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 …
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, …
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 …
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 …
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 …
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 …
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 …
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 …
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 …
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 …
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 …
“We pass through the present with our eyes blindfolded … Only later when the cloth is untied can we glance at the past and find out what we have experienced and what meaning it has.”
– Milan Kundera
Two days ago, during a clinical skills session on lymph node examination, my classmates insisted that I get what appeared to be an enlarged lymph node in my neck checked by the physician …
Last summer, I published a post called “Alternative Medicine is Kicking Our Ass.” In it, I focused on one particularly slick alt-thyroid site that has done a masterful job of sowing doubt regarding the advice mainstream physicians give to our patients about the thyroid. Not only that, but the site has called into question our competency as doctors, citing “evidence” that supposedly proves (it doesn’t) we …
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 50 to 190 mg/dL …
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 …
Medical crises come in many forms: from illnesses to sudden injuries. Most often the victims are unsuspecting. They may be gradual in onset or happen in seconds. There are many causes, from faulty drivers to electrolyte disturbances. Mine was caused by a squirrel, a routine yard rodent. In less than three seconds, I went from a practicing physician with a heavy patient load to temporarily disabled.
Returning home from a busy …
I’m excited to announce that I’ll be keynoting AACE 2019, the annual meeting of the American Association of Clinical Endocrinologists, April 27, 2019 in Los Angeles, CA.
Health professionals often hear about social media from a perspective of risk and negativity, especially with the headlines in the past year. But there’s another side: One where we can use social media as opportunities to educate patients …
There is a wealth of information about your health circulating in your blood. For people with diabetes, accessing that information can be a matter of life or death.
For nearly 30 years, the prevailing technology for checking the blood sugars of someone with diabetes has been the fingerstick. People with diabetes are often asked to stick their fingers and check their blood multiple times a day to assess whether their blood …
It was a slow day in the emergency department. I was sitting across the bedside from my patient who came in for a left forearm infection checkup. She was a 73-year-old female with a history of diabetes. She was elegant and soft-spoken. Prior to examining her wound, which had been worsening, I asked her what her A1c number is. She wondered what an A1c number was, and I explained that …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman with type 1 diabetes mellitus is evaluated for recent-onset glycemic fluctuations without symptomatic hypoglycemia. She was diagnosed with diabetes 7 years ago. Her HbA1c levels since diagnosis have ranged from 6.4% to 7.3%, with the most recent value at 7.3%. She reports eating a carbohydrate-consistent diet at each meal, with …
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