MKSAP: 55 year old man to undergo coronary artery bypass graft surgeryTest 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 ...

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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, ...

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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 ...

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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 ...

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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 ...

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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 ...

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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 ...

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"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 ...

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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 ...

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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 ...

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