A couple, both in their 50s, recently consulted me for managing their diabetes.

𝗠𝗮𝗻𝗮𝗴𝗶𝗻𝗴 𝗕𝗹𝗼𝗼𝗱 𝗦𝘂𝗴𝗮𝗿: 𝗦𝗺𝗮𝗿𝘁 𝗧𝗶𝗽𝘀 𝗳𝗼𝗿 𝗥𝗲𝗱𝘂𝗰𝗶𝗻𝗴 𝗥𝗶𝗰𝗲'𝘀 𝗚𝗹𝘆𝗰𝗮𝗲𝗺𝗶𝗰 𝗜𝗻𝗱𝗲𝘅 (𝗚𝗜)

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Thread 🧵 1/ A couple, both in their 50s, recently consulted me for managing their diabetes. They had it for over eight years. During routine check-up, it was found that their HbA1c levels were high (>9%). We had a deep discussion about their diet and lifestyle habits.

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Insulin is NOT a first choice medicine in type 2 diabetes mellitus (T2DM).

Exceptions:
- Short-term use in #T2DM:
(1) ketosis
(2) sepsis
(3) extremely high blood glucose
- Long-term use in #T2DM:
(4) secondary oral medication failure (also called ß-cell failure)
@sambit_dash

1.

https://twitter.com/sambit_dash/status/1187334173050068992

The guideline chart attached above is very clear - lifestyle modifications should be the first choice ± #metformin. Metformin is cheap.
I am least influenced by industry, and use long-term insulin in <5% T2DM, mostly for reason (4), usually after exhausting other options.

2.

Glasgow Coma Scale to assess students in a classroom. A practical scoring system for the "serious" medical teacher ;)

#medtwitter #edutwitter
#MedicalEducation #spoof If the classroom GCS is <8, that's COMA!
COMA = Class Outside My Awareness.

#Coma #Students #edchat #AcademicTwitter