Search

Dosing insulin is like a dance. The insulin dose is initially calculated, and then the blood glucose levels must be evaluated, in order to increase or decrease the insulin dose responsible for that blood glucose value. The goal is not to go chasing after the blood glucose has risen but to prevent its rise. For this, one must carefully take into account the quality and quantity of a given meal (and its carbohydrate content), the activity level, the patient’s health status, and how other medications could affect the blood glucose levels.

Insulin pump therapy has been around since the late 1970s. From the “Big Blue Brick” to the sensor-augmented pumps, significant improvements have been made in the technology. The first hybrid close loop device was approved for clinical use by the FDA in the fall of 2016.

Hypoglycemia is one of the most common complications of diabetes and a major limiting factor in the glycemic management of diabetes. Individuals with type 1 diabetes (T1D) and long-standing type 2 diabetes (T2D) have altered counterregulatory responses to hypoglycemia, which puts them at risk for recurrent hypoglycemia and may develop hypoglycemia unawareness. Acute hypoglycemia is associated with increased morbidity, impacts quality of life, and can even be fatal. Severe hypoglycemia should be treated promptly and should be followed by drastic changes in patient’s therapy and lifestyle. Optimal glycemic control while minimizing the risk of hypoglycemia is possible by applying the principles of aggressive therapy and practicing hypoglycemic risk reduction.