Thursday, January 24, 2013

Repetition of basic concepts moves them toward effective action

Questions from yesterday

 #1 Can you name one cause of elevated Fasting Glucose Tests not related to insulin 
      deficiency ?
      Answer- unrecognized low blood glucose between 2 and 3 am

#2  Can you name 2 groups of diabetes medications , other than insulin , that helps control 
      the dysfunctional  glucagon  problems ?
      Answer -  GLP-1 agonist - exenitide ( Byetta and Bydureon ) and liraglutide ( Victoza )
                        DPP-4 inhibitors - liragliptin ( Tradjenta ) , saxagliptin ( Onglyza ) , and 
                                                        sitagliptin ( Januvia )


The take home message from a few days ago is worth repeating

       ( remember : Repetition of basic concepts moves them toward effective action )

Take home message- 

                                         Look for patterns
  Do not focus on the occasional unexplainable glucose elevation look for patterns. Significant medical problems such as insulin deficiency and illness cause persistent glucose elevations. 

We have spent the last few days discussing the importance of testing the fasting glucose and and adjusting your medications to correct this test into your selected target range. I will  now add another term  , basal insulin.
                                         Basal Insulin.
Basal insulin is the steady insulin released from Beta cells maintaining normal fat and glucose metabolism when we are not eating. Basal insulin production is decreased in people with diabetes . 
                                                     Best tool
Your best tool for evaluating your basal insulin production is the fasting blood glucose test. This is the one test of the day that has not been effected by food intake.

             Persistant daily elevation of the Fasting glucose indicates ;
that you are not producing or taking enough insulin to suppress the inappropriate release of glucose from the liver.
Insulin deficiency is the most common cause for this problem . Illness ,especially unrecognized bladder infections , and medications such as steroids also have to be considered.

 Common ways of increasing Basal insulin and correcting the fasting glucose include.

  #1  adjusting the basal rate on a persons insulin pump      yes      no
  #2  adjusting the dose of Lantus insulin                                yes      no
  #3  adjusting the dose of bedtime NPH insulin                     yes      no
  #4  adjusting the dose of oral diabetes medication              yes      no
  #5  adding a medication  to more effectively  control 
        glucagon levels                                                                    yes      no
  #6  checking a 3 am glucose                                                     yes      no
  # 7 not eating a bedtime snack                                                 yes      no

Have fun , Be Smart and  set target goals and correct your fasting blood glucose
David Calder, MD


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Your comments and questions are appreciated. David Calder,MD