Longacting Insulins

Ultralente is usually given before the evening meal or at bedtime, has a duration of action that is quite variable (13-18 hours),and has variable peaking times between 8 and 14 hours. Ultralente has fallen into disfavor because of the peaks and valleys in its coverage. Glargine (Lantus) is an analog insulin with significant advantages over the Ultralente preparation. Glargine has an onset of action of 1-2 hours, is virtually peakless, and has a duration of action of 24 hours. Glargine is...

The Natural History Of Type 2 Diabetes

Although both insulin resistance and impaired insulin secretion precede the development of postprandial hyperglycemia and the subsequent type 2 diabetic phenotype, insulin resistance is more prominent in the prediabetic state and plays an important role in the pathogenesis of macrovascular disease. Insulin resistance is commonly the earliest manifestation in the development of type 2 diabetes, typically originating 5-10 years before postprandial glucose levels in the diabetic range (200 mg dL)....

Multiple Riskfactor Reduction

Control of blood pressure plays a critical role in preventing the macrovascular and microvascular complications of diabetes and is a major contributor to excess mortality and morbidity caused by end-stage renal disease, stroke, and cardiovascular catastrophe. The Hypertensive Optimal Treatment trial (37) evaluated the effect of calcium-channel blockers in 18,790 hypertensive patients (8 of whom had diabetes). Overall, the results showed that patients with intensive blood pressure control...

References

Steiner G. (200) Lipid intervention trials in diabetes. Diabetes Care 23(Suppl 2) B49-B53. 2. Mykkanen L, Laakso M, Penttila I, Pyorala K. (1991). Asymptomatic hyperglycemia and cardiovascular risk factors in the elderly. Atherosclerosis 88 153-161. 3. Best JD, O'Neal DN. (2000) Diabetic dyslipidemia, current treatment and recommendations. Drugs 59 1101-1111. 4. Lamarche B, Tchernof A, Moorjani S, et al. 91997) Small, dense low-density lipoprotein particles as a predictor of the risk of...

Diabetic Nephropathy

Diabetic nephropathy is the most frequent cause of end-stage renal disease in the United States, Japan, and Europe. In Europe and the United States, the incidence of diabetic nephropathy has increased substantially, rising by 150 in the past 10 years in the United States alone. Among patients who require dialysis, 40 had diabetic nephropathy, with a 15 higher mortality at 5 years and a 22 higher mortality at 1 year than their nondiabetic cohorts (35). The American Diabetes Association (ADA)...

Diabetes And Fats

Because the essential component of the diabetic paradigm is atherogenesis, it is critically important for patients with diabetes to limit their intake of dietary cholesterol, saturated fat, and trans-fatty acids. These remain important determinants of the plasma LDL cholesterol. Unsaturated fatty acids in the diet are in the form of monounsaturated and polyunsaturated fats. Monounsaturated fats have a single double-bond in their long carbon chain, whereas polyunsaturated fats have two or more...

Types of Stress Tests

Stress echocardiography is effective in demonstrating the effects of exercise and regional wall motion in addition to valvular incompetence. Four views are routinely evaluated, parasternal long, parasternal short, apical four-chamber and apical two-chamber with rest and exercise images juxtaposed. New or significant wall-motion abnormalities suggest myocardial ischemia. In this technique, images are compared at rest and within 1-2 minutes of exercise. This can provide helpful information on...

Introduction

The microvascular complications of diabetes include the following 3. Neuropathy, including mononeuropathy, diabetic amyotrophy, symmetric distal neuropathy, diabetic gastroparesis, diabetic diarrhea, neurogenic bladder, impaired cardiovascular reflexes, and sexual dysfunction (1). Both the Diabetes Control and Complications Trial (DCCT) (2) and the United Kingdom Perspective Diabetes Study (UKPDS) (3) have shown the importance of tight glycemic control in preventing microvascular disease. The...

Lipid Control

For lipid control, there have been several important primary-prevention and secondary-prevention trials. For primary prevention, seven studies with diabetic patients are noteworthy 1. The Prevention Study Texas Coronary Atherosclerosis Prevention Study (3). This study randomly assigned patients with average cholesterol levels of 221 mg dL, LDL of 150 mg dL, and lower than normal HDL of 36 mg dL for men and 40 mg dL for women, to 20-40 mg day of lovastatin or placebo, and followed them for an...

The Meglitinides

The meglitinides are more properly referred to as the glinides because repaglinide and nateglinide are not members of the same chemical class. Repaglinide is a benzoic acid derivative and nateglinide is a phenylalanine derivative. The glinides specifically target postprandial hyperglycemia, and, compared with sulfonylureas, have less risk of hypoglycemia and less continuous stimulation of the P-cells. The glinides are designed to return insulin levels to baseline between meals and to stimulate...