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290 Q&A related to diabetes

Metformin use in diabetes | Endocrinology | 08-2012
Metformin doesn t cause kidney dysfunction but it may cause lactic acidosis. In patients with advanced kidney disease, that s rare, with an estimated prevalence of 2-5 cases per 100,000, ...

Antipsychotics in children | Allergy | 04-2012
Atypical antipsychotics are being prescribed much more frequently with excellent results for bipolar disorder and aggressive outbursts, especially in autistic children. One must be cognizant of the metabolic effects and ...

Nephrotic syndrome | Nephrology | 04-2012
I presume you re talking about adult and not pediatric patients, where minimal change disease is the commonest cause and a therapeutic trial of prednisone is recommended before pursuing further ...

First steps in proteinuria | Nephrology | 12-2011
Clinical history and physical examination are important initial steps in evaluating patients with asymptomatic proteinuria, especially the history of diabetes, hypertension, family history of kidney disease, history of collagen disorder, ...

Greenland liver | Nephrology | 10-2011
It may be a normal variant in the Inuit populations, just as slightly low normal white cell count is common in Mediterranean peoples, and slightly high white cell count is ...

Blood and iron | Geriatrics, Hematology | 10-2011
Geriatrician s answer The World Health Organization s 1968 criteria defined anemia in adults as a hemoglobin less than 12 g dL in women and less than 13 g dL ...

Stomach on strike | Gastroenterology | 10-2011
Gastroparesis refers to a delay in gastric emptying and typically occurs in the absence of any obstruction e.g. pyloric stenosis . Classic symptoms include vomiting of undigested food many hours ...

Statins protect the liver | Nephrology | 09-2011
HMG co-enzyme reductase inhibitors the statins, in small studies have shown to be effective in reducing hepatic steatosis and retarding progressive fibrosis, in patients with non-alcoholic fatty liver disease NAFLD ...

Aortic stenosis in the elderly | Cardiology | 06-2011
Cardiologist s answer This is an evolving field. There s now data showing that percutaneous valves can be put in place. Recently a RCT of just over 700 patients showed ...

New antipsychotics, new side effects | Clinical Pharmacology | 06-2011
The new antipsychotics available in Canada are, in order of appearance, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole. Clozapine is the prototype of the newer antipsychotics but it has been available ...

Black holes in white matter | Neurology | 04-2011
Lacunes from the Latin word for hole, pit, or lake are small infarcts deep in the brain and were probably first described pathologically in 1843 by Durant-Fardel. The clinical presentations ...

The glucocorticoid effect | Endocrinology | 04-2011
Glucocorticoids effect on glucose metabolism is multifactorial and includes an increase of hepatic gluconeogenesis, inhibition of glucose uptake by adipose tissue, and alteration of insulin receptor and post-receptor functions. Glucocorticoid ...

Diabetes drugs for prediabetes | Endocrinology | 04-2011
To date the only medications that have been studied in the prevention of diabetes in metabolic syndrome are metformin, acarbose, and thiazolidinediones. Although DDP-4 and GLP-1 inhibitors would seem like ...

Too much of a good thing | Endocrinology | 02-2011
Sitagliptin Januvia is a dipeptidyl peptidase IV inhibitor that was developed to be used to control blood glucose among patients with Type 2 diabetes in conjunction with exercise and diet. ...

Transfusions skew HbA1c | Endocrinology | 12-2010
HbA1C measurements wouldn t be accurate in this situation. You would expect a falsely lowered A1c due to transfusion of blood that was not exposed to increased sugars.

Diabetes drugs: in with the new, out with the old? | Endocrinology | 12-2010
The incretins gliptins are another option as add-on therapy for metformin. So far, they have a good safety profile. The TZDs glitazones have lost favour as second line therapy in ...

Pioglitazone strictly for diabetic patients | Clinical Pharmacology | 12-2010
Several small studies and one study in non-diabetic patients with biopsy-proven non-alcoholic-steato-hepatitis NASH have shown beneficial effects with improvement in transaminase levels and degree of steatosis and variable effects on ...

ACE vs ARB | Cardiology | 10-2010
What s most important is to control blood pressure to target, irrespective of the agent s used. Of the various RAAS inhibitors, either ACE inhibitors or angiotensin receptor blockers do ...

An aspirin a day | Cardiology | 09-2010
Our understanding of the downside of aspirin for primary prevention has evolved in recent years. Nowadays it should typically be reserved for a very high-risk patient. It s been shown ...

Recognize temporal arteritis | Rheumatology | 09-2010
According to the American College of Rheumatology criteria for classification of temporal arteritis, at least 3 of the following 5 items must be present sensitivity 93.5 , specificity 91.2 Age ...

If you see it, it’s too far gone | Imaging | 06-2010
Avascular necrosis AVN , also known as osteonecrosis, aseptic necrosis and ischemic necrosis, results from temporary or permanent loss of blood supply to a section of bone that, if undetected ...

A second look at seniors’ drugs | Geriatrics | 05-2010
In Canada, seniors account for approximately 14 of the population yet receive 40 of prescriptions. This is undoubtedly related to the multiple co-morbidities of the elderly. With evidence-based guidelines for ...

For most kidneys, the only way is down | Nephrology | 05-2010
Except in the case of recovering from acute kidney disease, it s not normally possible to meaningfully raise GFR, although we can certainly slow its decline. The control of common ...

More praise for vitamin D | Nutrition | 04-2010
The benefits of vitamin D have been investigated in a variety of settings and to date the following can be said with some degree of confidence. Vitamin D supplementation that ...

ACE inhibitors in controlled diabetes? | Cardiology | 04-2010
If a diabetic patient has good control of diabetes with or without medication , has normal blood pressure lt 130 80 mm Hg and has no evidence of microalbuminuria checked ...

Antipsychotics for depression? | Psychiatry | 03-2010
More and more studies are being done on the use of antipsychotics in major depression. The vast majority of these are on the use of atypicals as an augmentation strategy ...

Watch the heart when following the kidneys | Nephrology | 02-2010
The control of common cardiovascular risk factors blood pressure BP , lipids, diabetes is key in patients with low eGFR, both to reduce cardiovascular mortality and morbidity, and to slow ...

Metformin in prediabetes | Endocrinology | 02-2010
Randomized controlled trials for example, the Diabetes Prevention Program have demonstrated that metformin can help in the prevention of type 2 diabetes. But lifestyle intervention diet, exercise and weight loss ...

Tracking early diabetes | Endocrinology | 02-2010
See my answer above on metformin in pre-diabetes. As for microvascular screening, the best tests are the same ones that we use to screen patients with diabetes i.e. referral to ...

Statins: safer than aspirin | Cardiology, Clinical Pharmacology | 01-2010
Cardiologist s response Sadly, in real life, arthritis and aches and pains are all too commonly present in the background of high-risk patients. But muscle ache shouldn t preclude statin ...

Can good HDL make up for bad LDL? | Cardiology | 10-2009
It sounds like you are wisely assessing the patient s global risk based on all cardiovascular risk factors. High HDL cholesterol is indeed protective, of course. But this effect needs ...

Diabetic but healthy | Cardiology | 09-2009
This is indeed a very good question, and a controversial one. To my mind, you ve identified a very low risk diabetic patient, being young and without known cardiac risk ...

Vitamin D for glycemic control | Endocrinology | 08-2009
There s evidence to suggest that vitamin D3 is important in the prevention of islet cell death. Vitamin D is required for the production of insulin, and improves insulin sensitivity. ...

Statins for fatty liver? | Other | 08-2009
Non-alcoholic fatty liver disease NAFLD is the most common cause of liver disease in the Western world and its incidence is increasing both in adults and children because of the ...

Seniors with sore feet | Geriatrics | 06-2009
Diabetes mellitus is certainly the commonest cause of peripheral neuropathy causing burning feet. But this symptom can occur with many other peripheral neuropathies and it would be reasonable to screen ...

Diagnostic clues in diabetes | Endocrinology | 06-2009
A low C-peptide supports the observation that the patient has deficient insulin production. It s not specific to type 1 diabetes. Islet cell antibodies are present in 80 of individuals ...

Reacting to JUPITER | Cardiology | 06-2009
The JUPITER trial is a landmark paper looking at 17,802 patients who were randomized to receive rosuvastatin 20 mg day or a placebo. Primary end points included fatal and nonfatal ...

Cancer drug helps occluded eyes | Ophthalmology | 05-2009
Retinal vein occlusion either central or branch remains a very common vascular problem in ophthalmology, with a great deal of associated visual morbidity. Although most often associated with typical cardiovascular ...

Catching them young in type II diabetes | Cardiology | 02-2009
Young patients with new onset diabetes have a low short-term clinical risk of developing vascular complications. Younger female patients of childbearing age particularly shouldn t be started on statins due ...

High systolic, low diastolic: what can it mean? | Cardiology | 01-2009
Often, elderly patients have isolated systolic hypertension indicative of poor vascular wall compliance, which presents with a widened pulse pressure. In elderly patients, this is a marker for stiff arteries ...

Do kidney donors get fair warning? | Nephrology | 01-2009
The short- and long-term risks associated with kidney donation are generally small. In the short term, there s the risk of bleeding or infection in the perioperative period. Death from ...

Platelet volume: a marker that’s hard to measure | Hematology | 01-2009
In general, it s believed that MPV is increased when there s increased platelet production or increased platelet turnover such as in chronic immune mediated thrombocytopenia or myeloproliferative disorders, as ...

Why is my patients’ hemoglobin glycated? | Endocrinology | 01-2009
HbA1c values are influenced by red cell survival therefore, falsely high values can occur when red cell turnover is low, resulting in a disproportionate number of older red cells. This ...

How low is too low for BP? | Cardiology | 11-2008
Current targets for blood pressure BP suggest that patients with a BP gt 140 90 mm Hg or gt 130 80 if they have diabetes should be considered for blood ...

Another bug to watch out for in the ICU | Infectious Disease | 11-2008
Acinetobacter baumannii, often grouped and considered clinically within the A. calcoaceticus-A. baumannii complex, is a Gram-negative bacterium that is widely distributed in nature. It s an opportunistic pathogen that predominantly ...

What to make of borderline eGFR? | Nephrology | 11-2008
Mild decreases in the estimated glomerular filtration rate eGFR are common and may be seen in up to nbsp 30 of healthy adults over the age of 20. It s ...

Off-label use of bevacizumab | Ophthalmology | 11-2008
Retinal vein occlusion remains a very common vascular problem in ophthalmology, with a great deal of associated visual morbidity. Although it s most often associated with typical cardiovascular risk factors, ...

Best dose of folic acid before pregnancy | Clinical Pharmacology | 10-2008
Though the efficacy of folic acid in primary prevention of neural tube defect has been shown clearly in a number of trials, these studies didn t demonstrate the ideal dose. ...

Fasting blood test -- first thing in the am? | Clinical Pharmacology | 09-2008
The person would still be fasting, of course, and the short answer is that, if the test results are normal, this is reassuring. On the other hand, if the blood ...

Diabetes: checking for neuropathy | Neurology | 09-2008
The fibres are calibrated to bend at a specific force when applied against the skin and a threshold of the lowest force perceived by the patient is determined. As you ...

Too much fluid implies high-risk pregnancy | Ob/Gyn | 09-2008
Polyhydramnios, or excessive amniotic fluid, occurs in up to 3.3 of all pregnancies. It usually develops gradually and gets diagnosed in the 3rd trimester. It's associated with an increase in ...

Are seal oil capsules beneficial? | Clinical Pharmacology | 09-2008
As in the case of many natural health products, claims of efficacy for seal oil haven't been backed up by a large body of evidence. That being said, studies of ...

What to monitor when prescribing antipsychotics | Psychiatry | 08-2008
Each of the various atypical antipsychotics has a somewhat different side effect profile, so the type of tests to do, lab or otherwise, will vary. For example, olanzapine and clozapine ...

Is low HDL-C really a risk factor? | Cardiology | 07-2008
The number one lipid target is still LDL-C, and this should be treated first, especially in high-risk patients. In those with very high risk, I aim for a value 2.0 ...

Which meds preclude blood donation? | Hematology | 07-2008
The list is extensive -- because some may harm the recipient and others the donor. Before accepting a donation, Canadian Blood Services first asks the person a number of questions ...

Sitagliptin: useful in diabetes combo? | Endocrinology | 07-2008
Sitagliptin is approved for use with metformin in Canada. It has, however, been prescribed safely with all other oral hypoglycemic agents.

Diabetes -- when to test fasting blood sugar | Endocrinology | 06-2008
Once a patient is diagnosed with diabetes, it's not necessary to repeat an FBS every 3-6 months. An HbA1c, however, is indicated. The FBS can be useful to verify the ...

How to beat recurrent UTIs | Urology | 05-2008
Long-term broad-spectrum antibiotics must not be used because they don't help and instead invite difficult resistant organisms. Instead, ascertain that there are no reversible underlying conditions, such as stone disease, ...

Incidental fatty liver finding: is it serious? | Gastroenterology | 05-2008
An incidental finding of a fatty liver on an ultrasound is important -- rather like other silent conditions like hyperlipidemia and hypertension. It can progress to steatohepatitis and cirrhosis in ...

Heart patients: when to order a stress test | Cardiology | 04-2008
Patients with an uncomplicated, successful PCI who remain symptom-free probably don't need routine stress testing unless they're at a high risk for recurrence. Such factors would include decreased left ventricular ...

Drugs when diet and exercise don't work | Endocrinology | 04-2008
Metformin was associated with a 31 decrease in progression to diabetes compared to placebo, rosiglitazone with 60 . These results came from two studies on the prevention of diabetes in ...

Navigating the rosiglitazone controversy | Clinical Pharmacology | 04-2008
This is an excellent question. A recent meta-analysis Nissen SE, Wolski K. NEJM 2007 356 24 2457-71 suggested that rosiglitazone, a drug used to treat type 2 diabetes, was associated ...

Make the right OC choices | Ob/Gyn, Neurology | 03-2008
The response of migraine to initiation of OCs varies between patients. Many show no change in headache pattern, a few improve and some worsen. Epidemiologic studies suggest that migraine and ...

Preventing hyponatremia in nursing homes | Nephrology | 02-2008
Hyponatremia -- defined as serum sodium 135 mmol L -- is often due to the body's inability to appropriately excrete dilute urine. Though any level of plasma osmolality may be ...

Does TIA need ER workup? | Neurology | 01-2008
The answer to this question depends on how quickly the necessary investigations are available in your area. We know that TIA carries with it a high risk of subsequent stroke ...

Interpreting eGFR in older adults (our geriatric specialist responds) | Nephrology, Geriatrics | 01-2008
The GFR progressively declines with age. After age 40, it decreases at a rate of 8-10 mL min 1.73 m2 per decade. In one study, people age 30 had an ...

Metformin: steer clear of lactic acidosis | Nephrology | 01-2008
Lactic acidosis associated with metformin is rare -- it has an estimated prevalence of 2-5 cases per 100,000 -- but it carries a high fatality rate of 50 . How ...

Averting kidney damage in juvenile diabetes | Nephrology | 4-2007
In juvenile or type 1 diabetes, when the blood pressure starts to increase or when there's evidence of microalbuminuria, then ACE inhibitors are the agent of choice for control. This ...

Advances in glucose monitoring | Endocrinology | 12-2007
CGMS are portable devices that allow for the continuous monitoring of glucose. Two systems are currently available, a 72-hour glucose sensor in which the data is downloaded after the patient ...

Is electrogastrography state-of-the-art? | Gastroenterology, Imaging | 11-2007
Numerous clinical trials and studies have shown that EGG is an accurate measurement of gastric myoelectrical activity, as our gastroenterologist has mentioned above. This test clinically falls within the realm ...

What body odours say | Endocrinology | 10-2007
A change in body odour may be a normal variant, e.g. puberty, or it may be due to intake of foods or spices like curry or cumin, or it can ...

Will home-based INR monitors take off? | Hematology | 09-2007
Home-based INR or point-of-care POC INR monitoring is possible for some individuals who require lifelong monitoring of their oral anticoagulation therapy, but it would never become as widely used as ...

Can statins speed mental deterioration in the elderly? | Geriatrics | 07-2007
Headache is a well recognized side effect of statins, occurring in about 10 of patients. Personally, I'm not aware of research showing any important association with confused states or delirium. ...

Which patients really need diet pills? | Endocrinology | 06-2007
Overweight is defined as a body mass index BMI amp gt 27 kg m amp lt sup amp gt 2 amp lt sup amp gt . Obesity refers to a ...

Plastics and the diabetes epidemic | Endocrinology | 05-2007
BPA is found in polycarbonate plastic in microwavable plastics, canned food linings, food containers, toys, etc. I'm not aware of any human studies yet in this area, however.

Incidental fatty liver finding | Gastroenterology | 05-2007
Fatty liver, unfortunately, is fairly common and the incidence is bound to increase to epidemic proportions -- thanks to obesity, diabetes, hyperlipidemia, etc. The most important clinical implication is that ...

The skinny on type 2 diabetes in lean patients | Endocrinology | 04-2007
A subset of lean patients with new-onset diabetes and without evidence of diabetic ketoacidosis may in fact have latent autoimmune diabetes of adults LADA . In this situation, there's pancreatic ...

Age-dependence of creatinine clearance | Nephrology | 04-2007
Renal mass and renal blood flow decline after age 30 renal blood flow decreases by about 10 per decade of life, from 600 mL min 1.73 m amp lt sup ...

When diabetes resolves | Endocrinology | 03-2007
I congratulate them on their excellent progress. I suggest that they continue to check their blood sugar once or twice per week to ensure that they remain euglycemic. Whenever they ...

Best treatments for essential tremor | Neurology, Geriatrics | 03-2007
Essential hand tremor ET is sometimes referred to as senile tremor when the onset is late in life. It's extremely common. Beta-blockers are usually the first line of drug treatment, ...



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