13th April 2019, Dr Chee L Khoo
SGLT2 inhibitors, as a class of anti-diabetic drugs, have been shown in multiple cardiovascular outcomes trials (EMPA-REQ, DECLARE-TIMI 58, CANVAS) to “reduce cardiovascular events in patients with type 2 diabetes (T2D)”. These are big headlines but as obsessive clinicians, we need to be more specific in the benefits of SGLT2 inhibitors in patients with T2D.…
13th April 2019, Dr Chee L Khoo
The monitoring of plasma glucose levels is crucial when we are titrating insulin doses, correlating lifestyle messages with glucose control and in detecting asymptomatic hypoglycaemia. Until now, finger-prick glucose checking is the gold standard for self-monitored blood glucose (SMBG). However, even with 7 point glucose monitoring, nocturnal hypoglycaemia may be difficult to detect.…
We read last fortnight about cerebral amyloid angiopathy (CAA). I am not sure that I can pick up a CAA when I see one. I mean, we are not experts in CT or MRI of the brain. A fairly obvious, bit chunk of an infarct is easy to spot. I can also pick up any asymmetry in the scan. Any more than that, i will have reached out to the printed report.…
23rd March 2019, Dr Chee L Khoo
You may remember receiving warnings recently from the Therapeutics Goods Administration (TGA) about a serious “rare” infection, called necrotising fasciitis of the perineum, also referred to as Fournier’s gangrene (FG). FG is reported to be associated with the use of SGLT2 inhibitors in patients with type 2 diabetes (T2D). The warning came on the back of similar warnings by the US Food and Drug Authority (FDA) in August 2018.…
10th March 2019, Dr Chee L Khoo
About 10% of all strokes are haemorrhagic strokes. In about 10% of cases of primary intracerebral haemorrhage (ICH), cerebral amyloid angiopathy (CAA) is regarded as a possible cause. The recurrence rate of ICH is significantly higher in patients with CAA. With improvements in MRI technology, CAA is increasingly recognised as a cause of ICH.…
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.…
44-year-old male with 1 month of increasing neck pain was referred for a cervical spine injection. A CT scan of the cervical spine two weeks prior (Figure A), revealed foraminal narrowing at the C5-6 level. There was a significant difference between the new scan and the previous scan. There was severe destruction of the C5-6 disc and of the adjacent C5 and C6 vertebral end plates with retrolisthesis of C5 on C6.…
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?…
9th January 2019, Dr John Goswell
According to a recent article in JAMA, in flight emergencies occur in about 1:600 flights. This comforting statistic should allow doctors to relax and enjoy their holidays. Not so for me. I have answered the call “Is there a doctor on the plane” twice now, even though I am not a “frequent flier”. …