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'I feel like a traffic light stuck on red. My friends ask me if I'm having hot flushes but this isn't flushes, it's permanent and I'm still having periods.' Carol is describing her facial appearance. She is 42 years of age, has had trouble controlling her weight all her life and has gained 10 kg over the past 2-3 years.

Background: Problems with traditional bolus insulins include delayed time to onset and offset, and with basal insulins, an overnight peak and poor reproducibility. Analogue insulins have been formulated to better emulate physiologic insulin secretion and improve glycaemic control without increasing hypoglycaemia., Objective: This article discusses analogue insulins and outlines their role in current diabetes management., Discussion: Analogue insulins do offer some advantages over traditional insulins. The bolus and basal analogues offer flexibility, and basal analogues reduce nocturnal hypoglycaemia. However, there is limited evidence supporting improved glycaemic control with analogue insulins. No study has looked at long term outcomes and hard endpoints. Rapid acting analogues are widely used, generally in type 1 diabetes. The basal analogues glargine and detemir are significantly more expensive compared to traditional basal insulins, but were listed on the Pharmaceutical Benefits Scheme on 1 October 2006. Glargine is available for patients with type 1 and insulin requiring type 2 diabetes, while detemir has been recommended only for patients with type 1 diabetes. Patients with type 1 diabetes, particularly those with hypoglycaemic unawareness, may be expected to derive most benefit from the new basal analogues.

Case Study: 'I've got these ugly red blotches on my legs and they are getting worse?' Lisa, 32 years of age, is an accountant who always presents herself meticulously. You can understand why she doesn't like the raised red brown blotches on her shins. The lesions are raised, indurated with follicular accentuation. They are an uneven red-brown colour that doesn't fade with pressure, nor does the tissue pit. Lisa seems more upset and agitated than you expected. When you ask if she's under stress at work she breaks down in tears and says she feels 'agitated and on edge all the time and can't sit still for a minute'.

Gestational diabetes affects around 5% of pregnant women, however the value of screening women for gestational diabetes has been hotly debated. On the positive side there has been potential benefits for the baby and, on the negative side, the costs of managing gestational diabetes to the mother. This controversy has largely been settled with the publication of the Australasian Carbohydrate Intolerance Study (ACHOIS). This article reviews the implications of ACHOIS for Australian women and their general practitioners.

Background: Diabetic nephropathy is a significant contributor to the morbidity, mortality and health care cost among patients with diabetes. With increasing understanding of this problem, the natural progression of diabetic nephropathy can potentially be changed., Objective: This article examines the natural history of diabetic nephropathy and provides guidelines on detection, management and future treatment possibilities of this complication., Discussion: Prevention and slowing progression are the most important aspects of the management of diabetic nephropathy. This involves monitoring renal function and risk factors for renal damage and early active intervention. The angiotensin converting enzyme inhibitors and receptor antagonists are important components of therapy, both for controlling hypertension and for slowing the progression of micro and macroalbuminuria. When microalbuminuria occurs, intensive intervention on a range of risk factors can halve the number of those suffering a cardiovascular event or progressing to macroalbuminuria. When renal insufficiency occurs, particularly when creatinine clearance is >30 mL/minute, referral to an nephrologist should be considered.

Higher protein diets are currently 'hot'. The CSIRO total wellbeing diet book has been on the bestseller list in Australia and internationally. Various other high protein diets have also had, or are getting, media attention. However, high protein diets, particularly for people with diabetes, are controversial. There are questions about effectiveness and safety, especially in the long term. As a general practitioner people will look to you for advice about what to eat. This article summarises the pros and cons of two of the popular higher protein diets--the Atkins diet and the CSIRO total wellbeing.

Objective: To examine the association of health status with stage along the diabetes continuum., Design, Setting and Participants: Self-reported health status (SF-36) was assessed in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Impaired fasting glucose (IFG), undiagnosed diabetes, diagnosed diabetes, glycaemic control and cardiovascular disease were determined from fasting blood and self-reported data., Results: The prevalence of diagnosed diabetes was 5.6% (95% CI: 4.9-6.3), with an additional 1.0% (95% CI: 0.7-1.4) previously undiagnosed. When compared to those with normal glucose, those with diabetes were significantly impaired on all SF-36 dimensions except Mental Health, and those with IFG (4.3%) were significantly impaired in terms of Physical Functioning and Bodily Pain when controlling for the effects of age, sex and cardiovascular disease. Poor glycaemic control (HbA1c >or= 7.0%) was also associated with impaired health status., Conclusions: Health status is impaired not only among those with diagnosed diabetes but also those with IFG and undiagnosed diabetes.

Background: Routine clinical measurements of glycated haemoglobin first became available during the early 1970s and are now accepted as the standard for estimated overall glycaemic exposure and risk of microvascular complications in diabetes., Objective: This article attempts to answer frequently asked questions concerning A1C, and provide guidance on how to make best use of A1C measurements in clinical practice., Discussion: Blood glucose gives immediate day-to-day information and A1C usually gives a reliable estimate of the average glycaemic exposure over the past 6-8 weeks. Both are important components of glycaemic monitoring. Discrepancies between these two estimates of glycaemia can usually be resolved by checking blood glucose and A1C techniques. Target A1C is less than 7%, but encouraging patients to aim slightly lower (eg. by 0.5%) on A1C can result in significant reduction in complication risk. There is a clear relationship between glycaemic control reflected by A1C and the progression of microvascular complications in both type 1 and type 2 diabetes.