Henry is a 67-year-old vice president of sales and marketing at a large telecommunications company. Diagnosed with type 2 diabetes 23 years ago, he has sought to keep his blood glucose, weight, and other cardiovascular risk factors in check through the following measures:
- using a basal-bolus insulin regimen:
- bed time insulin glargine (20 units); and
- pre-meal insulin lispro, dosed according to an Insulin:Carbohydrate ratio of 1:15 and correction factor of 50 (1 unit of insulin for every 50 mg/dl above his target blood glucose of 120 mg/dl).
- taking atorvastatin (10 mg) with low-dose aspirin (81 mg) daily;
- maintaining a ‘heart-healthy’ diet, containing large quantities of fruits and vegetables;
- checking his blood glucose every morning and evening; and
- walking 90 minutes per day.
Despite these healthy habits, Henry’s HBA1c is 8.2 %, higher than the widely accepted target of 7.0 %. At the same time, his self-monitoring of blood glucose (SMBG) logbook indicates pre-breakfast and pre-dinner average of 90–110 mg/dl, consistent with published guidelines.1,2 The handwritten entries also reveal regular breakfasts of cold cereal with a banana each morning, followed by frequent ‘pick-me-ups’ of fruit throughout the day. Scanning the pages, the physician notes the lack of mid-day readings compared with other time periods. Henry explains that he often takes clients out for extended lunch meetings and feels uncomfortable checking his blood glucose in these situations. He adds that because carbohydrate counting is ‘hit-or-miss’ in restaurants, he deliberately restricts his orders to lean meats and vegetables. Furthermore, with lunch as his major meal of the day, his dinner often consists of a salad, with fat-free dressing, prepared after a 5-mile ‘speed walk’ every evening. >To view the full article in PDF or eBook formats, please click on the icons above.