Treating hypos post sugar tax

Lucozade just isn’t what it used to be. With the sugar tax affecting the diabetics favourite emergency beverage the Independent Diabetes Trust have compiled a list of substitutes that you may wish to use.

For shear portability and cuteness Emma and I are great fans of Jelly Babies but you may have your own.

 

5-7 Dextrosol

4-5 Glucotabs

60 mls Glucojuice (one bottle)

150-200mls pure fruit juice

3-4 heaped teaspoons of sugar dissolved in water

4-5 Jelly Babies

RCGP: What doctors need to know about types one and two diabetes in young people

The Royal College of General Practitioners have recently released an educational programme for UK doctors which they have very kindly allowed me to link to our website.

I recorded this over a year ago and I think the college held off production until their type two diabetes low carb course was also released for doctors.

This means that the RCGP joins the American Association of Clinical Endocrinologists as supporters of low carbing  for both type one and two diabetes.  Surely the other clinical associations and Royal Colleges will follow in due course?

The screencast includes information on diagnosis, emergency situations, blood sugar and dietary management and contraception.

“I have also separately produced an educational screencast on Diabetes in adults (type 1), children and young people (type 1&2) for the Royal College of General Practitioners in my role as an RCGP Clinical Adviser”

http://elearning.rcgp.org.uk/mod/page/view.php?id=8368

 

What factors are most predictive of a heart attack?

Dr Malcolm Kendrick recently discussed a paper in which computers analysed routine clinical data from UK GP practices to identify the factors that most accurately predicted a cardiovascular event over the next ten years.  All the 378,256  people whose records were analysed were initially free of cardiovascular disease and 48 variables were identified.

The top ten things that were most likely to see you in hospital with a heart attack or stroke, in order,  were:

Chronic Obstructive Pulmonary Disease

Prescribed oral steroids

Older age

Severe mental illness

South Asian ethnicity

Prescribed immunosuppressants

Socio-economic deprivation

Chronic Kidney Disease

 

The least predictive were LDL, Forced expiratory volume ( a measure of asthma) and AST/ALT ( a measure of liver function).  Total cholesterol was 25th.

Can machine learning improve cardiovascular risk prediction using routine clinical data? http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174944

Lancet: Aspirin only works if it is the right dose for your weight

Low dose aspirin 75-100mg daily are only effective in reducing cardiovascular events in those who weigh less than 70kg found researcher Peter Rothwell.  This is the dose range used in the UK and the USA but 80% of all men and 50% of all women weigh more than 70kg.

Higher doses of aspirin are only effective for cardiovascular prevention in those over 70 kg and don’t work in those who weigh less than this. Therefore recommending the higher dose range won’t suit everyone either.

Some people also use aspirin to reduce the chances of other diseases such as colorectal cancer. The effects are thought to be dose related as well.

The take home message is that if you weigh less than 70kg stick to 75-100mg of aspirin a day, but if you weigh 70kg or over you should increase your dosage. For most people in the UK this will mean doubling up on 75mg to 150mg and in the USA where 82.5 mg is standard, upping this to 165mg daily.

Lancet doi:10.1016/S0140-6736(18)31133-4

 

 

 

 

 

 

BMJ: It doesn’t take much alcohol to damage your brain cells

Adapted from BMJ 24 February 18 Alcohol link to dementia is “robust” by Jacqui Wise

Chronic heavy drinking should be recognised as a major risk for dementia say French researchers.

They looked at over 31 million French adults discharged from hospital between 2008 and 2013. Over 1.1 million people had been diagnosed as having dementia.  In 57% of those with early onset dementia alcohol use was considered to be the cause.

Drinking more than 6 units of alcohol a day for a man and 4 units for a woman put you in the risk category of “heavy drinking” according to the World Health Organisation. This level will make both men and women more than three times more likely to develop dementia than they otherwise would.

Michael Schwarzinger said, ” The link between dementia and alcohol use is likely a result of alcohol leading to permanent structural and functional brain damage. Alcohol disorders also increase the risk of high blood pressure, diabetes, stroke, atrial fibrillation, and heart failure, which in turn increase the risk of vascular dementia. Heavy drinking is also associated with smoking, depression and low educational attainment which are also risk factors for dementia.”

Clive Ballard from the University of Exeter Medical School said, ” This study is immensely important. This evidence is robust and the public need to know about the relationship between alcohol consumption and dementia.”

My comment: I was really sad to read this report in the BMJ as I do love a nice glass of full bodied red when I’m eating a big lump of fatty spiced meat or a smelly gorgonzola. I was also dismayed to see what they regard as heavy drinking. 175 mls of most wines will be 2 units so two of them a day and you are three times more likely to get dementia, if you are a woman. I dread to think what a two week all inclusive holiday does to your brain. It is  always best to know these things before you get too batty to care. 

BMJ: Varicoceles can be a marker for metabolic syndrome and type two diabetes

Nancy Wang from Stanford University is a urologist and says, “Varicoceles which are varicose veins of the spermatic cords, are associated with low testosterone. This in turn makes men more likely to develop metabolic risks and heart disease. No one has connected the dots before now”.

These men have higher risks of heart disease, diabetes, and hyperlipidaemia.

My comment: Varicoceles feel just  like a bag of worms in the scrotum. Up to one in 5 men will develop these over their lifetime. 

BMJ: Bariatric surgery best done before a BMI of 50

More than a third of patients who had bariatric surgery got back to a BMI of 30 or less after one year. Some patients respond better than others, and some operations are more effective than others.

Having a BMI of less than 40 made it more likely for the person to reach their goal weight. Obviously, they had less to lose. Only one out of ten patients who had a BMI of 50 or over got down to a BMI of 30, which corresponds to the limit between being considered overweight and being considered obese.

Sleeve gastrectomy, gastric bypass or duodenal switch operations were the most effective. Adjustable gastric bands were less effective.

BMJ  9 Dec 2017 from JAMA Surg 2017