Dr. B Diabetes

A diabetic patient has a fasting glucose of 220 mg/dL. A 3 AM glucose check shows 50 mg/dL. What is the cause?

Somogyi effect (overnight hypoglycemia causing rebound hyperglycemia)

A diabetic patient has a fasting glucose of 220 mg/dL. A 3 AM glucose check shows 140 mg/dL. What is the cause?

Dawn phenomenon (early morning hormone release causing hyperglycemia)

What is the key difference between Somogyi effect and Dawn phenomenon?

Somogyi has LOW 3 AM glucose; Dawn has NORMAL or HIGH 3 AM glucose.

A 52-year-old patient is newly diagnosed with Type 2 diabetes. Their A1C is 11.2% and fasting glucose is 320 mg/dL. What is the most appropriate initial treatment?

Start insulin therapy because the A1C is greater than 10% and the glucose is greater than 300 mg/dL.

A patient with Type 2 diabetes has an A1C of 7.8% and fasting glucose of 160 mg/dL. What is the preferred initial treatment?

Metformin with lifestyle modifications because the A1C is below 10% and glucose is below 300 mg/dL.

A patient presents with weight loss, excessive thirst, frequent urination, and an A1C of 10.5%. What treatment should be considered?

Insulin therapy because the patient has symptomatic hyperglycemia and an A1C greater than 10%.

A1C < 9%

Usually start Metformin

A1C ≥ 9%

Consider dual therapy

A1C ≥ 10% or glucose ≥ 300

Start insulin