Tag Archives: #drleethegp

Statins are NOT satan, indeed the contrary!


satan2statins2Ok, so I am not Tim Noakes, neither am I a professor of medicine – though I have listened over the past 20 years to many of them and do on an ongoing basis. They as a whole (generalisation) tend to speak from journals and science. Science these days has to be proven quite well.

There is honestly so much rubbish on the internet from the absolute hogwash about statins to the dribble about vaccines.

LEt’s talks science and let’s talk LIFE quality and quantity.

No I am not a professor but I aim to give my patients the absolute best I can.

What do we know? We know that the diabetes/cardiovascular (another way of saying heart attacks) epidemic is growing on a log curve (if that does not shock you look up what a log curve is). It is not stopping, on the contrary it is snowballing. Why?

Multi-factorial.

What do we know from science and trials like Jupiter – these are big (100 000s) patients across continents. The long and the short is that if your number – LDL is at target (2.8 mmol/l) you will NOT have a heart attack and you will NOT have a stroke.

Now think about this for a minute, would you rather have a heart attack/stroke or would you rather have a bit of muscle ache? Not so bad if the heart attack takes you – although bad for the family. But a trainsmash if you are “maimed” by it, especially when we KNOW it is preventable.

WE have so many statin trials that it is unethical to have one arm on a statin and one arm off a statin – that’s how strong the evidence is as we KNOW the non-statin arm will have “events”.(Secondary prevention).

I am also not a huge fan of big pharma and whilst various conspiracy theories exist in this regard. This is not a conspiracy. This is indeed science.

“Statin therapy is effective at reducing cardiovascular event rates among those with prior myocardial infraction, stroke, diabetes, or overt hyperlipidemia, and current guidelines strongly recommend lipid-lowering therapy among these patient groups as an adjunct to aggressive lifestyle interventions. However, of the nearly 1.7 million heart attacks and strokes that occur annually in the United States, more than half occur among apparently healthy men and women with average or low levels of cholesterol. Thus, novel screening and treatment strategies for cardiovascular prevention are needed that can detect high vascular risk in the absence of hyperlipidemia, that are inexpensive and simple to implement in the primary care setting, and that can provide comparable or superior effectiveness compared to currently accepted approaches”. This is the opening paragraph of Jupiter. What jupiter was trying to ascertain is whether primary prevention is worth doing.

The results ? “Finally, in terms of net clinical benefit, when a composite end point of a first cardiovascular event, venous thromboembolism, or death from any cause is considered, the 5-year NNT in JUPITER was 18.13“”Current guidelines for statin therapy emphasize the need to achieve specific LDLC goals to maximize benefit. However, statins reduce hsCRP in a largely LDLC independent manner, and in the CARE,10 PROVE IT – TIMI 22,9 A to Z,11 and REVERSAL21 trials, best clinical outcomes in terms of event reduction or atherosclerotic regression were observed among those who not only reduced LDLC, but who also reduced hsCRP. Specifically, in these studies, the lowest clinical event rates were consistently seen among those who not only achieved LDLC levels <70 mg/dL, but who also achieved hsCRP levels <2 mg/L. Although these findings are consistent with laboratory evidence indicating antiinflammatory properties of statin therapy as well as current pathophysiologic understanding that atherothrombosis is a disorder of inflammation as well as hyperlipidemia, the concept “dual targets” for statin therapy remains controversial.22

“JUPITER not only confirms that men and women with elevated hsCRP and low LDLC are at substantial vascular risk, it demonstrates that statin therapy can cut that risk by half. Simplified guidelines that advocate combined lifestyle and pharmacological therapy in those groups where trial evidence clearly supports a net benefit have the potential to greatly improve patient care and public health.”

I have specifically quoted Jupiter verbatim as I am so tired of unsubstantiated claims in this regard and I would urge all the statin haters to read the science and chat to the professori of our times. The professori at large.

Statins are not the devil indeed if you are a loved one they may be the saviour. The saviour in terms of preventing a death or a person that now has to be “cared” for. The saviour of our failing medical system that does not need the added burden of cost of multiple patients with stroke and heart attack. Look up how much the average cost to medical aid (or patient if not on one) a heart attack/stroke costs in money terms. Then think about that cost in emotional/psychological terms. Then just have a little think about the vast body of science for a longer while than it takes to read some pathetic unsubstantiated claim on the vast body of internet rubbish. The choice really is yours, the answers are there if you look for them properly.

Circulation: Cardiovascular Quality and Outcomes.2009; 2: 279-285doi: 10.1161/CIRCOUTCOMES.109.868299statinsstatins2

 

 

 

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Exercise – an under-utilised drug – unlock your pent up “non deep breath”


One of the most efficacious keys to unlock insulin resistance, weight loss, fatigue and a plethora of diseases. We all (even me) seem to fright for exercise (when you are not into it). When you get into it you wonder how you “breathed” without it.

And it is indeed about breathing, “hema” “pephamula”.

Oxygen is a vital ingredient to the cell soup and without it you become : tired, unstable, overweight and insulin resistant to put it very plainly.

Even mild exercise like stretching and very beginner pilates classes engage your breathing muscles and get way more oxygen into the system so to speak.

Do it! Just do it. I am not saying do comrades to start. Start slow and get moving, even it if is just your ribcage to get more oxygen in.

Unlock the process and shake a leg.excersisebreathe

How does insulin work?


There are quite a few different types of insulin on the market and a whole bunch of brand new ones arriving soon.

The basic broad classification is long vs short acting. As their name implies they are long or short acting. What does that mean? When you require insulin you have both basal needs as well as prandial (meal time) needs. Your basic and ongoing metabolism needs glucose to go into the cells (all the cells in the whole body) on a minute to minute basis and hence a basal requirement of both glucose and insulin. Insulin is the key that gets the glucose in. When you eat carbohydrates you then require insulin to get the glucose load out of the blood circulation and into the cells where it can be used as fuel.

The long acting insulins cover basal requirements and act for a long time – 6 – 24 hours and some new long actings with a duration of about 48 hours.

The short acting insulins act for a short period of time, starting within about half an hour of injecting and then lasting for around 4 hours. There are brand new ultra short acting ones that are soon to arrive.

Insulin is a dangerous substance and the most acute danger is hypoglycaemia. In other words you inject too much insulin and the sugar plummets very low. At different levels for different people but generally below 2.5 mol/l you not only feel awful but can become unconscious and potentially no longer require a bucket list.

For this reason it is imperative that if you are injecting insulin you understand how it works, when it starts working, how long it works for, the shape of the curve of the action and also imperative to know what your number is – your blood glucose. Before injecting insulin you should ideally do a glucose test and factor this number into the equation.

action of insulins

action of insulins

how do insulins work

how do insulins work

A 2 % drop in A1c with just one addition – I call it a “smoothie”


Recently I have started quite a few patients on dexcom and to my and their delight with this simple intervention we have achieved a 2 % drop in A1c – WITH obliteration of hypos over a 2w to one month period. Previously unheard of!

For a type 1 diabetic who has long battled with both low sugars and high averages – neither good in long or short term it is a great joy to see the “smoothing” out of a very detailed download (c/o dexcom).

Yipee Yay!!dexdowndex sensor

all in the green, no lows no highs

all in the green, no lows no highs

Scrambled egg for breakfast


The pendulum doth swing from one end to the other. At the moment eggs are in. What is a good start to the day? Especially if you are not wanting to have a carb “excursion” it bodes well to have a protein start to the day. Breakfast is a very important meal, perhaps the most important and affects metabolism for the rest of the day. There are studies that link skipping breakfast to the development of type 2 diabetes. Other studies that link general good health to eating a good healthy breakfast.

There is so much rubbish out there for breakfast including just about all the cereals on the market though some are worse than others. They are jam-packed full of sugar.

Not everyone is happy to have eggs for breakfast – there are some other options : jogurt (no sugar added kind), fish (though if not keen on eggs less likely to be keen on fish I think) and then there is a whole range of future life breakfast that needs to be dosed in the correct portion and I would suggest the no sugar added one.

But back to scrambled eggs – easy to do, easy to flavour with just about anything from a touch of salt to cheese or even more adventurous toppings. If you are diabetic and you have protein for breakfast – it is “free” and does not require a dose of insulin. Bargain.scrambled eggs

Dexcom spaghetti


How does one unravel the download of dexcom spaghetti? I find continous monitoring is HUGELY beneficial to the patient on a literally minute to minute basis and in terms of the “knowing” what their sugars are and in terms of littlies the mom or dad “knowing” minute to minute “where” things are at.

For the health care professional however there is a lot of spaghetti to wade through.

My personal favourite is the graph that averages everything out and plots one average on a 24 hour day. For me I can USE this information to adjust settings and give advice. NO two days are quite the same, diabetes remains a learning game, but if you use your trends you will always win, just a little rhyme for a bit of fun.

Diabetes is a challenge, an obstacle, a learning game. I learnt recently from a very inspirational type 1 diabetic that one needs to dance with the obstacle. I am learning myself (as a health care provider) to dance with the obstacles I have in caring for diabetics.

how to unravel

how to unravel

Diabetes ketoacidosis ABC


I have blogged about DKA before. 

DKA – diabetes keto acidosis. Starving in the sea of plenty. Too much sugar – way too much in the blood stream and not enough insulin to get it – the glucose into the cell. Did you ever do those experiments at school about osmosis, where water moves through a membrane to where it is being drawn? In this case the cells, so to speak, dehydrate and start to die and the vascular system is “loaded” with glucose. The cells are dry dry dry and have no way of doing what they need to do – metabolism – without which the human whose cells they are die.

A process begins and catapults quickly and rapidly into a serious life threatening environment which is hostile in the nth degree. Acidosis – pH below 7.4 is very unkind and unfriendly to human life.

The by-products of this deranged metabolism – which is by the way the bodies way of desperately trying to stay alive – are called ketones – these one can measure. 

NOW, a 100 years ago we did not know about ketones, about 50 years ago we discovered a way to measure them in the URINE – major breakthrough. About 20!! years ago we learnt how to measure them in the BLOOD – this is FAR more accurate – far far more accurate, in terms of being related to the timing of what is actually happening in the body as well as giving an accurate quantitative measure of the ketones. In other words one can more accurately monitor and wash them out if you are checking the blood ketones.

Generally speaking if a doctor uses urine ketones to monitor and treat you it will take up to 10 days to get rid of the ketones. IF the doctor uses blood ketones you can see that they disappear (if of course you are doing the fluids correctly and the insulin infusion) within 12-24 hours at the most 48. Not you tell me, patient, medical aid and family which would YOU prefer? Ahospital stay of 2 days or 10 days, one in ICU or one in a well run ward?

Is there a good reason to use urine ketones over blood ketones? No I really don’t think so, it is like using a horse drawn cart to drive to work.

Sorry but I just can not take it any more. Surely it is indelibly printed on your inside if you are a doctor that you wish to do NO harm and wish to HELP your patient to the best of your ability? The best of our ability at this point in time when it comes to DKA is using blood ketones (not urine ketones and yes the occasional blood gas does help but it is a painful investigation and one can very easily and safely manage with new techology).

blood ketones vs urine ketones

blood ketones vs urine ketones