For patients on insulin who still have a high A1c despite normal fasting blood sugars, have them check their postprandial insulin, which is 2 hours after eating, to see if more mealtime insulin is needed. A postprandial blood sugar level should be less than 180 mg/dL.—Gina Luna, FNP-BC, BC-ADM, Palmdale, Calif.


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.