A BRIEF SUMMARY OF MY CLINICAL OBSERVATIONS

1. Remission lasting up to 18 months can be achieved. (No medications)

2. Diabetic ketoacidosis (DKA) is not strictly correlated with high blood glucose. It has been reported with low blood glucose (e.g. alcoholics with liver disease) and in children using the insulin pump (See German study in slide set). Dehydration is a common key component. The other risk factors for DKA are the presence of infection or inflammation.

3. In patients with normal renal function, safe (hypoglycemia-free) blood glucose control can be achieved with a single dose of glargine insulin daily. I have a polished simple step-wise method of achieving this. No such method is current taught in medical schools or to Endocrinology fellows.

4. Corollary: Multiple shot insulin or insulin pump methods are unnecessary in type 2 patients with normal renal function. The resultant hypoglycemia that attends this archaic approach (ADA method) results in damage to the brain, pancreas, and other organs. Hypoglycemia with its attendant catecholamine surge increases macrovascular complications such as MI and stroke.

5. Several years of poor control or "over-control" with multiple shot insulin results in loss of total beta-cell mass, giving the appearance that all diabetics ultimately deteriorate. This "natural history" interpretation is in error. Such patients are termed "brittle" and their postprandial glucose increases resemble that of "type 1" diabetics.

Roberto Victor Illa, M.D.