Tag Archives: Chronic Conditions

Insulin: Type 1 & Type 2 Diabetes Differences

When we think about insulin, we know that all of our bodies have a pancreas that sits in the middle of it and, within the pancreas, there specialized cells that go ahead and release insulin. The way I like to think about it is it’s a key that unlocks ourselves so that the food and nutrients we eat are able to be metabolized and used for fuel by our body.

In Type 1 diabetes, we always tell families it’s an autoimmune process. So for some reason, your body sees those insulin producing cells within your pancreas as being foreign, so it starts attacking those cells. So going back to that key analogy, we think about, all of a sudden there’s not a lot of keys available.

Youth with Type 2 diabetes have a different situation going on. In that situation., it’s an issue with insulin resistance and so the way that I think about it is that you still have keys, but the keys are the wrong shape now. The difference between Type 1 and Type 2 diabetes is really the fact that, in Type 1 diabetes, you are relying on exogenously administered insulin for survival.

In Type 2 diabetes, you have insulin that your body’s making. However, you cannot use it appropriately and so youth present with high blood sugars, but in conjunction with that, they often have high insulin levels and so we need to initiate insulin therapy. So giving injections, but over time we may be able to transition to alternative means to manage their glucose levels and I have to say, Yale is at the cutting edge of developing new treatments for kids diagnosed with diabetes.

When using injected insulin therapy or pumping insulin, what we’re trying to do is closely match what your body should be making and so there’s lots of different insulin therapies out there and the amazing thing to think is, you know, 100 years ago this was just discovered, it was one of the initial presentations on insulin therapy. It was here at Yale. People started on insulin therapy in 1922 and it’s come such a long way.

As somebody living with Type 1 diabetes, I can share with you that in 1987 when I was diagnosed, I was on purified pork insulin and so I don’t feel very old, but saying that I took a purified pork insulin therapy makes me feel very, very old and very grateful for how these therapies have improved and how we’re better able to match the physiologic profiles of what your body should make.

Multimorbidity: Affects 95% Of Adults Over Age 65

Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual’s carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient’s values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.

Read more

Disease Infographics: Multiple Sclerosis

Dr. C’s Journal: Care Of Hand Osteoarthritis

I started having hand pain about 20 years ago, and booked a visit with the rheumatologist in my medical building. He looked at my hands and immediately knew that I had osteoarthritis.

The thumb musculature (the thenar eminence) was angled with respect to the plane of the rest of my hand and wasn’t flat like normal. Some of my joints were slightly swollen and even warm to the touch, and many of my fingers were beginning to get crooked.

He ordered a rheumatoid panel, uric acid and inflammatory markers. The normal results confirmed his diagnosis of osteoarthritis.

The middle and index fingers have taken a lot of trauma over the years. They are also the crookedest, for the same reason. With the thinning of my skin or you can see the outline of my tendons  on the palm of my hand, and some are a little bit bumpy and irregular. I am unable to make a tight fist anymore, although my fingers will flex to some degree.

I practice exercises on my wrist, hands and fingers, such as rotating my wrist and thumb in a circular fashion, touching my thumb to the tips of my fingers in sequence, squeezing a rubber ball, and flattening out my hand against the back of my head. Recently, I have noticed a little resistance when I try to straighten out my ring fingers after flexing them, and worried about developing trigger finger. On further reading I found that trigger finger is not more common in people who have osteoarthritis.

I do a lot of swimming, and am worried that the irritative force of the water regularly acting up on my hand might be making the hand pain worse. But my hands seem to be a little bit better with the hand exercises. There seems to be less pain, although maybe I have the same amount of pain but tolerate it better since I’m doing something about it. One never knows about a preventative program, since you’re an experiment of one. You have to have faith that what you are doing is beneficial, and in harmony with medical studies. Perhaps my anti-inflammatory diet and turmeric, as well as my good sleep and aerobic exercise is also helping.

—Dr. C.

Chronic Conditions: Allergic Rhinitis (Nature)

Allergic #rhinitis is caused by IgE-mediated reactions to inhaled allergens and is one of the most common chronic conditions globally; it often co-occurs with #asthma and conjunctivitis.

Chronic Conditions: Does Stress Cause Ulcers?

Stress shoulders a lot of blame for health issues like high blood pressure, fatigue and depression — and rightly so. But when it comes to causing stomach ulcers, it gets a bit of a bad rap.

The main triggers for stomach ulcers, also known as peptic ulcers or gastric ulcers, are:

  • H. pylori infection caused by a common gut bacteria.
  • Overuse of over-the-counter pain relief medication known as NSAIDs, short for nonsteroidal anti-inflammatory drugs.

Chronic Conditions: How To Prevent Kidney Stones

Chronic Conditions: Non-Union Bone Fractures

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #59: Lyme Disease

Lyme disease is high on every hard-to-diagnose disease list, because it is relatively uncommon, and can produce a variety of disturbing symptoms often classified as psychosomatic.

It is caused by a deer tick bacterial injection of the Borrelia genus, which can progress to cause widespread problems. Not every tick bite will inject the bacterium, and ticks that have been attached for less than 12 to 24 hours are unlikely to have done so.

Risk factors include living in a wooded area, particularly on the east coast. With people fleeing the cities in the wake of Covid, exposure is more common.

The NYT columnist, Ross Douthat wrote a book about his travails: “patient heal thyself“. In this day and age of overworked  doctors, and with the huge variety of medical information available online, more and more people are going on a “medical odyssey”.

A painless red swelling, followed by an expanding area of red(erythema migrants), is often the best medical clue. Flu-like symptoms and enlargement of the lymph glands can accompany the “rash”. Tests are not positive for several weeks, and may be negative if and when the late symptoms of Lyme disease develop.

The earlier you get treated with a 10-day course antibiotics, the better. The problem is that not all tick bites produce infection, and so overtreatment is a real possibility.

Late symptoms can include fatigue, mental symptoms arthritis, liver problems and a variety of other symptoms. Like another bacterial disease, syphilis, lyme disease can be the great mimic.

Prevention is paramount. People living in endemic areas should wear long sleeves and pants when they go out into the woods, use insect repellent , and make sure their animals are kept tick-free.

A DWWR article on Nootkatone may be worth your time to read, since DEET and many other insecticides are toxic and have to be used with care.

Please refer to the following article by the Mayo clinic for more organized information.

-Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #56: LUPUS

Lupus, which used to be called lupus erythematosus because of its butterfly rash and light sensitivity, is an auto immune disease, along with celiac disease and several other autoimmune diseases, it is the great imitator. It can affect almost any organ system.

The great variety of symptoms, and relative rarity leads to a difficulty in establishing the diagnosis. Eventually, you may be lucky enough to  find someone who figures it out.

The butterfly rash over the bridge of the nose and cheeks is the most typical finding but it’s not present in all patients. Rheumatoid symptoms, including fatigue fever and joint involvement is common. Chest pain and shortness of breath can occur. Headache confusion and memory loss occurs. Involvement of the kidneys can also occur, it is often the involvement that is life-threatening. These are symptoms maywax and wane over a number of years.

The cause of lupus may involve a black background of infection, the medication, or even sunlight. As with most auto immune diseases, the actual cause is obscure.

Laboratory findings may include an anemia, kidney or liver involvement, and especially anti-nuclear antibody’s. Most people with lupus have a positive ANA test, but not all people with these positive tests have lupus. Other test maybe necessary.

Treatment is usually with Drugs which diminish the immune system. Targeting the B-lymphocytes specifically with rituximab or bulimumab may be helpful.

Lupus, the wolf, can be stealthy and severe. Patients often have to be their own advocate in order to get properly treated.

Please see the following mail clinic article for more information.

—Dr. C.

Read more