Time Stamps !! 0:50 - Case Begins 0:58 Patient History 1:24 What Questions should I be thinking about 1:54 Lifestyle Risk Factors 2:19 Managing Tricky Questions around changing lifestyle 2:52 Care Planning with Diabetic Patients 3:24 Complications of Diabetes 3:50 Good Management Outcomes 4:11 Quick Summary 4:20 Diabetic Management 4:28 National Guidelines 4:54 Diabetic Pharmacology 5:50 Diabetic Cholesterol Pharmacology 6:21 Secondary Prevention with Atheromatous Disease 7:03 Dr Patel’s Alphabet Strategy 7:15 A 7:35 B 7:37 C X 2 7:58 D 8:15 E 8:30 F 9:20 Management of Poorly Controlled Diabetes 9:35 Next steps 10:10 Higher risk patients 10:26 Summary 11:01 Sick Day Rules 11:11 Diabetic Ketoacidosis 11:27 Drugs to be cautious about (SAD MAN) 13:00 The questions 13:18 The Worried Patient (Family Hx) 13:40 HbA1c Levels 14:40 Diabetic Eye Disease
This is very informative and helpful. I myself am not a med student, I'm a pharmacy technician. But a LOT of my patients/clientele are diabetic or at high-risk, so it's good to know this information and be knowledgeable when they ask questions, and especially for the times when I refer them to the pharmacist for advice/recommendations, especially when he spoke about NSAIDs and his thoughts on metformin etc.
me again..did prof mean atorvastatin 20mg for primary prevention and 80mg for secondary. He says 80mg nocte for primary prevention at 5:57 mins? I'm easily confused. thanks
I was having a DM class on a course once and the teacher said something I never forgot: how can you tell an 80 year old person that she needs a diet for the rest of her life? I thought this was very interesting, seeing as my own diabetic grandma had a very very poor control of her glucose levels, but she absolutely refused dieting. How do you respect the patient's will AND help him at the same time? Eventually my grandma died of covid-19, but obviously DM didn't help
I’m not sure I agree with that person - diet is key for all patients regardless of age. It’s a little like telling a patient with a lung disease - “you need to stop smoking. It’s making things worse” At any age, making positive changes DOES help. We respect autonomy because you cannot force someone to act. But we can highlight the risks - which in diabetes include nerve damage, blindness, heart attack and amputation - it is for a patient to decide if they act on that advice. A key tenant of autonomy is that patients are able to make bad decisions. I knowledge those decisions, but I don’t respect those decisions - smoking as an example - and will continue to try to help the patient and maintain the doctor / patient relationship
Yes, I agree with you. But I was never able to get my grandma to properly eat healthy. She usually ate correctly, but she had days when she had chocolate cake like it was the only food left in the world. She was slowly losing her eyes. They were red and had that yellowy exsudate. No kidney or skin problems, but she went through an angioplasty in 2010 and had 2 stents. Angina. Also, let me ask you a question. We seem to be having a great number of covid patients coming with high glucose without previous DM diagnosis. Young patients even, having to go through and insulin drip. Is this also happening over there?
I was tested early last year as a fasting glucose test and my gp said it was normal but I feel like somethings not right. My heart pounds after excess sugar or carbs, if I don’t eat after 4 hours from last meal I get tingly lips and weakness and my circulation to my feet is terrible. My toes go bluish sometimes. Should I push for another test?
I think you are using mg/dl measures (more often used in the USA) we typically use mmol/l A fasted blood sugar should be below Below 5.5 mmol/l or Below 100 mg/dl Two hours after food Below 7.8 mmol/l Below 140 mg/dl I wouldn’t worry greatly, but a discussion with your doctor might be helpful.
It’s so close to the border, and seems surprising it would be lower after food. Try repeating tomorrow. I’d still suggest talking to your GP if concerned
I still don't get why doctors throw drugs at symptoms and don't try to fix the root cause. Why not put people on a low-carb diet with intermittent fasting and curing insulin resistance, The American Association for diabetes has already confirmed that the best diet for Type 2 diabetes is a ketogenic or plant-based diet. Isn't the aim to try and make the body sensitive to insulin again and improve metabolic syndrome by keeping insulin spikes to the minimum during the day. Modern western diets are riddled with sugars, hidden sugars, and simple carbohydrates that cause type 2 diabetes. Education into how food can be the medicine for the body should be taught, not throwing medication at it.
It’s very much not that simple. But perhaps you’ll agree with the basic approach we use “treat the patient not the disease /computer” Medications are an adjunct. We hope they will control the diabetes, whilst allowing the patient to - where possible - adjust lifestyle factors to improve the resistance as you say. HOWEVER that isn’t possible in all cases - it all depends on how damaged the pancreas is. For example some of the diabetic that are most difficult to treat as those with type 2 and no fat to lose - hence no gain from significant diet work The important thing is that medication is not one way. If the patient improves with the medications, and is able to address lifestyle factors then those tablets are not needed and come off We can’t leave a patient to accrue slow damage from diabetes whilst hoping their lifestyle changes are enough. They must be protected and locked after ASAP Hope that helps 😊
I think that proper education is needed for nutrition and science on how the body becomes insulin resistant and how to get rid of it. All diabetes Type 2 is, is an intollerance/Addiction to carbohydrates. You can still be "Skinny Fat" where you are thin and still have the insides of an overweight person and be nutrient deficient and your body not function the way it should. Doesnt it take a while for someone to become diabetic type 2, so wouldn't it be better to educate people once they are diagnosed rather than wait for their pancreas to become damaged. My mother is Type 2 and was advised to drink cow's milk by an NHS Weight loss program. There is sugar in cows' milk it would have spike her blood sugars and she would have had to have taken more medication to bring them down. My mother has been diabetic for 22 years and was on 3 types of medication to help bring her blood sugars down, it wasn't working. she started a healthy ketogenic diet and has now got to the point where her blood sugars have normalized and she has nearly come off all her meds. What I'm trying to say is, If I found out years ago what I know now my mother would not have suffered being a diabetic since I was 16. The whole western diet does not help anyone trying to lose weight as there are sugars and hidden sweeteners in everything, Heck Even I lost 5 1/2 stone in 7-9 months correcting my insulin resistance. I just don't think that throwing medication at something that clearly doesn't work and is making things worst is not the best way to treat the disease which can easily be fixed by reducing carbohydrates and reducing insulin spike throughout the day making sure you become more insulin sensitive.
Time Stamps !!
0:50 - Case Begins
0:58 Patient History
1:24 What Questions should I be thinking about
1:54 Lifestyle Risk Factors
2:19 Managing Tricky Questions around changing lifestyle
2:52 Care Planning with Diabetic Patients
3:24 Complications of Diabetes
3:50 Good Management Outcomes
4:11 Quick Summary
4:20 Diabetic Management
4:28 National Guidelines
4:54 Diabetic Pharmacology
5:50 Diabetic Cholesterol Pharmacology
6:21 Secondary Prevention with Atheromatous Disease
7:03 Dr Patel’s Alphabet Strategy
7:15 A
7:35 B
7:37 C X 2
7:58 D
8:15 E
8:30 F
9:20 Management of Poorly Controlled Diabetes
9:35 Next steps
10:10 Higher risk patients
10:26 Summary
11:01 Sick Day Rules
11:11 Diabetic Ketoacidosis
11:27 Drugs to be cautious about (SAD MAN)
13:00 The questions
13:18 The Worried Patient (Family Hx)
13:40 HbA1c Levels
14:40 Diabetic Eye Disease
This is very informative and helpful. I myself am not a med student, I'm a pharmacy technician. But a LOT of my patients/clientele are diabetic or at high-risk, so it's good to know this information and be knowledgeable when they ask questions, and especially for the times when I refer them to the pharmacist for advice/recommendations, especially when he spoke about NSAIDs and his thoughts on metformin etc.
👍
Bringing out the big guns early! (Dr James Gi at the beginning but otherwise super helpful!)
Sir, congratulations.
This video was very helpful for my article...
Have a nice weekend
Excellent glad it was a help
This new jingle is just dope
Tuh-tuh-tuh
Tuh-tuh-tuh-tuh
me again..did prof mean atorvastatin 20mg for primary prevention and 80mg for secondary. He says 80mg nocte for primary prevention at 5:57 mins? I'm easily confused. thanks
Thank you for this doctors💫💫
Our pleasure!
Very interesting and informative Dr,thank you
Glad it was helpful!
I recognize this checklist strategy with my diabetes doctors. I’ve had type 1 for 16 years, since I was 14. :)
I believe it was actually Prof Patel that came up with the ABCDE strategies
@@DrJamesGill That’s really cool! Glad you showed your talk with him on UA-cam. :D
I was having a DM class on a course once and the teacher said something I never forgot: how can you tell an 80 year old person that she needs a diet for the rest of her life?
I thought this was very interesting, seeing as my own diabetic grandma had a very very poor control of her glucose levels, but she absolutely refused dieting. How do you respect the patient's will AND help him at the same time?
Eventually my grandma died of covid-19, but obviously DM didn't help
I’m not sure I agree with that person - diet is key for all patients regardless of age.
It’s a little like telling a patient with a lung disease - “you need to stop smoking. It’s making things worse”
At any age, making positive changes DOES help.
We respect autonomy because you cannot force someone to act. But we can highlight the risks - which in diabetes include nerve damage, blindness, heart attack and amputation - it is for a patient to decide if they act on that advice.
A key tenant of autonomy is that patients are able to make bad decisions. I knowledge those decisions, but I don’t respect those decisions - smoking as an example - and will continue to try to help the patient and maintain the doctor / patient relationship
Yes, I agree with you. But I was never able to get my grandma to properly eat healthy. She usually ate correctly, but she had days when she had chocolate cake like it was the only food left in the world. She was slowly losing her eyes. They were red and had that yellowy exsudate. No kidney or skin problems, but she went through an angioplasty in 2010 and had 2 stents. Angina.
Also, let me ask you a question. We seem to be having a great number of covid patients coming with high glucose without previous DM diagnosis. Young patients even, having to go through and insulin drip. Is this also happening over there?
I was tested early last year as a fasting glucose test and my gp said it was normal but I feel like somethings not right. My heart pounds after excess sugar or carbs, if I don’t eat after 4 hours from last meal I get tingly lips and weakness and my circulation to my feet is terrible. My toes go bluish sometimes. Should I push for another test?
If you don’t feel right, you should certainly talk to your GP. But that doesn’t sound like an issue with sugars being high.
Thank you for replying, will definitely go in to see what’s happening
Thank you for doing this video I’m a type 2 diabetes.
Your welcome. I hope it was useful?
I just did my fasting suger checked and my fasting sugar was 101 and pp bsl ( post eating) was 81.. is this a problem ?
I think you are using mg/dl measures (more often used in the USA) we typically use mmol/l
A fasted blood sugar should be below
Below 5.5 mmol/l or Below 100 mg/dl
Two hours after food Below 7.8 mmol/l
Below 140 mg/dl
I wouldn’t worry greatly, but a discussion with your doctor might be helpful.
@@DrJamesGill thanks doctor. It is mg/dl. Surprisingly I did my test today and the video came. I was worries why it was 101 after fasting.
It’s so close to the border, and seems surprising it would be lower after food.
Try repeating tomorrow.
I’d still suggest talking to your GP if concerned
@@DrJamesGill thanks doctor
@@DrJamesGill did another test and everything is normal. Thanks doctor
Who the hell is this James Gi guy??? Dr. Gill you may want to look into this, seems like someones hacked your channel
Of all the typeos, there could have been worse thankfully
i'm having a senior moment. I've watched this twice and can't seem to find the bit that relates to G and H of Prof's alphabet? Please help me! :)
ah i saw Guardian drugs, what was H?
Hey Dr Gill! Why don’t you create an instagram account?
I don't really have the time is the shorter answer
excellent
I still don't get why doctors throw drugs at symptoms and don't try to fix the root cause. Why not put people on a low-carb diet with intermittent fasting and curing insulin resistance, The American Association for diabetes has already confirmed that the best diet for Type 2 diabetes is a ketogenic or plant-based diet. Isn't the aim to try and make the body sensitive to insulin again and improve metabolic syndrome by keeping insulin spikes to the minimum during the day. Modern western diets are riddled with sugars, hidden sugars, and simple carbohydrates that cause type 2 diabetes. Education into how food can be the medicine for the body should be taught, not throwing medication at it.
It’s very much not that simple. But perhaps you’ll agree with the basic approach we use “treat the patient not the disease /computer”
Medications are an adjunct. We hope they will control the diabetes, whilst allowing the patient to - where possible - adjust lifestyle factors to improve the resistance as you say.
HOWEVER that isn’t possible in all cases - it all depends on how damaged the pancreas is. For example some of the diabetic that are most difficult to treat as those with type 2 and no fat to lose - hence no gain from significant diet work
The important thing is that medication is not one way. If the patient improves with the medications, and is able to address lifestyle factors then those tablets are not needed and come off
We can’t leave a patient to accrue slow damage from diabetes whilst hoping their lifestyle changes are enough. They must be protected and locked after ASAP
Hope that helps 😊
I think that proper education is needed for nutrition and science on how the body becomes insulin resistant and how to get rid of it. All diabetes Type 2 is, is an intollerance/Addiction to carbohydrates.
You can still be "Skinny Fat" where you are thin and still have the insides of an overweight person and be nutrient deficient and your body not function the way it should.
Doesnt it take a while for someone to become diabetic type 2, so wouldn't it be better to educate people once they are diagnosed rather than wait for their pancreas to become damaged.
My mother is Type 2 and was advised to drink cow's milk by an NHS Weight loss program. There is sugar in cows' milk it would have spike her blood sugars and she would have had to have taken more medication to bring them down.
My mother has been diabetic for 22 years and was on 3 types of medication to help bring her blood sugars down, it wasn't working. she started a healthy ketogenic diet and has now got to the point where her blood sugars have normalized and she has nearly come off all her meds.
What I'm trying to say is, If I found out years ago what I know now my mother would not have suffered being a diabetic since I was 16. The whole western diet does not help anyone trying to lose weight as there are sugars and hidden sweeteners in everything, Heck Even I lost 5 1/2 stone in 7-9 months correcting my insulin resistance. I just don't think that throwing medication at something that clearly doesn't work and is making things worst is not the best way to treat the disease which can easily be fixed by reducing carbohydrates and reducing insulin spike throughout the day making sure you become more insulin sensitive.
This was a poor choice of video for background noise, turned out to be far too interesting.
Cholesterol? Statins? In 2021? Is this a kind of joke? 😯
Huh? Statins save lives this is an absolute fact. With LARGE amounts a research behind it