June 29th, 2011 by KerriSparling in True Stories
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I do not enjoy basal testing. Even though I sometimes go six hour clips without having a snack (thanks, Birdy and your busy ways), something about knowing I can’t eat or exercise makes me want to do a 5K while simultaneously chomping down on some soft serve.
But when I noticed that I was going to bed at a completely normal blood sugar, but waking up in the 180 – 220 mg/dl range for three days in a row, I knew I needed to do some basal tweaking.
Making adjustments to my overnight basal rates always skeeves me out. I’m a very deep sleeper (as evidenced by the fact that Siah prowling around on the bed all night doesn’t wake me in the slightest, but makes Chris say “We’re sleeping with the door SHUT tonight,” in the morning), and I have a very healthy fear of overnight low blood sugars. My symptoms of a low on the overnights used to be this body-drenching sweat, but since the birth of my daughter, that symptom has all but disappeared. Now, I don’t have any symptoms at all. Blood sugars of 60, 50, and lower don’t even register until I prick my finger and go, “Oh. I guess I’m low?” Read more »
*This blog post was originally published at Six Until Me.*
June 23rd, 2011 by PJSkerrett in Health Tips, Opinion
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For several years I’ve been preaching in the pages of the Harvard Heart Letter about the importance of taking part in clinical trials. Why? Because I believe they improve medical care, telling us what works and what doesn’t. Figuring it was time to put up or shut up, I volunteered for a clinical trial. I’m glad I did—I learned a lot, received excellent care, and saw first-hand the effort it takes.
The trial was called Targeting Inflammation Using Salsalate in Type 2 Diabetes, or TINSAL-T2D for short. It was being conducted at 16 centers, including the Joslin Diabetes Center in Boston, a short walk from my office. Its aim was to see if an old drug called salsalate (a cousin of aspirin) could arrest low-grade inflammation that may—emphasis on may—make muscles resistant to the effects of insulin and eventually tip the body into type 2 diabetes.
I responded to an ad for TINSAL-T2D and, after undergoing a few preliminary tests, was accepted to take part in it. I was given a bottle of blue pills and asked to take several of them every day. No one—not lead investigator Dr. Allison Goldfine, not study nurse Kathleen Foster, and certainly not me—knew if the pills were the real thing or a placebo. I was also asked to check my blood sugar every morning, and to show up monthly for blood tests and questions galore.
I just finished my year-long stint, still not knowing whether I was taking salsalate or a placebo. I really don’t care, though I’m keen to know if salsalate worked as hoped, something I’ll learn when the results are published.
Why bother?
Read more »
*This blog post was originally published at Harvard Health Blog*
June 23rd, 2011 by Glenn Laffel, M.D., Ph.D. in Opinion
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We have all seen people exhibit flagrantly unhealthy behavior. Some of us–though we’d never admit it–derive a certain, smug satisfaction by observing them. At least I don’t do that!
Somewhere in the course of our daily lives though, most of us do exhibit behavior that suggests at least some disregard for our health. We don’t change our diet, though we know we should. We don’t floss, take medications as prescribed, or get the screening tests we’re supposed to.
Multiple intertwining causes underlie all unhealthy behavior, of course. I had always figured that one pervasive cause was the lack of a simple, observable connection between health-related behaviors and health outcomes. There is a long delay for example, between establishing unhealthy dietary preferences and the sequellae of that behavior (a heart attack, diabetes or whatever). The longer the delay between cause and effect, the more likely someone will be to exhibit unhealthy behavior.
On the other hand, if there’s a short interval between cause and effect—it only takes minutes for susceptible people to develop a severe allergic reaction after eating peanuts, for example—well, that’s where I’d expect high adherence to the required healthy behavior.
If I’m right, then we have a problem. For many chronic diseases (diabetes, heart disease, some cancers) Read more »
*This blog post was originally published at Pizaazz*
June 20th, 2011 by Davis Liu, M.D. in Opinion
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Doctors are professionals. But are doctors cowboys or pit crews? Recently, physician writer, Dr. Atul Gawande, spoke about the challenges for the next generation of doctors in his commencement speech titled, Cowboys and Pit Crews, at Harvard Medical School. Gawande notes that advancement of knowledge in American medicine has resulted in an amazing ability to provide care that was impossible a century ago. Yet, something else also occurred in the process.
“[Medicine’s complexity] has exceeded our individual capabilities as doctors…
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.”
Despite all of the advancements in medicine, the outcomes and consistency in treatment and care are not as good as they could be. Doctors are not doing basic things. The fact that Gawande, author of The Checklist Manifesto, spoke at one of the finest medical schools in the country indicates how much more the profession needs to go.
“We don’t have to look far for evidence. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
June 19th, 2011 by DeborahSchwarzRPA in Research
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Science Translational Medicine
The April 27, 2011 issue of Science Translational Medicine included a study titled “Differential Metabolic Impact of Gastric Bypass Surgery Versus Dietary Intervention in Obese Diabetic Subjects Despite Identical Weight Loss.”
Melissa Bagloo, MD, Assistant Professor of Clinical Surgery at the Center for Metabolic and Weight Loss Surgery, NYP/Columbia, explains the context and importance of this study.
Q: What did this study find?
Dr. Bagloo: For years, surgeons have observed that gastric bypass surgery cures diabetes in over 80% of patients with diabetes. This improvement in blood sugar levels happens almost immediately after surgery, and far before any significant weight loss occurs. What’s more, studies have found that when patients lose the same amount of weight through diet as other patients lose after surgery, those who had surgery experience significantly better improvement in their diabetes than those who lost weight non-surgically. So we know surgery dramatically improves or resolves diabetes, but we do not know why this happens.
This recent study in Science Translational Medicine found an important clue as to why this effect may occur. The researchers found that Read more »
*This blog post was originally published at Columbia University Department of Surgery Blog*
