![]() Many people do well with one long-acting shot of insulin (like Lantus) in the evening. Appropriate adjustments are made thereafter. Upon starting a healthy (McDougall) diet, the overall daily insulin dosage should be reduced by about 30% to help prevent hypoglycemia. People with type-1 diabetes must stay on insulin, but the administration of medication should be as unobtrusive as possible. Diet prevents complications of kidney failure, heart disease, stroke, blindness, and premature death for type-1, type-1.5, type-2, and non-diabetic, patients. Diet is also my fundamental treatment (including insulin) for type-1 diabetes. Using the proper diet, cure rates for type-2 diabetes approach 100% (with associated weight loss). After all this expense, trouble, and turmoil there is only a 0.4% HgBA1c improvement in control by CGM over standard (glucose-finger-stick) monitoring.ĭiet is my fundamental treatment for diabetes. Rather than a pleasant chat about the grandchildren over dinner, the conversation focuses on blood sugars, which are read as often as every five minutes, and insulin doses that follow. Monitors and pumps actually destroy the quality of peoples' lives not just of individual patient but of friends and family. No health benefits have ever been demonstrated from attempts to meticulously control blood sugars by using this technology. To add to the misery, the patient still must perform fingertip blood checks two to four times a day to keep the monitor calibrated. Often patients wear an additional device, called an insulin pump (costing more than $5,000) that responds to these signals and medicates the patient with offsetting doses of insulin. The sensors, which attach to the monitor, are only good for three to seven days, but they are expensive, too: $35 to $100 apiece. The CGM monitors themselves cost from $1,000 to $1,400. Monitors worn by the patient continuously check blood sugars (Continuous Glucose Monitoring or CMG) as often as every five minutes. One harmful consequence of this primary ambition has been the development of high-tech devices. The treatment goal for diabetes is making numbers look better. Read more about ERCP/EUS Workshops."State of the Art" in Medicine: Meters and Pumps Jamidar MD and Harry Aslanian MD, of the Yale School of Medicine Department of Internal Medicine, Section of Digestive Diseases. For example, it is now possible to capture real time histologic information in the biliary tree at the time of ERCP utilizing a technique known as confocal endomicroscopy. There are ongoing refinements in technique as well as strategies to minimize complication rates in this procedure and the scope of indications continues to expand. Therapeutic ERCP/EUS is an evolving and increasingly important part of gastroenterology. The Therapeutic ERCP/EUS Workshop is a live demonstration of Therapeutic ERCP/EUS. Inzucchi MD, of the Yale School of Medicine Department of Internal Medicine, Section of Endocrinology. Now in its ninth year, the Diabetes program consists of newsletters and tests presented in a monograph twice each year based on highlights from meetings of the Annual Scientific Sessions of the American Cardiology Association, the Annual Scientific Sessions of the American Diabetes Association, the Annual Meeting of the European Association for the Study of Diabetes, and the Annual Scientific Sessions of the American Heart Association.
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