Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 78-year-old woman who resides in a nursing home is seen for management of her diabetes mellitus. The patient's blood glucose log shows levels ranging between 40 and 400 mg/dL (2.2 and 22.2 mmol/L). She otherwise feels well. She has been on insulin for more ...
Posts tagged Diabetes
3 best practices for both physicians and patients to treat diabetes
As diabetic patients and their physicians continue to work together to combat this metabolic disorder, researchers and medical organizations are uncovering new ways to fight this illness. With 26 million Americans currently battling the disease and 79 million already diagnosed with pre-diabetes, this disease poses a serious threat to our society and our overall healthcare system.With these startling statistics in mind, the Northern States Ambulatory Research Network (NORTHSTAR), a practice-based ...
Quality indicators can harm the elderly
Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators.The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve ...
Physicians aren’t taking mobile health seriously
I just returned home from mHealth Summit Meeting in DC which, in my opinion, is still one of the biggest and best mobile health conferences of the year. On the first day of the conference, I discussed the EndoGoddess App as a use case example of mobile health from the practicioner point of view.Sadly, the numbers of physicians in the mobile health entrepreneural space at mHealth Summit were still few and essentially ...
How political correctness interferes with healthcare
Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term "fat," "obese," or "morbidly obese" because they were stigmatizing, blaming, and the least motivating to ...
MKSAP: 55-year-old man to undergo coronary artery bypass graft surgery
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin A1c value was 7.8%, and his plasma glucose level 2 hours prior to scheduled surgery was 238 mg/dL (13.2 mmol/L). Hemoglobin ...
A medical student becomes a diabetic and finds public disapproval
Recently, our whole class was asked to "become" a diabetic to try and really understand what it is we’re diagnosing people with. Fantastic idea. Fantastic opportunity.Not so fantastic to carry out. I opted for the insulin-dependent, type I option, which meant I had to keep a diary of what I ate (including counting carbohydrates), regularly check my glucose level, and inject myself before meals. (We didn’t actually inject insulin or saline, ...
Steps you can take to prevent developing diabetes
In the past decade, the incidence of diabetes in the U.S. has nearly doubled – this is due in large part to the obesity epidemic. Currently, it is estimated that the lifetime risk of developing diabetes is around 1 in 3 for males an 2 in 5 for females born after 2000. When you consider that type II diabetes has a strong genetic component – the risk for a ...
Hospital discharge summaries are a health literacy issue
A couple of years ago, a frail 88 year old Filipino woman came into the emergency department of my hospital complaining of confusion and weakness of her left arm. Her blood sugar level was extraordinarily low, so low that she would have died had she not received immediate treatment.The emergency room doctors treated her by injecting her with sugar, and then called the team of internists on call to admit ...
Control and be responsible for your diabetes
Diabetes tries to steal moments from me every second of every day. I choose to steal these moments back. Thus, the chosen name for my attitude toward diabetes, Outlaw Diabetic.Unlike the majority of the 360 million diabetics worldwide, I did not become a diabetic in my adult life. I became a type I diabetic at 14 months old. As a result, I have never had to change my way ...
Checking blood sugar is a habit that must be formed
If you don’t know there is a problem how can you fix it? Checking blood sugar for a diabetic is mandatory. This applies to both Type I and II diabetics. I check my blood sugar at least 8 times per day. I do this to allow me to closely monitor my blood sugar level. As a disciplined diabetic, I run the risk of low blood sugar episodes more frequently ...
The physical and emotional costs of non-compliance
There are multiple costs to non-compliance, including financial, both personal and societal, and physical-emotional. When patients fail to comply with treatment protocols, fail to get prescribed tests, or fail to stop destructive behaviors, there is a societal cost.Today, I want to address the physical and emotional costs of non-compliance. I just read a brilliant article by Roxanne Sukol, MD. Dr. Sukol’s article discussed the fact that diabetes starts ...
The majority with diabetes do not lead a disciplined diabetic life
"More than half of all Americans may develop diabetes or pre-diabetes by 2020, unless prevention strategies aimed at weight loss and increased physical activity are widely implemented, according to a new analysis. Diabetes is an epidemic, " according to Denise Mann in WebMD Health News.At 14 months old, the doctor told my parents that the disease would ultimately take my life. The doctor motioned my father into the hallway of ...
Doctors diagnose diabetes 10 years later than the disease warrants
I like my patients vertical. Not horizontal.If I can help it, I want to make sure that nobody gets a disease that could have been prevented. Sure, accidents happen. And illnesses show up every day in the lives of people who did nothing to deserve them, and who could have done nothing to prevent them. But not all illnesses.Physicians know that newly diagnosed diabetic patients present to the doctor ...
Educated online by people with diabetes
Recently, I saw one of my sons blithely dipping a chip into salsa, happily munching away while multi-tasking at something else – not a care in the world about his food.It brought a smile to my face – but there was a touch of sadness with it.You see, my work has brought me into contact with a number of PWDs (People With Diabetes) who are active on-line. And as I’ve ...
What is normal for a teen with diabetes?
by Doctor D, MDA teacher asks Doctor D about a diabetic teenager in his class: "His sugar readings are often over 400. His mom says this is normal. Can this be normal?"What is normal?a) A state of harmony within the body and mind that leads to health and well-being. b) The typical or status quo for a person; the way things usually are. c) WTF? There is no such ...
Preventing disease saves the crippling costs of tertiary care
When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance.His untreated diabetes made his feet go numb. He stepped on a nail and didn't realize it until he noticed ...
Are memory loss and mood disorders actually diabetes of the brain?
An excerpt from Feed Your Brain Lose Your Belly. by Larry McCleary, MD As diseases, memory loss and mood disorders appear to have very little in common. But could memory loss (even severe memory loss such as that which occurs in Alzheimer’s disease) and mood illnesses such as depression and bipolar disorder, actually be treated much the same ...
Treating patients with pre-diabetes: Weight loss and carbohydrate restriction
What physician has not stifled a groan when a patient presents with a chief complaint of "I just don't feel right, Doc."About this time last year, I had that "not quite right" feeling and vague, seemingly unrelated symptoms ... sweating, mid-morning headaches, and frequent feelings of hunger, which I was accustomed to satisfying with a muffin.Like most people -- patients and clinicians alike -- I ignored these subtle signals.One evening, ...
Patients using Facebook for health information
Do you use Facebook to look for health information?If you said "yes," and use social networking sites to research your health, you could be in the minority, or majority, depending on which study you read.Recently, a survey released by the ...
