Ashcroft SJ.The beta-cell K(ATP) channel. J Membr Biol 2001;176:187-206.
Holleman F and Hoekstra JBL. Insulin Lispro. N Engl J Med 1997;337:176-183.
Kahn CR et al. Unraveling the mechanism of action of thiazolidinediones. J Clin Invest 2000;106:1305-1307.
Miki TK et al. The structure and function of the ATP-sensitive K+ channel in insulin-secreting pancreatic beta-cells. J Molec Endocrinol 1999;22:113-123.
Mudaliar S and Henry RR. New oral therapies for type 2 diabetes mellitus: The glitazones or insulin sensitizers. Annu Rev Med 2001;52:239-257.
Virkamaki A et al. Protein-protein interaction in insulin signaling and the molecular mechanisms of insulin resistance. J Clin Invest 1999;103:931-943.
^ Case Study Insulin Regimens
His physician prescribes 20 units NPH and 5 units regular insulin at breakfast, and 10 units NPH and 5 units regular insulin at dinner. After a few days, Mr. Smith begins to notice this approximate pattern in his blood sugar measurements:
8 a.m. (fasting), about 110; noon (before lunch), about 120; 5 p.m. (before dinner), about 55; bedtime, about 115.
When his blood sugar is about 55, he feels shaky and sweaty, but this goes away if he has something to eat. Which of the following changes would you recommend to his regimen?
Decrease his morning regular insulin Decrease his morning NPH insulin Stop evening insulin and add a sulfonylurea at bedtime
Have him eat a larger lunch Move his evening NPH insulin from supper time to bedtime
Answer: Mr. Smith should decrease his morning NPH insulin. Since on awakening his fasting glucose is in the normal range and after taking his morning regular insulin his blood glucose remains in the normal range, there is no need to adjust either his morning regular insulin or his bedtime NPH insulin. Regular insulin is short-acting and would not result in a 5 p.m. low glucose level. The longer-acting NPH insulin given in the morning would continue to lower glucose for the rest of the morning and afternoon, in this case resulting in excessive blood glucose at dinner time.
Was this article helpful?
All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.