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Different types of type 2 diabetes – the more the merrier?

June 1, 2018, Dr Chee L Khoo

Different categories of type 2 diabetes

Have you noticed that your patients with type 2 diabetes (T2D) are a heterogeneous group? Some T2D patients are more insulin resistant than others. Some T2D patients are more insulin deficient than others. These tend to be the younger T2D. Some patients are obese and some are not.…

Hypoglycaemia is more than just an inconvenience

May 15, 2018, Dr Chee L Khoo

Unless you have experienced a severe hypoglycaemia, you don’t actually appreciate the petrifying effects it has on your patients. In addition to increased morbidity and mortality, it is associated with a reduction in health-related quality of life, increased fear and anxiety, reduced productivity and increased healthcare costs through increased utilisation of healthcare resources and blood glucose monitoring.…

Continuous Glucose Monitoring coming to general practice – are you ready?

May 15, 2018, Dr Chee L  Khoo

You probably think that insulin pump (so-called continuous subcutaneous insulin infusion or CSII) and continuous glucose monitoring (CGM) are all to do with Type 1 diabetes (T1D) in diabetes centres and you probably don’t need to know about it, you are probably right. Well, almost. I mean, how often do you come across CGM and CSII in general practice?…

SGLT2 inhibitor/DPP4 inhibitor combo under PBS – sorting out the confusion

May 1, 2018 Dr Chee L Khoo

When I wrote the article last fortnight about new SLT2 inhibitor/DPP4 inhibitor combo now on the PBS, the situation was still very confused. Since that article, more information has  come to light. Yes, we are allowed to use both DPP4 inhibitors (DPP4i) and SLGT2 inhibitors (SGLT2i) together when patients with type 2 diabetes (T2D) if the HbA1c is >7.0%.…

Getting T2D to target – two heads better than one

April 15, 2018, Dr Chee L Khoo

To get our patients with type 2 diabetes (T2D) to glycaemic target using oral agents,  you can either use an SGLT2 inhibitor (SGLT2i) or a DPP4 inhibitor DPP4i) after metformin (with or without a sulphonylurea) but not both. If you stop a DPP4 inhibitor to start a SGLT2ior vice versa, in general, the HbA1c remain unchanged.…

Metformin in pregnancy – where are we now?

April 2018, Dr Chee L Khoo

Another day, another study published on the good or bad about metformin use in pregnancy. There is a lot of confusion and unknowns about the benefit or safety of metformin to the mother-to-be or to the long-term outcome of the baby. When there is a lot of conflicting data coming our way, we need to sit back and look at the overall picture of hyperglycaemia in pregnancy and its management before we can make sense of these studies.…

Multi-disciplinary care of T2D – does it work in primary care?

April 2018, Dr Chee L Khoo

Multi-disciplinary care (MDC) is often hailed as THE comprehensive management for patients with type 2 diabetes (T2D). We refer these patients to podiatrists, exercise physios, dietitians, diabetes educators and sometimes, endocrinologists. Now, that is MDC, isn’t it? We are part of the MDC team. Do we see the benefit that is often hailed from MDC?…

Ketosis may improve glycaemic control – can we use it in T2D therapy?

April 2018, Dr Chee L Khoo

Ketogenesis is the production of ketone bodies (KB) when glucose levels decline and the glucagon:insulin ratio is high. When the body is deprived of glucose, KB act as an alternative fuel source for brain, heart, kidneys and skeletal muscles. KB have also been shown to have other physiological functions including lower glucose levels.

To understand the potential therapeutic implications of KB, we need to revise our knowledge about KB metabolism.…

Statins and Muscles – worse than we think

March 15, 2018,  Dr Chee L Khoo

“Doc, my muscles feels tired every time I try to exercise”. Are these patients just unfit or is it the statin or is that just another excuse? Between 7-29% of patients on statins report muscle complaints (depending on who reports them). Often these symptoms are exacerbated with physical activity and exercises. Muscle soreness, muscle pains and muscle tenderness are probably relatively easier to quantify in patients but non-specific muscle fatigue are much harder to pin down.…

Metformin during pregnancy – Goldilocks principle strikes again!

March 15, 2018 Dr Chee L Khoo

Hyperglycaemia during pregnancy has significant metabolic consequences for the mother, the pregnancy as well as for the offspring’s future health. It is tempting to assume that keeping the glucose lower during pregnancy must be beneficial for both parties. Metformin has been used in women with PCOS, GDM and obesity during pregnancy in an attempt to improve pregnancy and foetal outcomes but this practice is not based on solid scientific evidence.…

VLCD may cause initial reduction in cardiac function

March 2018, Dr Chee L Khoo

Several meta-analyses of randomised clinical trials showed that ketogenic diets induce a long-term significant improvement in body weight, diastolic blood pressure, triglycerides and HDL-cholesterol, when compared to low fat diets. However, rapid weight loss may cause a transient rise in plasma triglycerides which can contribute to impairment in cardiac function in the short term.

The heart has a very high energy demand, which is met almost entirely by the mitochondrial oxidation of fatty acids and carbohydrates.…

Dasiglucagon – the new glucagon

February 2018, Dr Chee L Khoo

Hypoglycaemia is one of the most common endocrine emergencies and the most feared complication of having diabetes. Treatment of severe hypoglycaemia in patients who are unable to take oral treatment is limited to either glucagon or glucose injections both of which requires some experience in playing with syringes and bottles. Dasiglucagon, a novel soluble glucagon analog, is a ready to use rescue pen developed for treatment of severe hypoglycaemia.…

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