series reporting >200 pregnancies in type 1 DM and/or >100 pregnancies in type 2 DM were included.</p><p><strong>Results:</strong> Thirty-four studies were identified (15 in type 1 DM [1997-2007], 19 in type 2 DM [1986-2007]). In type 1 DM, major congenital anomalies now account for ~50% of pregnancy losses, and all-cause perinatal mortality remains higher than in the general population. Several studies have suggested that the perinatal mortality rate is higher in type 2 DM than in type 1 DM. Factors other than glycemic control probably explain this phenomenon: women with type 2 DM typically are older and more obese, and they come from disadvantaged communities—all risk factors for pregnancy loss, particularly late intrauterine death and chorioamnionitis. In some women, type 2 DM may be recognized for the first time during pregnancy; pregnancies in these women carry the same risks of pregnancy loss as those in women with established DM.</p><p><strong>Conclusions:</strong> Demographic changes in the prevalence of obesity suggest that the prevalence of type 2 DM in pregnancy will almost certainly increase. Although meticulous glycemic control is undoubtedly important in achieving good pregnancy outcomes, clinicians should be aware of the multiple risk factors faced by women with DM.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 3","pages":"Pages 167-175"},"PeriodicalIF":0.0,"publicationDate":"2008-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80036-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89095231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
InsulinPub Date : 2008-07-01DOI: 10.1016/S1557-0843(08)80038-3
Intekhab Ahmed MD, Barry J. Goldstein MD, PhD
{"title":"Insulin and endothelial function: A brief review","authors":"Intekhab Ahmed MD, Barry J. Goldstein MD, PhD","doi":"10.1016/S1557-0843(08)80038-3","DOIUrl":"10.1016/S1557-0843(08)80038-3","url":null,"abstract":"<div><p><strong>Background:</strong> In recent years, the novel effects of insulin beyond control of glucose metabolism have been appreciated, especially those that impact vascular function. A better understanding of insulin's protective interactions with the endothelium has provided clinicians with a justification for more aggressive use of insulin—not only to control glucose levels, but also to potentially reduce the progression of atherosclerosis and its pathogenic sequelae.</p><p><strong>Objective:</strong> In this brief review, we provide a snapshot of the available research and clinical findings signifying beneficial effects of insulin on the endothelium.</p><p><strong>Methods:</strong> We conducted a MEDLINE search of articles published in English from 1965 through 2007 using the search terms <em>insulin, endothelium</em>, and <em>anti-inflammatory</em>. Articles with a focus on “insulin resistance” per se were excluded from this review.</p><p><strong>Results:</strong> The literature search identified 200 articles that addressed the effects of insulin on endothelium and the interaction between insulin and the vasculature.</p><p><strong>Conclusions:</strong> In addition to mitigating hyperglycemic toxicity, insulin has multiple beneficial interactions with the endothelium in physiologic and disease states. The anti-inflammatory actions of insulin confer beneficial effects in preventing and minimizing morbidity and mortality due to atherosclerosis, especially in acute settings like myocardial infarction.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 3","pages":"Pages 185-188"},"PeriodicalIF":0.0,"publicationDate":"2008-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80038-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90352915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
InsulinPub Date : 2008-07-01DOI: 10.1016/S1557-0843(08)80037-1
Jeff Unger MD
{"title":"Reducing oxidative stress in patients with type 2 diabetes mellitus: A primary care call to action","authors":"Jeff Unger MD","doi":"10.1016/S1557-0843(08)80037-1","DOIUrl":"10.1016/S1557-0843(08)80037-1","url":null,"abstract":"<div><p><strong>Background:</strong> Oxidative stress is believed to be the primary cause of the microvascular and macrovascular complications of type 2 diabetes mellitus (DM).</p><p><strong>Objective:</strong> This paper examines the evidence linking oxidative stress with long-term complications of type 2 DM and explores methods to minimize its effect.</p><p><strong>Methods:</strong> A literature search was performed to identify relevant studies for this review. Articles published in English from 2000 to 2008 were identified through searches of PubMed, <em>Diabetes Care</em>, and Google using the search terms <em>oxidative stress, postprandial hyperglycemia, ACCORD Trial</em>, and <em>endothelial cell dysfunction</em>.</p><p><strong>Results:</strong> The literature search identified 423 articles. Although chronic hyperglycemia can be effectively monitored and targeted using glycosylated hemoglobin concentrations, postprandial glucose levels are also important. Postprandial glucose excursions are exhibited by almost all patients with type 2 DM and are independent risk factors for cardiovascular morbidity and mortality. Furthermore, glucose fluctuations during the postprandial period elicit more oxidative stress than chronic, sustained hyperglycemia and can lead to endothelial dysfunction, vascular inflammation, and microvascular complications. In turn, endothelial dysfunction has been implicated in the development of vascular pathologies such as atherosclerosis. Pharmacologic interventions (eg, rapid-acting insulin analogues that target post-prandial glucose excursions) reduce oxidative stress and vascular inflammation and improve endothelial dysfunction.</p><p><strong>Conclusions:</strong> Given the important role of oxidative stress in the development of complications of type 2 DM, physi-cians should consider methods to reduce oxidative stress that may occur during both acute (postprandial) and chronic hyperglycemia. One critical aspect is to reduce postprandial glucose levels to <180 mg/dL while lowering fasting glucose levels to <110 mg/dL. By coaching patients to reach these goals, physicians and other health care professionals can minimize the risk of long-term complications of type 2 DM.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 3","pages":"Pages 176-184"},"PeriodicalIF":0.0,"publicationDate":"2008-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80037-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73604029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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