"The hospital room was as cold as dead skin, the hallway crowded with lost souls and reeking of illness." ― Raquel Cepeda, "Bird of Paradise: How I Became Latina" Once upon a time, I met a young lady who wanted to be a doctor. I could see the naked determination and resolve in her eyes. Her older sister, who was a friend, asked her to talk to me about her dream. I asked ...

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Fact-checking has become one of the buzziest buzzwords in journalism. There are more than 100 fact-checking projects around the world. It’s been trotted out to counter alleged “fake” news.  And to monitor the accuracy of political leaders who stretch the boundaries of believability. April 2 has been proclaimed International Fact-Checking Day. Indeed, genuine fact-checking may play an important role in political news coverage. FactCheck.org has been working in this space for 15 years. The ...

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One of the great nuisances in medicine is diagnosis coding. According to Medicare and insurance companies across the U.S., each and every disease must have a unique number. Everything must be quantified and recorded. Why? To facilitate analysis, number-crunching, regulations, reimbursements and, of course, we sometimes joke, to perpetuate the jobs of the coders. They usually know the nuances better than the doctors. Is it truly possible to describe Mrs. Brown's ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old woman is evaluated for management of type 2 diabetes mellitus diagnosed 3 months ago. She was asymptomatic at diagnosis with an initial HbA1c value of 9.7%. Her initial interventions included lifestyle modifications with weight loss and metformin. She is motivated to continue to lose weight. Medical history ...

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In August 2014, a 13-year-old boy with Type 1 diabetes died after being treated by self-described “master herbalist” Tim Morrow who was tried for child abuse resulting in death and practicing medicine without a license. He had told the boy’s mother to stop administering insulin and instead prescribed herbs which he sold. According to one report, Morrow told the parents that insulin was poison, and if they took ...

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Eli Lilly and Co. recently announced with some fanfare that it was manufacturing a generic version of its own best-selling insulin brand, Humalog, which it would sell for half off — $137.35 versus about $275.

David Ricks, the chief executive of Lilly, said the company was making this seemingly beneficent gesture because “many patients are struggling to afford their insulin.”

But they’re struggling, in large part, ...

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Samuel was an English gentleman hailing from London. Close to 10 percent of the U.S. population, over 30 million people, lives with diabetes. Five years ago, Samuel was diagnosed with type 2 diabetes. Taking lisinopril and glipizide, he also goes on hour-long walks every morning at 6:30 a.m. to keep his A1c at his comfort number of 5.5. It has not always been this way for Samuel as he was ...

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I chose endocrinology to be my lifelong profession out of love for the complex interactions of endocrine glands and intricate feedback loops. I take pride in preventing medical complications, prolonging life expectancy, and providing complex care to type 1 and type 2 diabetics. At times, this field of work requires spending hours -- either with the patient or before or after patient visits -- counseling, examining blood glucose data and ...

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For a long time, I didn’t feel as if I were getting any older. Because I’ve been at my institution since 1975, I’ve always been surrounded by the people who educated me. Though my teachers and mentors have undoubtedly aged, to me, none of them seems much older than they were when I first met them. And since for most of those years our student-teacher relationship has remained unchanged, when ...

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A wag once said: “There is no such thing as a healthy person, just one who has not had enough tests.” As we make every minor deviation from the average into a disease, that jest is becoming uncomfortably close to the way our current medical system behaves. Part of the problem is that many diseases represent an arbitrary cut-off of a number. Thus, hypertension is defined as a blood pressure above a ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old woman is evaluated during a routine examination. She feels well and has no exercise limitations. Medical history is significant for hypertension treated with enalapril. She does not smoke. At her last examination 4 years ago, her blood pressure was 122/76 mm Hg. Laboratory studies at that time ...

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Busy primary care physicians have a lot on their plates. But when it comes to helping people with diabetes learn how to improve their health, they don’t have to do it all themselves. Diabetes self-management education and support (DSMES) programs, led by a diabetes educator, can provide vital assistance by helping people with diabetes maintain a healthy weight, quit smoking, begin an exercise routine and integrate other self-management behaviors into ...

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I recently had a patient whose blood sugar was well controlled until he lost his health insurance. He purchased his diabetes pills because they’re cheap, but he couldn’t afford the insulin. His diabetes had been well controlled. Now, almost a year later, his hemoglobin A1C was 14, or double what it should be. The HbA1C measures sugar control over the last three months. The bee sting kit or EpiPen cost hike ...

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My husband, who's had type 2 diabetes for 20 years, had been struggling for a long while to lower his hemoglobin A1C — a number that measures how well he's managing his blood sugar over time. When he and I finally investigated the issue, it turned out that someone close to him was thwarting his efforts. This person is an addict. Her drug of choice is sugar — often candy no ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. The aim of medical education is not only to transfer scientific knowledge, but also impart the wisdom accumulated over the long history of medicine that equips us to apply this knowledge for the betterment of our patients. Although much of medical wisdom transmitted in ...

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I met Mr. B during my week on the endocrine service of my internal medicine rotation. My attending told me we were being consulted for this patient’s high sugars and a foot ulcer, and asked me to take the history. I walked into Mr. B’s room and was immediately struck by its stench. Mr. B had undergone a resection of his bladder tumor the day before and as a result was ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is evaluated for a new skin rash of 10 days' duration. The rash appeared abruptly and is not tender or pruritic. The patient has poorly controlled type 2 diabetes mellitus. His current medications include metformin and glyburide. Family history is unremarkable. On physical examination, vital signs are ...

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I was in the hospital when I heard the word “apple.”  Without hesitating, I reached into my pocket to see if I had my phone.  But the person speaking was referring to the fruit, not the product.  This got me thinking: “Has technology and our products now become more important than our health?” Technology surrounds us and has become a large part of how we live on a daily basis. I’m ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man variable 2-hour postprandial blood glucose is evaluated during a routine follow-up examination. He has type 2 diabetes mellitus. Review of his blood glucose log demonstrates fasting blood glucose values ranging from 120 to 160 mg/dL (6.7-8.9 mmol/L) and variable 2-hour postprandial blood glucose values ranging from ...

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I just had a conversation with a physician and faculty member at my school. He started the conversation like this: “It’s alright if you disagree with me, and I can disagree with you too. Good academic discourse should allow people to disagree with each other.” He then allowed me to question him and explain my perspectives for over an hour as he explained his answers, helped clarify some points, and gave ...

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