Serious hypoglycemia associated with misuse of repaglinide.

OBJECTIVE: To report the first case of a serious hypoglycemic episode associated with the misuse of repaglinide. METHODS: The history, clinical findings, laboratory features, and clinical course of this case are described. RESULTS: In a 48-year-old man with autoimmune hepatitis, diabetes developed in association with corticosteroid therapy. Postprandial plasma glucose levels remained in the range of 150 to 200 mg/dL after a 6-week trial of diet-alone therapy, and treatment was begun with repaglinide, 0.5 mg before each meal. On the 11th day of therapy, the patient had a severe episode of hypoglycemia (plasma glucose level of 33 mg/dL) and seizures during the night, after forgetting his dose of repaglinide before the evening meal and subsequently taking the medication 3 hours after that meal. CONCLUSION: Serious hypoglycemia is always a potential consequence of agents that stimulate endogenous release of insulin. In this case report, serious hypoglycemia occurred in a patient at higher risk by virtue of hepatic insufficiency and was clearly associated with the misuse (late postprandial administration) of repaglinide. Continued emphasis on the need to administer repaglinide before meals (and to omit the drug if a meal has been missed or the dose has not been taken preprandially) is indicated if hypoglycemic episodes are to be avoided.

Effect of premixed nph and regular insulin on glucose control and health-related quality of life in patients with type 2 diabetes mellitus.

OBJECTIVE: To compare the effect of the addition of regular insulin as a premixed 70/30 insulin to the treatment regimen of patients with type 2 diabetes who had used NPH insulin alone relative to overall glycemic control (postprandial blood glucose), patient satisfaction, and health-related quality of life. METHODS: We studied 90 patients with type 2 diabetes in a 10-week, randomized, double-blind, crossover trial involving 9 clinical investigators. Patients previously treated with NPH insulin alone were transferred to 30% regular insulin added to 70% NPH as a premixed insulin (70/30) administered twice daily. Patients in one sequence group received NPH insulin twice daily for 4 weeks followed by 70/30 insulin for 4 weeks; in the second sequence group, the order was reversed. RESULTS: The magnitude of the 1.5- and 2-hour postprandial glucose excursion was reduced with 70/30 insulin in comparison with NPH insulin, and patients treated with 70/30 insulin experienced fewer hypoglycemic events than with NPH insulin. With regard to health-related quality of life, patients treated with 70/30 insulin rated their physical functioning as better; rated their ability to be spontaneous, follow the meal plan, and interact socially to be less difficult; and had less fear of hypoglycemia and perceived their diabetes to be better controlled than when treated with NPH insulin alone. CONCLUSION: In patients with type 2 diabetes mellitus, premixed 70/30 insulin improved postprandial glycemic control and health-related quality of life without increasing the frequency of hypoglycemic events and without any additional cost.

Increased incidence of type I diabetes in children of older mothers.

Analysis of chart data in a large series of patients with juvenile-onset, type I diabetes shows a highly significant (P less than 0.001) increased incidence in the children born to older mothers. Diabetes was also much more frequent in the late-birth-order siblings, and this appears to be an alternative expression of advanced maternal age. This observation suggests that there may be a subset of children who eventually develop type I diabetes and are at increased risk by virtue of being born to older mothers.

Experience with penile prostheses in the treatment of impotence in diabetic men.

Increasing use of penile prostheses to treat impotence in diabetic men warrants a detailed assessment of functional and subjective outcomes within this group. This study uses record review and patient-partner questionnaire techniques to examine this population and evaluate postoperative satisfaction in terms of changes in patterns of sexual activity, health status, and complication rates. The satisfaction rates among patients and partners were 81% and 83%, respectively. Frequency of sexual activity was increased, and physical enjoyment was improved among satisfied recipients. Most postoperative complications were treatable and led to dissatisfaction only if they were irreparable. Most prostheses are therefore being used successfully. We recommend that impotent diabetic men be informed of the availability of prosthetic implants.

Diet and diabetes mellitus.

Optimal control of any stage of diabetes is possible only with optimal dietary management. Furthermore, in 90% of stable patients who comply with regimens like those described, this dietary approach alone will suffice for control.