Diabetes care

452 articles · Since 2004

Articles, page 9

Society’s health should not be doctors’ responsibilities

December 8, 2015Dec 8, 2015106

I thoroughly enjoy my 65-year-old male with his horrendous diabetic foot ulcer. But there’s not enough insulin in the state of Tennessee to cover the two bacon, egg, and cheese biscuits he eats every morning. And I adore my 57-year-old…

And I adore my 57-year-old female with COPD. But the inhalers won’t work until she stops smoking two packs of cigarettes per day. I laugh every time I see that hilarious 32-year-old with hypertension. But the …

Conditions and diseases

MKSAP: 60-year-old woman with gastroparesis

mksap

December 5, 2015Dec 5, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated during a routine follow-up appointment. She has gastroparesis associated with long-standing type 2 diabetes mellitus. Improved blood sugar control…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 60-year-old woman is evaluated during a routine follow-up appointment. She has gastroparesis associated with long-standing type 2 diabetes mellitus. Improved blood sugar control and efforts to eat small, frequent meals did not result in symptom improvement. In addition to these interventions, metoclopramide was started 6 months ago, after which her nausea and periodic vomiting …

Conditions and diseases

Test your medicine knowledge: 48-year-old woman with type 2 diabetes mellitus

mksap

October 31, 2015Oct 31, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old woman is evaluated during a follow-up visit. She has a 5-year history of type 2 diabetes mellitus. She has no other significant…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 48-year-old woman is evaluated during a follow-up visit. She has a 5-year history of type 2 diabetes mellitus. She has no other significant medical history. Medications are atorvastatin, metformin, and a multivitamin. She works as a mail carrier and has a walking route that takes 3 hours each day. She consumes a diet high …

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Conditions and diseases

Test your medicine knowledge: 58-year-old man with type 2 diabetes

mksap

October 3, 2015Oct 3, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated during a routine appointment. He is asymptomatic. He was diagnosed with type 2 diabetes mellitus 4 years ago and…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 58-year-old man is evaluated during a routine appointment. He is asymptomatic. He was diagnosed with type 2 diabetes mellitus 4 years ago and has hypertension, dyslipidemia, and obesity. His medications are enteric-coated low-dose aspirin, lisinopril, fluvastatin (20 mg/d), and metformin.

His calculated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohort Equations is …

Physician voices

A physician’s experience with a false positive test result

Justin Reno, MD

July 14, 2015Jul 14, 2015

“Your wife has gestational diabetes.” My heart stopped when my wife’s physician called to tell me this. “I want you to tell her because it’ll be easier to give it some time and let it sink in. Tell her to…

Let me give some background information. I’m …

Conditions and diseases

MKSAP: 38-year-old pregnant woman with hypertension and diabetes

mksap

April 26, 2015Apr 26, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated during a follow-up visit. She has a history of well-controlled hypertension and type 1 diabetes mellitus. She is at…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 38-year-old woman is evaluated during a follow-up visit. She has a history of well-controlled hypertension and type 1 diabetes mellitus. She is at 16 weeks’ gestation with her first pregnancy. Prior to conception she was taking lisinopril, which was discontinued in anticipation of the pregnancy, and labetalol was initiated. Other medications …

Conditions and diseases

MKSAP: 44-year-old man with a family history of diabetes

mksap

March 28, 2015Mar 28, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old man is evaluated during a routine examination. He is concerned about his general health and risk of diabetes mellitus. He has no…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 44-year-old man is evaluated during a routine examination. He is concerned about his general health and risk of diabetes mellitus. He has no medical problems. Both parents and his sister have type 2 diabetes mellitus.

On physical examination, temperature is normal, blood pressure is 130/79 mm Hg, pulse rate is 66/min, and …

Conditions and diseases

MKSAP: 60-year-old man with type 2 diabetes mellitus

mksap

March 7, 2015Mar 7, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man is evaluated as a new patient. He was diagnosed with type 2 diabetes mellitus during a health insurance evaluation 6 months…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 60-year-old man is evaluated as a new patient. He was diagnosed with type 2 diabetes mellitus during a health insurance evaluation 6 months ago. At that time, metformin was initiated. Medical history is otherwise unremarkable.

On physical examination, blood pressure is 145/94 mm Hg; other vital signs are normal. BMI is 29. …

Physician voices

I am proud of our society. We provide care to everyone.

Michael Joel Pottash, MD, MPH

February 20, 2015Feb 20, 201527

She is always a difficult admission. The long chart review. The vague complaints. The entitled attitude. The misdirection. These are expected. As is the cake at her bedside after a diabetic crisis. The two-liter soda after an emergent fluid dialysis. The urine toxicology was positive for cocaine. The staff knows her well. I know her well. I give her the attention, kindness and empathy that I give to every patient. …

Medical education

Taking care of patients who stop caring about themselves

Stephanie Van, MD

February 13, 2015Feb 13, 20155

It’s been a long day, and you just want to decompress. My boyfriend tells me about his day. I get to hear about the insane amount of reading he has to do for graduate school, or about the occasional annoying customer he’s had to deal with at his part-time job as a bank teller. When it’s my turn to decompress, I usually gripe about a patient or two from the …

Health policy

Fixing overtreatment: Lone rangers need not apply

Shannon Brownlee

February 10, 2015Feb 10, 201532

Why is it so hard to make a dent in the huge volume of unnecessary health care? In the U.S., about 20 to 30 percent of the medical interventions American patients receive are useless and often harmful, and waste hundreds…

Insurers have known this for decades. These days, many more doctors have begun to see the big picture, along with policy makers. But the …

Conditions and diseases

MKSAP: 74-year-old man with fever and chills

mksap

January 17, 2015Jan 17, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 74-year-old man is evaluated in the emergency department for a 3-day history of fever and chills as well as confusion. He has a…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 74-year-old man is evaluated in the emergency department for a 3-day history of fever and chills as well as confusion. He has a 5-week history of a nonhealing ulcer on the plantar surface of his left foot. He has diabetes mellitus, hypertension, and peripheral vascular disease for which he takes metformin, …

Conditions and diseases

MKSAP: 67-year-old man with type 2 diabetes mellitus

mksap

November 29, 2014Nov 29, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old man is evaluated following a recent diagnosis of type 2 diabetes mellitus. On physical examination, blood pressure is 134/84 mm Hg; other…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 67-year-old man is evaluated following a recent diagnosis of type 2 diabetes mellitus.

On physical examination, blood pressure is 134/84 mm Hg; other vital signs are normal. BMI is 30. The remainder of the examination is unremarkable.

Laboratory studies show an HbA1c of 7.8%, blood urea nitrogen 15 mg/dL (5.4 mmol/L), and serum …

Conditions and diseases

MKSAP: 42-year-old man with severe burning and stabbing pain

mksap

October 25, 2014Oct 25, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 42-year-old man is evaluated for a 6-day history of severe burning and stabbing pain in both feet that is worse in the toes.…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 42-year-old man is evaluated for a 6-day history of severe burning and stabbing pain in both feet that is worse in the toes. The pain is more severe at night, is aggravated when the bed sheets touch his skin, and is partially relieved when he walks or massages his feet. The …

Health technology

Improve patient behavior with virtual assistants

Thomas Morrow, MD

October 19, 2014Oct 19, 20145

Few will argue that the overall health of Americans has deteriorated in the past quarter century. Diabetes or prediabetes afflicts nearly 120 million people. Roughly two of three Americans are either overweight or obese. Pharmaceutical companies focus on drug discovery as a solution. Thousands of apps for smart phones are being developed to change our destructive behavior. But, lacking in both of these is a true solution, one that draws …

Conditions and diseases

MKSAP: 72-year-old unconscious woman in the ER

mksap

September 20, 2014Sep 20, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict …

Physician voices

Introduce our patients to mentors

Heather Alva

August 26, 2014Aug 26, 20145

A resident once offered me this piece of advice: Find mentors whom you admire. Not just for their rapport with patients, but also for their lifestyle, their hours and their family life. Make goals that you know to be realistic…

My question now: Why stop there? Why not share that ounce of brilliant advice with our patients? Why don’t we link older, successful patients with diabetes …

Read more…

Introduce our patients to mentors

Conditions and diseases

Stop comparing depression to diabetes

Claudia M. Gold, MD

August 5, 2014Aug 5, 201411

At the recent gubernatorial candidates forum on mental health, Martha Coakley repeated the oft-heard phrase that depression is like diabetes. Her motivation was good, the idea being to reduce the stigma of mental illness, and to offer “parity” or equal insurance coverage, for mental and physical illness. However, I am concerned that this phrase, and its companion, “ADHD is like diabetes,” will, in fact, have the exact opposite effect.

A recent New …

Read more…

Stop comparing depression to diabetes

Health policy

What happens in the VA health system matters to all of us

David Mokotoff, MD

May 26, 2014May 26, 20145

Whether you are a veteran of not, the recent report of waiting lists, and possibly preventable deaths of veterans, has implications for all citizens. There is no large health system which functions perfectly. But I would say that the efficiency of any given system is inversely related to its size. If this is true, then the VA health system is, and has always been, a bureaucratic and wasteful mess. Like …

Physician voices

Why the quality measures used in health care are deeply flawed

Karen S. Sibert, MD

May 12, 2014May 12, 20145

Nobody stands up to argue against quality and value in health care. You might as well argue against motherhood, or puppies. Yet many physicians are inherently skeptical of definitions of “quality” that are imposed from above, whether by outside evaluators…

There’s good reason for skepticism. Some of the “evidence” behind “evidence-based medicine” has turned out to be flawed, tainted by financial conflict …

Diabetes care

Articles, page 9

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