Diabetes Features Archive

Case Study: Hyperglycemia, concern for diabetic ketoacidosis, and type 1 diabetes

Case Study: Hyperglycemia, concern for diabetic ketoacidosis, and type 1 diabetes

A 36-year-old man with type 1 diabetes presents to the emergency room with hyperglycemia and possible diabetic ketoacidosis after not taking his insulin for 3 days.

Using information technology to tailor diabetes care

Using information technology to tailor diabetes care

A study of one tracking system's effect finds improvement in the management of diabetes.

Case Study in Diabetes: Use of DPP-4 inhibitors with GLP-1 agonists

Case Study in Diabetes: Use of DPP-4 inhibitors with GLP-1 agonists

A 63-year-old man with type 2 diabetes was admitted to the hospital to undergo right robotic partial nephrectomy.

The 2017 Standards of Medical Care in Diabetes: an update from the ADA

The 2017 Standards of Medical Care in Diabetes: an update from the ADA

The document addresses important new issues in diabetes management, including metabolic surgery and a more specific definition of hypoglycemia.

Diabetic peripheral neuropathy: an overview

Diabetic peripheral neuropathy: an overview

Often underreported and undertreated, outcomes can be improved in this condition with appropriate screening and diagnosis.

Cultural considerations in diabetes: controlling HbA1c in a patient observing Ramadan

Cultural considerations in diabetes: controlling HbA1c in a patient observing Ramadan

A patient with type 2 diabetes is undergoing dialysis and needs to control his HbA1c levels while fasting during Ramadan.

Medical nutrition
 therapy in diabetes

Medical nutrition
 therapy in diabetes

Developing personalized nutrition goals with a registered dietitian
can be effective in managing non-insulin-dependent diabetes.

Managing nephropathy in a patient with type 2 diabetes

Managing nephropathy in a patient with type 2 diabetes

A patient with type 2 diabetes presents with elevated microalbumin levels and a recent history of elevated glucose due to bedtime snacking.

Avoiding hypoglycemia in a hospitalized patient with diabetes and increased physical activity

Avoiding hypoglycemia in a hospitalized patient with diabetes and increased physical activity

While undergoing physical therapy after a stroke, a patient with type 1 diabetes has a hypoglycemia-related stroke.

Severe insulin resistance in a patient with type 2 diabetes

Severe insulin resistance in a patient with type 2 diabetes

Patients with type 2 diabetes and severe insulin resistance may require large doses of insulin to achieve glycemic control.

Metformin XR for diabetes care

Metformin XR for diabetes care

Patients who forget to take Metformin SR twice daily can be switched to Metformin XR with once daily dosing.

Diabetes management in the younger adult population

Diabetes management in the younger adult population

Patients aged 20 to 44 years who have diabetes have unique health concerns compared with older and younger patients with diabetes.

SGLT2 receptor blockers 
for diabetes

SGLT2 receptor blockers 
for diabetes


SGLT2 receptor blockers are only approved for type 2 diabetes.

Management and treatment of peripheral neuropathy

Management and treatment of peripheral neuropathy

An older patient with type 2 diabetes expresses concern about potential peripheral neuropathy.

Getting hemoglobin A1c under control after a relapse

Getting hemoglobin A1c under control after a relapse

A patient with diabetes questions the necessity of starting a statin.

When type 1 diabetes complicates surgery

When type 1 diabetes complicates surgery

The patient, aged 69 years, had a 43-year history of type 1 diabetes and was scheduled to undergo a chest wall resection.

Renal failure in a patient with maturity onset diabetes of the young

Renal failure in a patient with maturity onset diabetes of the young

A patient presented to the office with a 45-year history of maturity onset diabetes of the young after renal failure.

Nonprescription approaches to metabolic syndrome

Nonprescription approaches to metabolic syndrome

Metabolic syndrome can be managed using changes in diet and exercise.

Dietary fiber: The prebiotic connection

Dietary fiber: The prebiotic connection

Adequate fiber intake is critical for maintaining good health, but only 5% of Americans consume the recommended daily amount.

Preventing and treating periodontitis

Preventing and treating periodontitis

NPs and PAs must work in collaboration with oral health clinicians to effectively educate patients in the prevention of periodontal disease.

Antidepressant for neuropathy pain leads to hyponatremia

Antidepressant for neuropathy pain leads to hyponatremia

An older male patient started antidepressants for neuropathy pain but developed hyponatremia as a result.

Type 2 diabetes management in a post-bariatric surgery patient

Type 2 diabetes management in a post-bariatric surgery patient

A patient, aged 57 years, was admitted to the hospital to undergo gastric bypass surgery. He had a history of type 2 diabetes for ten years.

Think broadly to diagnose the cause of chronic abdominal pain

Think broadly to diagnose the cause of chronic abdominal pain

When diagnosing the cause of chronic abdominal pain, a more specific history and a broad consideration of causes can help with diagnosis.

Elevated blood glucose, weight loss in patient with type 1 diabetes

Elevated blood glucose, weight loss in patient with type 1 diabetes

A patient, Ms. B., was diagnosed with type 1 diabetes three years ago.

Diabetes program helped beat cancer

Diabetes program helped beat cancer


Encouraging a patient to get an overdue Pap exam resulted in an early discovery of uterine cancer that could have gone undetected.

Hypoglycemia in an ambulatory-care setting

Hypoglycemia in an ambulatory-care setting

A type 1 diabetes patient presents to an outpatient facility agitated and slurring his words. Emergency medical help was called to assist the patient.

Statins cut microvascular risk in diabetes

Statins cut microvascular risk in diabetes

Compared with patients who had not taken statins, those who had were less likely to develop diabetic neuropathy by 34%, diabetic retinopathy by 40%, and gangrene by 12%.

Preoperative management in a patient with type 2 diabetes

Preoperative management in a patient with type 2 diabetes

After a patient's elective surgery was postponed due to glucose readings, an assessment of his medical profile and history were evaluated to manage his type 2 diabetes mellitus complications.

Debunking diabetes nutrition, carbohydrate myths

Debunking diabetes nutrition, carbohydrate myths

The Grain Foods Foundation explores popular carbohydrate-related myths and assumptions patients with diabetes have likely encountered.

Easy formula for identifying normal glomerular filtration rate

Easy formula for identifying normal glomerular filtration rate

Each patient loses 0.8% kidney function/year after the age of 30. If you round this to a loss of 1% per year (for simplicity), you can calculate if a GFR is normal for a patient's age.

Be cautious of metformin
 use in chronic kidney disease patients

Be cautious of metformin
 use in chronic kidney disease patients

In specific situations, clinicians should monitor a patient's metformin use in order to prevent dialysis and higher risk of kidney failure.

Identifying obstructive sleep apnea

Identifying obstructive sleep apnea


Airflow disturbances during sleep need to be recognized and evaluated before harm comes to the patients themselves or those around them.

Nuts may lower heart, diabetes risks

Nuts may lower heart, diabetes risks

Patients who ate nuts regularly had reduced diabetes, fatal and nonfatal ischemic heart disease.

An obese woman ­presents with polyuria and blurred vision

An obese woman ­presents with polyuria and blurred vision

A patient recently diagnosed with diabetes complains of worsening malaise and fatigue as well as bilateral extremity cramps.

The case for vegetarianism in the fight against heart disease

The case for vegetarianism in the fight against heart disease

Multiple studies show that just about any low-meat or no-meat diet reduces almost all controllable risk factors for cardiovascular disease.

Dyspnea and cough in an elderly woman with diabetes and CHF

Dyspnea and cough in an elderly woman with diabetes and CHF

Our patient had an extensive medical history, but were her new-onset symptoms the result of poor compliance?

CT assesses plaque in diabetes

CT assesses plaque in diabetes

Only about one-third of the coronary plaque detected showed calcification.

Environmental exposures worsen untreated diabetes

Environmental exposures worsen untreated diabetes

Heavy metal exposure from a patient's well water accelerated multisystem damage associated with diabetes.

A spreading shin rash signifies systemic disease

A spreading shin rash signifies systemic disease

A "bruise" from a minor injury continues to linger for weeks.

Hair loss in a post-menopausal woman with diabetes

Hair loss in a post-menopausal woman with diabetes

Are hormonal changes to blame, or something else?

Cardiac workup for patients 
with diabetes

Cardiac workup for patients 
with diabetes


Are more aggressive approaches to cardiac work up warranted in patients with diabetes?

Blood glucose test reliability

Blood glucose test reliability

In which disease states or at what stages of chronic kidney disease is the HbA1c test no longer reliable?

A schizophrenic patient with poorly controlled diabetes

A schizophrenic patient with poorly controlled diabetes

Dietary supervision may have driven the patient out of his facility.

Misdiagnosed with type 2 diabetes

Misdiagnosed with type 2 diabetes

Despite adhering to lifestyle modifications, a woman's glycemic control remains inadequate.

Frozen shoulder susceptibility 
in diabetic patients

Frozen shoulder susceptibility 
in diabetic patients

Why are individuals with diabetes especially prone to developing frozen shoulder?

Depression complicates wound treatment in a diabetes patient

Depression complicates wound treatment in a diabetes patient

An off-label treatment gives a patient in pain a second chance.

Techniques for blood glucose monitoring

Techniques for blood glucose monitoring

Many patients with diabetes develop poor blood-glucose monitoring habits over time. Reviewing technique helps assure the process is painless.

Restrict fruit juice in a diabetic diet?

Restrict fruit juice in a diabetic diet?

Does fruit juice carry the same diabetes risk as other sugar-sweetened beverages?

Bariatric surgery may reduce type 2 diabetes in obese patients

Bariatric surgery may reduce type 2 diabetes in obese patients

Bariatric surgery may induce type 2 diabetes remission in obese patients, but more direct evidence is needed.

No CV, mortality benefit with omega-3 fatty acids in diabetes patients

No CV, mortality benefit with omega-3 fatty acids in diabetes patients

Omega-3 fatty acid supplementation does not reduce mortality or cardiovascular events in patients with or at high risk for diabetes.

Interventions for prediabetes

Interventions for prediabetes

Two clinicians disagree on a diagnosis after reviewing two-hour oral glucose tolerance test results. Who is correct?

How much insulin does it take to lower blood sugar?

How much insulin does it take to lower blood sugar?

A patient with newly diagnosed diabetes has a hemoglobin (Hb) A1c of 12.2% and glucose 350 mg/dL, despite increasing insulin (glargine [Lantus]) to 25 units. What else can be done to lower blood sugar?

Asymptomatic red lesions

Asymptomatic red lesions

Two patients present with asymptomatic red lesions -- a 60-year-old man, whose lesion was present for five years before beginning to bleed, and a 27-year-old man whose lesion doubled in size during a two year period. Can you differentiate between the two?

Optimizing technology for diabetes care

Optimizing technology for diabetes care

Advancements in diabetes care abound, but busy practice schedules 
make staying current difficult.

Gynecomastia in a patient on dialysis

A 69-year-old man with multiple health conditions develops gynecomastia after hemodialysis. Are the two related?

"Predisease": A concept whose time has come?

"Predisease": A concept whose time has come?

Treating patients before they develop a disease is tempting, but the old 
adage still applies: First, do no harm.

A practical guide to 
metabolic syndrome

A practical guide to 
metabolic syndrome

With obesity on the rise, more patients are at risk for metabolic 
syndrome, a diagnosis given to a set of simultaneous disorders.

Raising vs. lowering bedtime insulin

How can a clinician determine whether it's appropriate to raise or lower bedtime insulin in a patient experiencing difficulty controlling morning glucose levels?

Intensive-dose vs. moderate-dose statins increase diabetes risk, but lower CVD risk

Statins are widely used for treating elevated cholesterol for both primary and secondary prevention of coronary artery disease. One concern about their use has been the possibility of increasing the risk of diabetes.

How is microalbumin:creatinine ratio interpreted?

How is microalbumin:creatinine ratio interpreted?

When is it appropriate to refer diabetic and hypertensive patients to a renal specialist?

Maturity onset diabetes 
of the young 


What is maturity onset diabetes of the young (MODY)? How does it differ from types 1 and 2 diabetes?

Alternative therapy for gestational diabetes

Alternative therapy for gestational diabetes

Insulin is the only agent recommended to lower glucose levels in pregnant 
women, but a second-generation sulfonylurea may provide another option.

Diagnosing new-onset diabetes in children and teens

Diagnosing new-onset diabetes in children and teens

Type 2 diabetes in this population is increasing, but type1 diabetes is more prevalent. The ability to differentiate between these conditions is crucial.

Screening for B12 deficiency in diabetic patients

What is the treatment goal for B12 in a patient with diabetic neuropathy, given the wide range of normal (200-950 pg/mL)?

New strategies against obesity comorbidities

New strategies against obesity comorbidities

Obese adults are at risk for many serious health conditions, including diabetes, coronary heart disease, hypertension, stroke, obstructive sleep apnea (OSA), depression and liver disease.

Stat Consult: Polycystic ovary syndrome

Stat Consult: Polycystic ovary syndrome

A quick review of polycystic ovary syndrome, a heterogeneous androgen excess syndrome that can cause hirsutism, secondary amenorrhea, obesity, hyperinsulinemia and infertility, providing the latest global evidence for diagnosis and treatment.

Consider many factors when assessing GI bleed risk

The risk for experiencing a serious GI event rises exponentially with increasing numbers of risk factors.

Are certain antidiabetes drugs better than others after gastric bypass?

Following gastric bypass surgery, many patients will still need metformin or glipizide (Glucotrol). Is there any evidence that one class of hypoglycemic agents is better absorbed than another?

Are ACE inhibitors and ARBs recommended for renal disease?

Tight glycemic, BP and cholesterol control, as well as weight reduction, exercise and smoking cessation can help prevent renal nephropathy.

Insulin detemir as first-line diabetes treatment

What are the effects of using insulin detemir as first-line treatment for type 2 diabetes?

Metformin's impact on levels of vitamin B12

How much B12 supplement is adequate for patients on metformin?

Nutrition therapy for new diabetes patients

Nutrition therapy for new diabetes patients

The latest evidence-based dietary recommendations from the American Diabetes Association focus on disease prevention and treatment.

Diabetic retinopathy: diagnosis, prevention and treatment

Diabetic retinopathy: diagnosis, prevention and treatment

Diabetic retinopathy is the most common eye disorder in people with diabetes and is a primary cause of blindness in adults.

Diagnosis and treatment of latent autoimmune diabetes in adults still evolving

Diagnosis and treatment of latent autoimmune diabetes in adults still evolving

Latent autoimmune diabetes in adults is often mistakenly diagnosed and treated as type 2 diabetes.

C-peptide against type 2 diabetes?

Is there any role for C-peptide in the management of type 2 diabetes mellitus?

When is it OK to stop insulin?

Is it prudent to discontinue insulin in an incarcerated man with diabetes who was started on insulin while in jail, but who wishes to stop treatment?

Exercising to control diabetes

Exercising to control diabetes

Unlike other chronic life-threatening diseases type 2 diabetes can be managed and even reversed. Exercising can help patients reduce the risk of complications, including stroke and heart disease.

Managing type 2 diabetes with renal impairment

Managing type 2 diabetes with renal impairment

Early identification and treatment is essential to the prevention of chronic kidney disease, a common diabetes complication.

Caring for women with diabetes

Caring for women with diabetes

Consider psychosocial factors, heart disease and other unique risk factors when treating women with diabetes.

Managing diabetic neuropathic pain

Managing diabetic neuropathic pain

Neuropathy is one of the most common diabetic comorbidities — affecting about 60% to 70% of patients. Managing glucose levels is the most direct way to prevent nerve damage and alleviate pain.

Educating vulnerable populations about diabetes

Educating vulnerable populations about diabetes

Health care practitioners may need to navigate language barriers, cultural differences and health-literacy challenges to effectively educate patients with diabetes.

Blisters on swollen ankles

A black woman aged 52 years developed large (1.5-2.0 cm wide), fluid-filled blisters on her swollen ankles. There were no other symptoms, and the patient's health history was unremarkable except for anemia. What could be the cause?

Referral to a specialist not in time

Referral to a specialist not in time

Did a patient die because her clinicians waited too long before referring her to a wound-care clinic?

Taking coenzyme Q10 with lipid-lowering meds

Does research support the addition of coenzyme Q10 for those on lipid-lowering medication?

Bringing up weight loss with children

What is the best way to tactfully discuss a child's excess weight with his or her parent?

Screening for diabetes now more convenient

Screening for diabetes now more convenient

Because the HbA1c test doesn't require fasting, clinicians hope it will reduce the number of people going undiagnosed with type 2 diabetes

Maturity-onset diabetes screening

What are the most recent screening and diagnostic criteria for maturity-onset diabetes of the young?

A man who can't stay warm

A 54-year-old man from India with a history of type 2 diabetes, hypertension, and dyslipidemia, has cold hands and feet despite wearing sufficient clothing. A specialist has ruled out Raynaud's disease.

Nurse understands bigger picture after caring for devoted couple

Husband and wife in an arranged marriage share story of life-long bond forged during a crisis.

Tractor accident holds answers to severe pruritic rash years later

Nurse's curiosity leads to a cure for a debilitating skin condition.

Selenium

Selenium

Selenium is a stable trace-metal element that is found in such cruciferous foods as broccoli, garlic, and onions, as well as in meats, seafood, and nuts. In the human body, selenium is essential for protein synthesis and multiple enzymatic functions.

Patient undergoing amputation gets once last dance

Patient undergoing amputation gets once last dance

A 72-year-old man with a diabetic foot ulcer shares one of his past times before surgery.

Diabetic foot ulcers in underinsured patients

Diabetic foot ulcers in underinsured patients

Successful treatment can cost tens of thousands of dollars. With limited access to care, these patients often present with advanced disease.

Alternatives to insulin

In rural health-care settings, many patients are reluctant to use insulin.

New technology aids glucose monitoring

New technology aids glucose monitoring

Designed to record blood sugar levels throughout the day, these devices spot trends that may go unnoticed with standard tests and measurements.

Anticoagulation on dialysis

How can I ensure that patients receiving dialysis maintain therapeutic anticoagulation while on warfarin?

Patients must take ownership of their care

When it is OK to say, "I have done as much as I can for this patient."

Screening for microalbuminuria in patients with diabetic nephropathy

How does screening for microalbuminuria change the management of these patients?

Exercise guidelines for patients with diabetes

Exercise guidelines for patients with diabetes

Prescribe at least 150 minutes of moderate-intensity or 90 minutes of vigorous-intensity aerobic exercises per week, plus some weight training.

An antipsychotic's side effects derail a patient's symptom management

An antipsychotic's side effects derail a patient's symptom management

After five years of treatment without side effects, his glucose level took off.

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