Faculty Bibliography

Exercise has variable effects on diabetes control. It may cause deterioration in diabetes regulation if patients are hyperglycemic, whereas it may reduce blood glucose levels in well-controlled patients. Factors influencing the magnitude of blood glucose reduction include timing of meal ingestion, peak of insulin activity and whether the extremity injected is exercised. Plasma cholesterol and triglyceride levels decrease while high-density lipoprotein levels may increase with activity.

Self-monitoring of blood glucose levels has become popular due to the limitations in the use of urine testing for assessing the status of diabetes control. Furthermore, the recent emphasis on the importance of diabetes regulation entails that patients tailor the insulin doses based on blood glucose levels. This review discusses the methodology of capillary blood glucose monitoring and its application to insulin adjustments. When performed properly, self-monitoring is accurate, reliable, and effective. It can also be beneficial in detecting hypoglycemia and may have a positive psychological impact as well. The reduction in the frequency of office and laboratory visits makes self-monitoring potentially cost-effective. Although useful for a broad segment of the type I diabetic population and for an increasingly large number of individuals with type II diabetes, self-monitoring may have a limited role in patients with severe, irreversible complications

The present study investigated the feasibility of basal continuous subcutaneous insulin infusion (CSII) in four patients with postoperative sepsis or extensive burns during continuous enteral hyperalimentation with 2,500 to 3,000 calories/day, containing approximately 390 g of simple carbohydrates. The mean duration of CSII treatment was 16.8 days (range, seven to 32 days). The mean capillary blood glucose level fell from 322 +/- 52 mg/dL during pre-CSII therapy to 195 +/- 33 mg/dL during CSII therapy. Only 1.3% of 1,254 capillary blood glucose values were less than 60 mg/dL. Most values (61.6%) were between 61 and 200 mg/dL. The mean insulin infusion rate was 2.5 +/- 1.5 units/hr. These preliminary observations suggest that basal infusion CSII is a safe and effective means of improving blood glucose control in patients receiving enteral hyperalimentation despite the high glucose intake and presence of insulin resistance. Thus, CSII therapy can enhance the metabolic response to hyperalimentation without requiring an intravenous access route.