Once thought to be a beneficial response to critical illness, hyperglycemia is now recognized as independently associated with death and other adverse outcomes in various groups of critically ill patients. Whether normalization of blood glucose by insulin infusion is beneficial in such patients has been a subject of debate in the critical care community. Some new guidelines have been published.

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The development of hyperglycemia in type 2 diabetes results from a combination of metabolic abnormalities including insulin resistance, diminished insulin secretion and excess hepatic glucose production. Diet, exercise and weight loss are helpful in improving glucose control, but most patients ultimately require drug therapy.

Chromium is marketed as a dietary supplement, usually containing 20-500 mcg of a chromium salt. It has been promoted for weight loss, muscle building, and for prevention and treatment of diabetes, among other claims. As a dietary supplement, chromium can be sold without proof of efficacy or safety.

The development of hyperglycemia in type 2 diabetes results from a combination of metabolic abnormalities including insulin resistance, excess hepatic glucose production and diminished insulin secretion. In many patients, diet and regular exercise can improve glucose control. Most drugs currently available for management of type 2 diabetes increase insulin supply (sulfonylureas, other secretagogues and insulin itself), decrease insulin resistance (thiazolidinediones) or improve the effectiveness of insulin (biguanides). Alpha-glucosidase inhibitors reduce the rate of glucose absorption. Newer agents such as pramlintide (Symlin) and exenatide (Byetta) have multiple effects to increase satiety and reduce postprandial hyperglycemia.

The July 2003 edition of the Canadian Adverse Reaction Newsletter, published by Health Canada (the Canadian FDA), reported that the Health Canada database had received more spontaneous reports of hypoglycemia (19) and hyperglycemia (7) with gatifloxacin (Tequin) than with other quinolone antibiotics.