all things to do with diabetes obesity and metabolism
10th March 2019, Dr Chee L Khoo
It makes sense that patients with type 1 diabetes (T1D) on insulin pump be fitted with continuous glucose monitoring (CGM) which facilitate insulin titration. It’s even better if the CGM sensor directly “talks” to the pump and adjust the basal insulin rate with an algorithm based on the blood glucose levels. There are ample studies demonstrating better glycaemic control when you use both pump and CGM for management of patients with T1D.…
27th February 2019, Dr Chee L Khoo
Primum non nocere (first do no harm) is quite an appropriate term when is comes to managing pregnant women who either have dysglycaemia or are at risk of dysglycaemia. While there is no question that hyperglycaemia during pregnancy is associated with both poor maternal and foetal outcomes as well as epigenetic changes which can affect the next generation, who and how to treat is still debatable.…
22nd February 2019, Dr Chee L Khoo
Increased oxidative stress appears to be a significant factor leading to insulin resistance, dyslipidaemia, β-cell dysfunction, impaired glucose tolerance and ultimately leading to type 2 diabetes (T2D). Ascorbic acid (AA) is a water soluble anti-oxidant that reduces oxidative damage at the cellular and tissue level. So, logically, AA supplementation should therefore reduce oxidate stress and lead to improvement in glycaemic control in patients with diabetes.…
13th February 2019, Dr Chee L Khoo
It’s all too confusing. It used to be low fat diet. It’s now low carbohydrate (carb) diet. Some studies show that low carb diet loses more weight than low fat diet while others show the opposite. Yet, other studies show no significant difference between the diets. So, which is it then? Have you wondered that perhaps, we are looking at different patients responding to different diets.…
27th January 2019, Dr Chee L Khoo
Energy consumption, regulation and storage vital for the survival of the organism. We have specialised cells that manages the above but often, the cells do a bit of each depending on the energy needs of the organism at the time. When you think about it, the most effective cell to do all of the above is actually the adipocyte.…
27th January 2019, Dr Chee L Khoo
As GPs we often see little kids already carrying extra weight and we know that many of these will go on to become overweight or obese adults. Many overweight kids and overweight adults will go on to develop type 2 diabetes. Interestingly, some obese kids don’t go on to become diabetic. Which subsets of these overweight kids don’t go on to develop diabetes?…
27th January 2019, Dr Chee L Khoo
It’s tempting to rely too much on HbA1c when managing our patients with type 2 diabetes (T2D). It is not uncommon to come across patients with pretty optimal HbA1c (under 6.5-7.0%) and we pat them on the back with the message “well done”. Often, the fasting glucose levels is just glossed over. Should we even bother with the fasting glucose levels at all these days?…
4th January 2019, Dr Chee L Khoo
When you treat a medical condition with an agent with known intended effects, it is not uncommon that we come across some of the unintended effects of the agent. Glucagon-like peptide 1 receptor antagonists (GLP1-RAs) are very useful agents which not only improve glucose control via its known effects on insulin and glucagon but it is associated with modest weight loss.…
24th December 2018, Dr Chee L Khoo
Losing weight is the second hardest thing to do. The hardest is keeping that weight off. With weight loss, hunger increases and energy expenditure decreases as the body adapts physiologically to the weight loss. The kilogram loss is not all fat loss. Some of the losses are muscles and with less muscle bulk, basal metabolic rate also decreases adding further to the decrease in energy expenditure. …
13th December 2018, Dr Chee L Khoo
Three weeks ago, 25 of our GP and allied health professional (AHP) colleagues sacrificed their valuable Saturday and became engaged in a highly interactive session exploring the use of injectables in the management of our patients with type 2 diabetes. Evaluation, comments and suggestions from the participants have just been collated and here at the Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU) we are just absolutely delighted about the results.…
13th December 2018, Dr Chee L Khoo
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the latest therapeutic strategy in the treatment of type 2 diabetes mellitus (T2DM). They feature prominently in the latest international diabetes management guidelines. They not only improve glycaemic control but recent clinical trials demonstrated cardiovascular protection, combined with a reduction in body weight and blood pressure. There used to be three SGLT2 inhibitors, dapagliflozin, empagliflozin and canagliflozin until canagliflozin withdrew from the Australian market.…
10th December, 2018, Dr Chee L Khoo
Elevated triglyceride (TG) level serves as an independent marker for an increased risk of ischaemic events, as shown in epidemiologic and mendelian randomisation studies (1-5). However, in most of the statin trials, patients with high TG are generally excluded. There is confusion out there as to whether fish oils is useful or not for cardiovascular protection.…