Practical Pointers: Diabetes

This Practical Pointers column originally was published in the May 1990 issue of Consultant. The authors were Emil L. Georgieve, MD, from Oak Forest, Illinois; Leon W. Berube, MD, from Mechaniscville, Maryland; and James C. Farley, MD, from Wilkes-Barre, Pennsylvania.

Primary Test for Diabetes

Before I send a diabetic patient home to monitor blood glucose levels using colorimetric methods (visual comparison of color changes on glucose oxidase strips), I test his or her color perception. In the short time I have been doing this, I have already encountered patients who would have perceived only misleading results. For those persons, I recommend glucometers that show a digital readout.

Emil L. Georgieve, MD
Oak Forest, Illinois

Incremental Lunch for Diabetics

A combination of short- to medium-duration insulins given twice a day is usually adequate to regulate blood glucose levels in patients with insulin-dependent diabetes mellitus. But the one period of less-than-optimal control is lunchtime, when consumed food releases a glucose bolus. An insulin pump or third injection of regular insulin before lunch has obvious disadvantages. An alternative is the incremental lunch: one half-pint of milk and a sandwich that the patient consumes in small amounts over a 3-hour period. The patient should begin nibbling around 10:00 AM (or earlier if hypoglycemic symptoms develop), and finish around 1:00 PM. This type of meal helps maintain proper weight as well as a more satisfactory blood glucose level throughout the day. Many patients have a daytime schedule that lends itself to this plan.

Leon W. Berube, MD
Mechanicsville, Maryland

The Dietary Fiber-Blood Sugar Connection

If your insulin-dependent diabetic patient under good control suddenly starts developing hypoglycemic reactions, and there has been no increase in insulin dosage or exercise level and no decrease in dietary intake, ask about his or her fiber intake. Increased dietary fiber can cause a decrease in mean plasma glucose concentration, thus significantly lowering a patient’s daily insulin requirements.

James C. Farley, MD
Wilkes-Barre, Pennsylvania