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Patients With Diabetes Are Treated Differently In The ER

Patients with Diabetes Are Treated Differently in the ER

Patients with Diabetes Are Treated Differently in the ER

A trip to the ER is different for patients with diabetes compared to those without. Diabetes can lead to more serious complications doctors would be concerned about, as well as influence diagnostics and potential treatments. Emergency room physician Dr. Troy Madsen explains why it’s important your physicians know your diabetic status early with emergency treatment.
Transcript
Interviewer: How does a patient with diabetes change the way emergency room physicians would treat you? That's next on The Scope.
Announcer: Health tips, medical views, research and more for a happier, healthier life. From the University of Utah Health Sciences, this is The Scope.
Interviewer: Dr. Madsen, if somebody comes into the emergency room and you find out they have diabetes, does that change the way that you would treat whatever condition that they're in the ER for?
Dr. Madsen: It really does. It affects the way I look at things and it often affects the way I treat things. And the reason for that is, certainly with diabetes, there are the immediate issues where maybe they have a high blood sugar or really low blood sugar. Either they use too much insulin or maybe they haven't been using their insulin, and certainly there's that factor. But diabetes changes a lot of other things as well.
So if someone comes in and they say to me, "I'm having chest pain," I mean, this is a 30-year-old otherwise healthy person, I'm like, "Okay, we'll get an EK to do some tests," I'm not too concerned. If this person has diabetes even, maybe in their 30s, that heightens my concern a little bit more for heart dise Continue reading

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Lack of Sleep Tied to Diabetes in Pregnancy

Lack of Sleep Tied to Diabetes in Pregnancy

Lack of sleep may raise the risk for gestational diabetes.
Gestational diabetes — abnormally high blood sugar that develops during pregnancy — can lead to excessive birth weight, preterm birth or respiratory distress in the baby, among other problems. It can also increase the mother’s risk for Type 2 diabetes later in life.
Researchers pooled data from eight studies involving 17,595 women. Seven of the studies depended on self-reports of sleep, and one measured sleep duration. After adjusting for variables such as age, body mass index and ethnicity, they found that women who slept less than 6.25 hours a night were almost three times as likely to have gestational diabetes as those who slept more. The study is in Sleep Medicine Reviews.
The reasons for the link are not known, but the authors suggest that hormonal changes in pregnancy as well as systematic inflammation tied to lack of sleep can lead to insulin resistance and high blood glucose levels. But the study is observational and does not prove a causal relationship between poor sleep and gestational diabetes.
“Minimizing sleep disruption is important — limiting caffeine, avoiding electronics at bedtime and so on,” said the lead author, Dr. Sirimon Reutrakul, an associate professor of medicine at the University of Illinois at Chicago. “It’s another factor that may influence overall health. But it’s easier said than done.” Continue reading

Is It Time to Change the Type 2 Diabetes Treatment Paradigm? No! Metformin Should Remain the Foundation Therapy for Type 2 Diabetes

Is It Time to Change the Type 2 Diabetes Treatment Paradigm? No! Metformin Should Remain the Foundation Therapy for Type 2 Diabetes

Most treatment guidelines, including those from the American Diabetes Association/European Association for the Study of Diabetes and the International Diabetes Federation, suggest metformin be used as the first-line therapy after diet and exercise. This recommendation is based on the considerable body of evidence that has accumulated over the last 30 years, but it is also supported on clinical grounds based on metformin’s affordability and tolerability. As such, metformin is the most commonly used oral antihyperglycemic agent in the U.S. However, based on the release of newer agents over the recent past, some have suggested that the modern approach to disease management should be based upon identification of its etiology and correcting the underlying biological disturbances. That is, we should use interventions that normalize or at least ameliorate the recognized derangements in physiology that drive the clinical manifestation of disease, in this circumstance, hyperglycemia. Thus, it is argued that therapeutic interventions that target glycemia but do not correct the underlying pathogenic disturbances are unlikely to result in a sustained benefit on the disease process. In our field, there is an evolving debate regarding the suggested first step in diabetes management and a call for a new paradigm. Given the current controversy, we provide a Point-Counterpoint debate on this issue. In the point narrative that precedes the counterpoint narrative below, Drs. Abdul-Ghani and DeFronzo provide their argument that a treatment approach for type 2 diabetes based upon correcting t Continue reading

9 Gestational Diabetes Myths

9 Gestational Diabetes Myths

As a specialist in gestational diabetes nutrition, I get a lot of questions about blood sugar and pregnancy.
Gestational diabetes is controversial. It’s complicated. And there’s a lot of misinformation out there.
I do my best to address the controversies in interviews and with participants in my online gestational diabetes course, but since I’ve been receiving more and more inquiries in my inbox from fellow healthcare professionals, I wanted to dispel some gestational diabetes myths head-on right here on the blog.
I’ll also be attending some midwifery conferences this year (including one this weekend), and I figured this resource would be a helpful place to refer practitioners if they have questions.
Given the medical interventions that are commonly pushed on women with gestational diabetes (believe me, I’m also disheartened by the over-medicalization of pregnancy and birth), it’s important to understand the science behind high blood sugar and pregnancy.
My goal is to help moms and practitioners make better decisions – based on fact, not fear – so they can have the healthiest pregnancy possible.
9 Gestational Diabetes Myths
Myth #1: Blood Sugar Levels are Naturally Higher In Pregnancy
There’s a lot of misinformation floating around about blood sugar levels in pregnancy. Some think that gestational diabetes is a “diagnosis looking for a disease.” In other words, they believe that blood sugar levels naturally go up during pregnancy, so there’s nothing to worry about.
Some practitioners don’t even test for gestational diabetes and just tell their pati Continue reading

Increased heart rate and cardiovascular risk in hypertension and diabetes

Increased heart rate and cardiovascular risk in hypertension and diabetes

High resting heart rate increases the risk of cardiovascular morbidity and mortality in the general population, as well as in those with hypertension, and in those with type 2 diabetes. Drugs that increase the heart rate may adversely affect cardiovascular health
Population studies have shown that there is a relationship between high resting heart rate and increased risk of cardiovascular events and mortality. This has also been obvious in most studies in patients with hypertension - findings summarized in a report from a Consensus Meeting of the European Society of Hypertension in 2005.1 This report was updated in 2016 in a statement from the Second Consensus Conference, which concluded that heart rate measurement should be included in the routine assessment of the hypertensive patient.2 A similar view was reported from a group reviewing publications from the Asia Pacific region.3
An analysis of prospective studies in patients with hypertension found that night-time heart rate measured by ambulatory recordings was a better predictor of mortality than elevated heart rate in the clinic.4 The analysis included 7602 hypertensive patients with ambulatory blood pressure (BP) and heart rate recordings from 6 prospective studies in Italy, Japan and Australia. They defined tachycardia as an office heart rate >85 beats/minute or a night-time heart rate >76 beats/minute (these represented the upper quintiles). Patients with elevated heart rate in the clinic but normal night-time heart rate were considered to have white-coat tachycardia whereas those with normal clinic heart rate but Continue reading

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