Brain glucose control – a cause of type 2 diabetes?

17th January 2021, Dr Chee L Khoo

brain glucose control

The pathogenesis of type 2 diabetes involves insulin resistance, β-cell failure, α-cell over-activity and the loss of the incretins. The brain is responsible for homeostatic control of a broad range of variables upon which our survival depends. Why wouldn’t the brain be involved with glucose control?  There is increasing evidence that both the pancreas and the brain are jointly responsible for maintaining glucose within and tight setpoint.…

Weekly insulin is coming. Is it any good?

13th December 2020, Dr Chee Khoo

Insulin

First, we have twice daily then once daily GLP1 injections. This was followed by weekly GLP1 injectables. The same is occurring with the insulins. Once daily insulins have been around for a few years and is well established as basal insulins in patients with type 1 and type 2 diabetes. We now have a weekly insulin coming onto the market.…

Pro-opio-melanocortin deficiency obesity – what has it taught us?

obese kids?

27th November 2020, Dr Chee L Khoo

Every so often you come across reports of some “ultra-rare” disease that has a treatment available now and you probably thought that it really doesn’t concern you or your patients. In a recent small study reported in The Lancet, Karine Clément, Erica van den Akker et. al. presented the results of setmelanotide in participants with proopio-melanocortin (POMC) gene mutation which is associated with severe childhood obesity.…

Multi-use lancet device for blood glucose monitoring – URGENT cautionary tale

27th October 2020, Dr Chee L Khoo

blood glucose monitoring

Some of you would have read about the use of the multi-use lancet devices for testing different individuals that was in mandatory quarantine in Victoria between March and August this year. The lancets were disposable but the device holding the lancets were not. I thought everyone knew. I was wrong. Judging by the comments online after the publication of that issue in the Medical Republic, I suspect many of you don’t actually know the infection risk these devices pose and I felt the imperative to write this urgent article.…

Can lifestyle measures prevent GDM?

12th October 2020, Dr Chee L Khoo

We know from various diabetes prevention programs that intensive lifestyle interventions can be successful in reducing progression to diabetes. As GDM is more common in women with higher BMI and in the many high- risk groups and it is logical to ask the question “can we prevent GDM in these women?” If we could reduce progression of patients who has prediabetes to diabetes, we should, in theory, reduce prevalence of GDM in women who are at high risk of GDM.…

Hypoglycaemia in non-diabetics – is it a problem?

hypoglycaemia

27th September 2020, Dr Chee L Khoo

We know that hyperglycaemia is associated with increased cardiovascular mortality. We also know that in patients with diabetes, hypoglycaemia is also associated with increased cardiovascular morbidity and mortality. What about patients who don’t have diabetes and have low blood glucose (<4.0 mmol/L)? I am sure we all have patients who do not have diabetes but on screening blood tests, have BSL lower than 4.0 mmol/L.…

GDM Screening – Can HbA1c replace OGTT during the pandemic?

14th September 2020, Dr Chee L Khoo

We have many patients who have borderline high fasting glucose in their routine check-up. In non-pregnant adults, we have been able to use HbA1c as a generic screening test for type 2 diabetes (T2D) for some time. Unfortunately, neither non-diabetic fasting glucose readings nor HbA1c totally exclude the presence of diabetes. I am sure you have come across patients with non-diabetic fasting glucose and HbA1c but yet fail their oral glucose tolerance test (OGTT).…

“Less glucocentric diabetes management” – what does that mean to you?

14th September 2020, Dr Chee L Khoo

“Less glucocentric?”

Over the last decade, there has been a push for a less glucocentric management of diabetes. For some, less glucocentric means accepting poorer glycaemic control in our patients with diabetes. It was meant to direct us to not be fixated on managing glucose control without looking at other aspects of the diabetes complications.…

GDM screening – who, when and how?

14th September 2020, Dr Chee L Khoo

Tell me this is not, broadly, what you have in mind when you think about gestational diabetes mellitus (GDM). We know that hyperglycaemia and pregnancy does not mix well. GDM is not quite full-blown diabetes in pregnancy but is nonetheless, associated with risks for the mother and infant and with long-term metabolic consequences in both mother and child.…

Do you know this giant lurking in SWS?

27th August 2020, Dr Chee L Khoo

I first met him in December 2014 just before he started work at Western Sydney University in 2015. For someone who has just arrived in south west Sydney, I was most impressed to see how well he grasped the problems we have with the quality of care in patients with diabetes in our area.…

Medical Nutritional Therapy – why are you not prescribing it?

26th July 2020, Dr Chee L Khoo

Whenever we think about management of hyperglycaemia in patients with type 2 diabetes (T2D), we usually think about the most efficacious hypoglycaemic agent we can find (and on the PBS). If you look carefully at most management guidelines, lifestyle measures appears at the very top of the algorithm, side by side metformin. Sadly, it is often not the most prominent and usually, dismissed as an important part of the treatment algorithm.…