The Curbsiders Internal Medicine Podcast

#296 Diabetes FAQ with Dr. Jeff Colburn

Sep 27, 2021
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ADVICE

Workup To Differentiate Type 1 vs Type 2

  • When diagnosing new diabetes, assess type with age, GAD65/islet autoantibodies, and a postprandial C‑peptide paired with glucose.
  • Order diabetes education and tailor treatment after clarifying insulin deficiency versus resistance.
ADVICE

Use Insulin First For Severe Hyperglycemia

  • Start insulin acutely for severe hyperglycemia to rapidly correct glycemia and relieve catabolism.
  • Reassess later to determine if insulin is temporary (glucose toxicity) or long‑term based on doses and recovery.
ADVICE

Introduce Therapies Gradually

  • Avoid overwhelming newly diagnosed patients with multiple complex injectable regimens all at once.
  • Start sensible basics (education, metformin, basal insulin if needed) and escalate gradually.
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