The potential to improve diabetes control with vitamin D replacement in African American patients: case report and literature review.

African Americans have a higher prevalence of Diabetes mellitus and associated complications. The prevalence of Vitamin D deficiency is also higher in African Americans. We report an African American veteran who was followed for a period of 10 years in the Endocrine clinic for insulin-requiring diabetes. Despite intensive, medical, nutritional and educational efforts during that period, no discernible progress was made in achieving any improvement in glycemic control. The patient appeared to be noncompliant with recommended strategies to improve glycemia. The patient was seen recently and was found to be profoundly Vitamin D deficient with a 25 (OH) Vitamin D level of 11.6 ng/ml [30-100 ng/ml]. While patient did not wish to change his insulin regimen or diabetic management, he was willing to accept Vitamin D therapy. Replacement with Vitamin D was associated with significant improvement in glycosylated hemoglobin to previously unmatched levels of glycemic control. We discuss the multiple potential mechanisms by which improved Vitamin D status may result in improved diabetes control. Given the current pandemic of Vitamin D deficiency and the plethora of potential benefits, we recommend maintaining adequate Vitamin D reserves in diabetic patients with a special emphasis on minority populations.

Benefits of twice-daily injection with insulin glargine: a case report and review of the literature.

Insulin Glargine is recommended as a once-daily basal insulin. We report a patient in whom nocturnal administration of Glargine was associated with significant morning hypoglycemia despite titration of insulin dose. Changing the Glargine regimen to morning administration did not result in improvement. However, changing to a twice-daily regimen of Glargine resulted in the resolution of the hypoglycemia. Few studies have addressed the role of multiple daily injections of Glargine and this remains a valuable option in the management of diabetic patients. Prior studies using multiple daily injections with NPH insulin and Ultralente have demonstrated success. We propose that patients with hypoglycemia despite titration of once daily Glargine should be considered for a twice-daily regimen. Despite a slight increase in cost and inconvenience for the patient, the increases frequency of administration may result in a greater success in achieving glycemic targets.