A patient with complex, advanced stage type 2 diabetes – where do we start?

14th September 2019. Dr Chee L Khoo

We all have patients similar to this presenting to the practice not that infrequently. This is a real case that I came across just recently. Joanne was referred to the practice by a friend of a friend. She had just been discharged from the local hospital after three weeks following amputation of the lateral two toes of her right foot.

Immune check point inhibitors, microbiome and antibiotics

13th September, 2019. Dr Chee L Khoo

Checkpoint molecules are key regulators of the immune system. These checkpoint molecules are expressed by T cells and are essential for maintenance of immunological tolerance by preventing the unimpeded activation of T cells. Tumour cells capitalise on these checkpoint molecules to protect themselves from attacks by the immune system. Checkpoint therapy block inhibitory checkpoints, restoring immune system function.…

Double diabetes means double jeopardy

10th September 2019. Dr Chee L Khoo

Have you noticed that most patients with type 1 diabetes (T1D) are not only small and petite but are often devoid of muscles when diagnosed. Insulin is a growth factor and without endogenous insulin, muscle growth is often stymied. We can’t push insulin therapy too hard because it will result in hypoglycaemia. Patients with T1D generally have normal lipids (especially triglycerides) and don’t have elements of metabolic syndrome.…

Psst! Wanna fly for free?

28th August 2019, Dr Chee L Khoo

Now, most of us travel overseas a lot. We have already seen how to get lounge access in a previous article. It would be nice if you could also use your frequent flyer points during peak season and fly for free as well. What if you don’t have enough points? Well, what if I can get you more points for free so that you can use those points to fly for free.…

Lipid guidelines – what’s new in 2019?

23rd August 2019, Dr Chee L Khoo

Remember we used to have lipid targets for patients with diabetes and patients with cardiovascular disease. Life was simple then. Just follow those numbers. Then the 2013 ACC/AHA guidelines told us to throw away those targets and put everyone with cardiovascular (CV) risk above a certain figure on maximally tolerated statins. It’s kind of set and forget strategy.…

Adding ezetimibe to statins in the elderly – should we bother?

13th August 2019, Dr Chee L Khoo

Although persons 75 years or older account for 6% of the population, they account for more than 65%of all deaths due to cardiovascular disease (CVD) (1). We know from numerous trials that intensive treatment to reduce lipid levels reduces CV events in patients after they have an ACS (2). What about elderly patients (>75 years old)?…

QT interval – how long is too long? Is it relevant in GP?

26th July 2019, Dr Chee L Khoo

All of us remember the association of QT prolongation with the dramatic Torsale de Pointes (TdP) and sudden cardiac death (SCD) from medical school. Fortunately, both are relatively rare in general practice and we really don’t need to know much about QT prolongation in general practice as it belongs to the hospital people and the cardiologists, right?…

Acid suppression in infants – 2 questions to ponder before prescribing

13th July 2019, Dr Chee L Khoo

Gastroesophageal acid reflux disease in babies is a common presentation in general practice. Crying, frequent vomiting or regurgitation and sometimes poor weight gain can transform a lovely and cute baby into a monster. Acid suppressants, including proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs) are increasingly being prescribed for this debilitating (to both baby and parents) condition.…

At least 3 other reasons why you should use GLP1-RAs early in diabetes management

13th July 2019, Dr Chee L Khoo

New anti-diabetic agents are coming thick and fast. It is easy to get confused as to which agent to use. For injectables, there are currently at least a dozen different insulin preparations and 5 GLP1 -Receptor Analogues (GLP1-RAs) available in Australia. Some are on the Pharmaceutical Benefits Scheme (PBS), some not. It is easy to put them all in the too hard basket.…

Cardiovascular health – are eggs in or out?

13th July 2019, Dr Chee L Khoo

First, it’s not good, then it’s Ok and now we are not sure. Maybe it is, maybe it isn’t. We are talking about eggs and the association with cardiovascular disease and mortality. It’s stuck in many of our and our patients’ minds that eggs are no good. It doesn’t help when the 2015-2020 Dietary Guidelines for Americans came out with somewhat contradictory recommendations: “ (1) Cholesterol is not a nutrient of concern for overconsumption” and (2) “Individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern” (1).…

Fasting or non-fasting lipid levels – doesn’t it really matter?

22nd June 2019, Dr Chee L Khoo

It is standard to measure blood lipids after an 8-12 hour fast. Pretty much all our guidelines for management of cardiometabolic conditions are based on these fasting blood levels. The actual reading is important because it guides us to determine whether a patient is commenced on a statin or not. Do meals affect lipid levels?…

The young T2D – more trouble ahead than you think

13th May 2019, Dr Chee L Khoo

You are already seeing the worrying trend of younger and younger patients being diagnosed with type 2 diabetes (T2D). My youngest is 25 years old when first diagnosed with T2D. I am sure many of you have patients younger than that. Of course, we need to make sure that these are not patients with type 1 diabetes.…