Diagnosing and managing diabetes mellitus (was: A test for Glass318).
Andrew B. Chung, MD/PhD
>
> Hello Glass
Not Glass.
> Troll or Doctor?
Glass is possibly a physician. If not, a pretender rather than a
"troll," which would be a mythological creature that would not be able
to post anything here on usenet.
> You have certainly caused some discussion.
More controversy than discussion.
> A challenge for you. You don't want to risk your credentials
> on the open net, so convince us, if you can, of your merit
> in a different way.
There would be no risk to his credentials here. The concern would be
the possibility of unwanted intrusion into possibly both his personal
and professional life.
> Of course, you do not have to reply. In
> fact, I am not expecting one. However, a negative or
> inadequate response will also assist us to decide whether
> you belong in the killfile or become required reading.
>
> 1. Describe as clearly as you can for lay readers the
> differences in nature, treatment and diagnostic tests for
> Type 1, Type 2, LADA and MODY.
Type-1 diabetes mellitus - persistent severe hyperglycemia with
ketoacidosis (DKA) because of insulin lack arising from the loss of
the insulin producing cells of the pancreas because of auto-
antibodies. These antibodies can be detected by blood tests. The
absence of endogenous insulin can also be determined by blood
testing. However, a young person presenting acutely ill with DKA
requiring large amounts parenteral fluids containing dextrose and
insulin is diagnostic. The treatment is a mix of long and short
acting insulin analogues.
Type-2 diabetes mellitus - persistent hyperglycemia without
ketoacidosis because of insulin resistance combined with inadequate
production of insulin by the pancreas that has lost insulin producing
cells because of the inflammatory cascade initiated by the pro-
inflammatory cytokines from visceral adipose tissue (VAT). This is the
most common type of diabetes mellitus in the U.S. The treatment is
with medications that either increase insulin sensitivity or increase
insulin levels or both. The latter may include exogenous long and
short acting insulin analogues. Insulin requirements can be
considerably larger than for type-1 diabetics because of insulin
resistance despite endogenous insulin production.
Latent Autoimmune Diabetes in Adults (LADA) - uncommon form of
diabetes mellitus that is also known as antibody-positive type-2
diabetes because auto-antibodies to insulin-producing cells (beta
islet cells) of the pancreas are present. The preferred treatment is
with exogenous insulin and insulin sensitizers in hopes of preserving
beta islet cell function for as long as possible.
Maturity Onset Diabetes of the Young (MODY) - very rare inherited
forms of diabetes mellitus that are diagnosed by family history
leading to the application of highly specialized genetic testing.
Because insulin sensitivity is typically normal, treatment entails
increasing beta islet cell production and release of insulin.
> 2. Several lay people here have developed "Getting Started"
> advice for a newly diagnosed type 2. Provide the advice you
> would offer to a newly diagnosed type 2 including diet,
ADA diet dovetailed with the diabetic 2PD-OMER Approach.
Goal: Become hungrier (healthier) to lose all the visceral adipose
tissue (VAT) to cure the insulin resistance (IR/MetS).
> testing,
Once before first meal of the day (ie fasting blood glucose or FBG).
> exercise
Ultra-low impact exercise (Taiji) that is the only exercise has been
shown in randomized controlled trials to reverse the osteoarthritis
that folks with type-2 diabetes typically have.
> and initial timing and dosage of metformin if prescribed.
Instead of metformin, would typically prescribe an oral hypoglycemic
(blood glucose lowering) agent to be taken only when the FBG is
greater than 120 mg/dL.
> Presume that this patient is 50yo, 20lbs
> overweight, has BP of 150/90, fasting blood glucose of 144
> (measured twice on different days), Trigs of 250, LDL 160
> and HDL 25. They mention a random blood glucose taken at
> home of 250.
High BP should be addressed with an ACE inhibitor if tolerated. If
not, an ARB would be an acceptable alternative. Either will increase
insulin sensitivity.
Hypertriglyceridemia should be addressed with high dose DHA and EPA,
which are available by prescription. Goal is to lower triglycerides
to below 150 mg/dL. Fibrates can be added if high dose DHA and EPA
prove inadequate. These too will increase insulin sensitivity.
LDL will decrease and HDL will increase with loss of VAT. This too
will increase insulin sensitivity.
The above measures typically obviate the need for metformin, which is
not a benign drug with the possible adverse lethal effect of lactic
acidosis especially in folks with comorbidities (heart and kidney
disease) as often is the case for type-2 diabetics.
> 3. Which specialist referrals would you recommend to that
> patient as a matter of course during the first month or two
> of treatment?
Referrals should be made to an opthalmologist, a podiatrist, and a
certified diabetes educator (CDE).
> 4. Read the following paper and provide a discussion in
> language comprehensible to a layperson of the authors'
> methods, results and conclusions and the implications of
> those conclusions for treatment of type 2 dyslipidemia.
> http://atvb.ahajournals.org/cgi/content/full/25/8/1697
>From your source:
"Conclusion- Insulin resistance and DM2 are associated with excess
hepatic production of VLDL1 particles similar in size and composition
to those in nondiabetic subjects. We propose that hyperglycemia is the
driving force that aggravates overproduction of VLDL1 in DM2."
The problem with the latter proposal is the observation that there is
excess hepatic production of VLDL1 in folks with isolated IR/MetS sans
hyperglycemia.
Therefore, what should be targeted to reduce hypertriglycemia in
type-2 diabetes is **not** the hyperglycemia but rather the insulin
resistance (IR/MetS). The latter is addressed most effectively by
losing the VAT.
It remains wiser to eat less, down to the optimal amount to become
healthier (hungrier) to lose the VAT, to cure the IR/MetS, and to
possibly cure the type-2 diabetes:
http://HeartMDPhD.com/HolySpirit/Healing
Be hungry... be healthy... be blessed:
http://HeartMDPhD.com/PressRelease
Prayerfully in Jesus' awesome love,
Andrew <><
--
Andrew B. Chung, MD/PhD
Cardiologist
Andy is Evil
in news:1185421186.7...@k79g2000hse.googlegroups.com:
Sock Notice: "andrew" in use. Sock puppets heartdoc(s) 9 thru 17 having
spam launchers rewound.
> neighbor Alan S wrote:
>>
>> Hello Glass
>
> Not Glass.
Yet Andrew replies.
>
>> Troll or Doctor?
>
> Glass is possibly a physician. If not, a pretender rather than a
> "troll," which would be a mythological creature that would not be able
> to post anything here on usenet.
This pedantic usage of the word "troll" is almost funny, as though Andrew
were attempting a joke.
>
>> You have certainly caused some discussion.
>
> More controversy than discussion.
Not on SMC. Andrew brought it here. More noise from SMC's SCM.
>
snippity
>
Here comes the SCAM
> ADA diet dovetailed with the diabetic 2PD-OMER Approach.
How to do the MUCH SPAMMED 2PD-OMER Approach
1.Buy a food scale.
2.Measure what you eat.
3.Gradually cut the total amount eaten down to 2 pounds a day.
4.Walk for 4096 days in a Middle Eastern desert wearing robes from an
old Hollywood Biblical epic carrying a hip flask in case you have to (or
want to) drink your own urine.
Weight loss (but not survival) guaranteed by a million dollar promise
underwritten by the Imbese branch of the Somalian National Bank. Simply
post all your bank details to this newsgroup to apply.
There you go, all you need to know _and_ you don't need to visit his
K00K site.
>
> Goal: Become hungrier (healthier) to lose all the visceral adipose
> tissue (VAT) to cure the insulin resistance (IR/MetS).
Andrew's goal: To be right.
>
>
It is entirely possible that the medical answers submitted by Andrew were
valid, but given his history of obsessive Usenet abuse, his disingenuous
argumentation, and the cloud under which he left Emory, what sane person
would take his word for anything ?
>
> http://HeartMDPhD.com/HolySpirit/Healing
SPAM SITE
>
snip
>
> http://HeartMDPhD.com/PressRelease
SCAM ALERT
SPAM
SPAM
SPAM
>
snip
> 2PD-O-Fries Andrew B. Chung, MD/PhD/NJ/WOKA/SCM**
> Ex-Cardiologist
>
>
Andy is Evil
**NJ-->NutJob,WOKA-->Winner Of K00K Awards,SCM-->Sad Counter Monkey
jb
And this is called stalking. I have collected several of your posts
now harrassing this man, and you have failed on a constant basis to
prove anything against him.
I'm turning these posts over to the feds.
Cary Kittrell
Actually, this is called "mocking".
> I have collected several of your posts
> now harrassing this man, and you have failed on a constant basis to
> prove anything against him.
>
> I'm turning these posts over to the feds.
Good show! Well done!
I'm sure the helicopters are in the air even as
we speak.
Because after all, if we allow even one poster on
Usenet to disparage another, the terrorists will
have won.
-- cary
Andrew B. Chung, MD/PhD
> Alan S <loralgtweightandca...@gmail.com> wrote:
> > "krom" <thekromremoverem...@hotmail.com> wrote:
>
> > >Perhaps have a nice glass of wine as you wait...altho i got the feeling you
> > >could plant a vineyard and make your own wine before this guy comes through
> > >sadly.
> >
> > >KROM
> >
> > To be honest, I truly hope I'm wrong. Despite the
> > differences of opinion we could do with a sane qualified doc
> > on the group for a different point of view. I've always felt
> > that the best way to improve out knowledge is healthy
> > debate; unfortunately too many can't see the difference
> > between that and an argument or flame war.
> >
> > However, the response so far has been underwhelming.
>
> Interesting. Today has been unusually busy but such is life outside
> the internet.
Ime, such is the abundant life with LORD Jesus Christ.
> For the record, I am an Internist with an unusually high number of
> Diabetic patients. Not a surgeon!
Sadly, among surgeons, it would be a vascular surgeon who would
possibly have an unusually high number of diabetic patients.
> This is ridiculous but I will use it as mental exercise so here you
> go:
>
> Question 1. I am tempted not to answer your first question because
> anyone can Google or use Web MD, cut and paste the info you requested.
> I realized, however, that you said "lay readers". You may point out
> inaccuracies - I'm no biochemist.
The Holy Spirit guides me to write the following as a biochemist (PhD
in human genetics and molecular medicine):
> a) Your body needs energy to function (we call it ATP)
Yes, the energy resides in the high energy phosphate bonds of ATP.
> b) Energy is produced by 'burning' or using fuel
ATP is made from ADP and pyrophosphate by either glycolysis or a
process called oxidative phosphorylation in organelles called
mitochondria. These organelles are known by lay folks as the "power
plants" of our cells.
> c) Your body's fuel: Glucose and Free fatty acids (your body processes
> glucose in such a way that energy is released in the form of ATP,
> which is used in almost every process that occurs in the body. E.g.
> muscle contraction)
Inaccurate because you have ironically forgotten the brain :-) Only
glucose is the "fuel" for the **entire** body, including especially
the brain.
This comes from the understanding that physiologically the brain's
"fuel" has to be that which can be used for rapid bursts of ATP
production to match the excitatory bursts of highly energetic neuronal
activity that occurs with the processing of sensory input and with
thought itself.
This would necessarily have to be exclusively glucose for the process
called glycolysis:
http://en.wikipedia.org/wiki/Glycolysis
With only fatty acids as "fuel" the liver will start making harmful
ketones (ketones are harmful because they increase rates of lipid
peroxidation) to supply muscles with a suboptimal alternative (ketones
are suboptimal for muscle because they do not permit glycolysis which
type-2 muscle fibers, those fibers which confer strength, rely on) to
glucose and will start breaking amino acids down to make the glucose
that the brain needs in this setting where dietary carbohydrates are
absent and glycogen stores have become depleted. Because optimal
levels of amino acids are needed for optimal rates of protein
synthesis, rates of protein breakdown start to exceed the rates of
protein synthesis. This is the reason why inadequate-carb diets result
in muscle wasting. The latter would be a bad thing especially for
type-2 diabetics because it tends to worsen insulin resistance.
Indeed, loss of hunger confirms that starvation ketosis from
inadequate carbohydrate intake is a bad thing.
flyingrat
and...@emorycardiology.com says...
> Be hungry... be healthy... be blessed:
Andrew Chung:
Is a frequent and proven liar (evidence archived forever on Google)
Has lost numerous NNTP accounts with supernews and others, has had many
Google accounts nuked, and his vanity domain heartmdphd.com is now
banned from setting up accounts. He is instead using multiple Google
sock accounts and email addresses in the format love#@thetruth.com (#
being a number)
Is unemployed after being sacked with cause from his one and only job
after just over 80 days
Fled the state of Florida, and now claims to practice in Georgia despite
having no admission priveliges in the State's hospitals
Runs a phony foundation with a total declared income of circa $200, the
ownership and contact details of which are obfuscated on its website
Makes failed prophecies concerning earthquakes with areas and dates,
which don't happen (remember the bible quotes about false prophets)
Performed a public attempt at 'exorcising' a Malaysian sock on usenet,
then denied doing it. He has recently reversed position again and admits
to practicing exorcism by usenet, proving himself a liar in the process.
Promotes a dangerous diet, with a million dollar guarantee that he
demands thirty dollars to access details of. This despite being
unemployed. His soliciting and spamming for donations looks to be
similar to the Nigerian Advance Fee Fraud, where victims pay money
upfront in the hope of coming into riches but find they have merely
bought into a lie. Part of his advice is to pour nail polish remover onto food.
Declares he has a cardiology practice despite posting night and day from
the same IP address (his home presumably) or a coffee shop internet cafe
Makes further false prophecies that we should now be all dying in a bird
flu pandemic. When these fail to happen, he does them all over again and
changes the dates. Nuclear war is another Chung spciality, which
naturally doesn't happen when he says it is going to.
Worships evil hatemonger Fred Phelps and will not denounce the acts of
Westboro's congregation. He even accuses someone with the name Phelps of
being Fred's son and refuses to accept he is completely wrong.
Uses the same patter as Pat Robertson, indicating his religious activity
is confined to watching cable TV. No evidence Chung has ever attended a
church.
Has a tendency to cyberstalk, particularly women. His wife fled some
time ago to another state, an act which Chung tries to pass off as "being
on vacation".
Frequently passes himself off as being qualified in areas such as
endocrinology, despite making incredibly fundamental blunders in his
'advice'. It is no wonder the Florida heart facility terminated him, and
has publicly denounced his version of events. Again archived on Google.
Don't forget the fake fast, where he didn't lose any weight, as well as
the infamous 666 stamping fiasco. His latest vile trick is spamming the
blogs of dying cancer patients and then crowing triumphantly when they
pass away.
glass318
>
> - Show quoted text -
What are you talking about, Dr. Chung? Do you always have to say
something? Read my post again because me thinks you are just saying
the same things I have said in more "non-layman" language. I
personally do onot like copying and pasting and Wikipedia is not my
primary source of mediacl information.
FYI, Ketones are used by the BRAIN (and many other cells) as fuel in
times of need--e.g. during starvation. This is ONE of the ways we
survive prolonged periods of fasting. It is not as good as glucose but
it is the next best thing in times of need.
Didn't read anything new from your posting.
Doug Freyburger
>
> FYI, Ketones are used by the BRAIN (and many other cells) as fuel in
> times of need--e.g. during starvation.
Ketones are used by the cells as a response to a successful
predator hunt. Humans are omnivores and that's one form of
success in getting food. Low carbing takes advantage of this
feature of ketones and it has nothing to do with starvation.
> This is ONE of the ways we survive prolonged periods of fasting.
Too but not relevant to low carbing.
> It is not as good as glucose but
That's a claim that fairs poorly when checked for accuracy.
> it is the next best thing in times of need.
Or in times of success. The primary reason for releasing
ketones has nothing to do with starvation.
Andy is Evil
news:Zb2qi.53210$5j1....@newssvr21.news.prodigy.net:
> Andy is Evil wrote:
a thoroughly delighful summary of one of Andrew's posts.
>> Andy is Evil
>>
>> **NJ-->NutJob,WOKA-->Winner Of K00K Awards,SCM-->Sad Counter Monkey
>
> And this is called stalking.
> I have collected several of your posts now harrassing this man, and you
> have failed on a constant basis to prove anything against him.
You do realise that by your definition you've just admitted to stalking me.
>
> I'm turning these posts over to the feds.
Great, I'm sure they could do with a laugh. While you're at it you could
also post details of Andrews scam to the relevant authorities. Perhaps even
the same guy at the fed office or the AMA if he's too busy. If they don't
want to take an interest, try reporting Andrew to Google and his ISP for the
ridiculous number of sockpuppets, off-topic posts, and spamming that he daily
excretes onto Usenet.
Perhaps while we're waiting for their reply you could explain on this
newsgroup why you support lying and spamming.
Andy is Evil, but jb is just stoopid.
sai...@gmail.com
Under normal circumstances, Insulin prevents ketone formation by
inhibiting the breakdown of fatty acids. Insulin acts on the liver
inhibiting transformation of Acetyl-CoA into ketones. This means
ketones are not a significant source of energy when humans are living
under normal circumstances but the brain and other organs (especially
skeletal muscle) do use ketones as fuel.
Glucose is does not hold EXCLUSIVE rights for fuel supply to the
brain. Our bodies have evolved SMARTLY over time. Your statement
applies probably extinct variations of our species. We are very
adaptable.
This is science. Not conjecture.
Andrew B. Chung, MD/PhD
See the Subject line for the topic that the Holy Spirit has guided me
to write about.
> Do you always have to say something?
No.
> Read my post again because me thinks you are just saying
> the same things I have said in more "non-layman" language.
Fatty acids do not serve as "fuel" for the **entire** body as glucose
serves as fuel. What you have written in "layman" language does not
accurately reflect this important aspect of biochemistry as applied to
the physiology of macronutrient utilization..
> I personally do onot like copying and pasting
Nor do I so I have not.
> and Wikipedia is not my primary source of mediacl information.
It is adequate for helping laypersons understand fundamental
biochemistry, which would not be medical information.
> FYI, Ketones are used by the BRAIN (and many other cells) as fuel in
> times of need--e.g. during starvation.
If this were true, starving folks would survive being injected with
exogenous insulin which would cause iatrogenic hypoglycemia.
Instead, starving folks still go into hypoglycemic shock which will be
manifest by confusion followed by seizures, coma, and then death.
> This is ONE of the ways we survive prolonged periods of fasting.
With only ketones and no glucose from gluconeogenesis, there would be
immediate death from hypoglycemic shock in the setting of starvation.
> It is not as good as glucose but it is the next best thing in times of need.
Glucose is absolutely required for normal brain function.
Folks who have ever experienced delirium from hypoglycemia (ie our
medicated diabetic readers) should be able to affirm this.
That you lack this fundamental piece of knowledge does not bode well
for the rest of your knowledgebase.
> Didn't read anything new from your posting.
The fundamentals are not supposed to be new.
Truth is simple.
Andrew B. Chung, MD/PhD
> satan via a sockpuppet (demon) wrote nothing meaningful:
> > Andrew, in the Holy Spirit, boldly wrote:
> >
> >
> > <hiss sputter hiss hiss>
>
> And this is called stalking. I have collected several of your posts
> now harrassing this man, and you have failed on a constant basis to
> prove anything against him.
Such is the work of satan via his sockpuppets (demons)
> I'm turning these posts over to the feds.
Only GOD can destroy satan by throwing him into a lake of burning
sulfur.
This will happen soon.
jb
> jb <j...@dallas.global.net> wrote in
> news:Zb2qi.53210$5j1....@newssvr21.news.prodigy.net:
>
>> Andy is Evil wrote:
> a thoroughly delighful summary of one of Andrew's posts.
>>> Andy is Evil
>>>
>>> **NJ-->NutJob,WOKA-->Winner Of K00K Awards,SCM-->Sad Counter Monkey
>> And this is called stalking.
>
>> I have collected several of your posts now harrassing this man, and you
>> have failed on a constant basis to prove anything against him.
>
> You do realise that by your definition you've just admitted to stalking me.
I realize that you should turn on your spell checker before you try
again to impress me with your arrogance and malice.
I've responded to two of your posts, one addressing me (this one)
and one harassing and defaming Andrew. If you've ever read the federal laws
on stalking then you will have to admit yourself that guilt is
determined by demonstration of a repeated pattern of malice. Your posts,
your handle and your responses to Andrew bear out the deliberate design
of a campaign of harassment and defamation.
The laws are explicit on this. You've made your bed, and you will get
a chance to lie in it. I know the authorities pursue cases of this
nature, particularly where a professional person is compromised. As to
whether they will charge you, I cannot say, but I have no qualms about
furnishing them the evidence, and I have ZERO sympathy for you.
This will be the last time I respond to you UNLESS you also decide to
harass me. My advice....don't do it. Twice the crime, twice the time...
My advice to you, stop bothering people while you're still free of an
iron cage. Do you think you're able to do that, because from what i read
of your post you don't know how to use a spell checker.
johnniemccoy@
"glass318" <glas...@yahoo.com> wrote in message
news:1185474186.7...@b79g2000hse.googlegroups.com...
superior-like dissmissal of the last speaker...lol
JOhn
JOhn
Andy is Evil
news:0Ocqi.84$jo5...@nlpi061.nbdc.sbc.com:
> Andy is Evil wrote:
>> jb <j...@dallas.global.net> wrote in
>> news:Zb2qi.53210$5j1....@newssvr21.news.prodigy.net:
>>
>>> Andy is Evil wrote:
>> a thoroughly delighful summary of one of Andrew's posts.
>>>> Andy is Evil
>>>>
>>>> **NJ-->NutJob,WOKA-->Winner Of K00K Awards,SCM-->Sad Counter Monkey
>>> And this is called stalking.
>>
>>> I have collected several of your posts now harrassing this man, and
>>> you have failed on a constant basis to prove anything against him.
>>
>> You do realise that by your definition you've just admitted to stalking
>> me.
>
> I realize that you should turn on your spell checker before you try
> again to impress me with your arrogance and malice.
Spell checker, shmell checker... natural is best.
Malice? Moi? Amusement at your ineptitude at best. Other people might at
this point construct an elaborate and soul destroying flame with
references about your parenthood and unnatural sexual proclivities,
particularly regarding your siblings and animals. Personally, I just find
you too small to bother.
Okay sparky, I'm gonna type real slow for yuh just sos yuh git tuh anser
the questin you snippied truthfully.
Why do you support the repeated net abuse of Andrew B. Chung ?
Why do you support his use of many sockpuppets ?
Why do you support his posting off-topic?
Why do you support his spamming ?
>
snippity
> Your posts,> your handle and your responses to Andrew bear out the
deliberate design of a campaign of harassment and defamation.
Andrew defames himself every time he SPAMS his SCAM over sci.med and
support groups. He reduces his standing every time he replies
disingenuously. He demon-strates his abuse every time he creates a new
sockpuppet to get past peoples kill files. I am merely highlighting his
actions.
Now before your head falls to one side and you start drooling again, I'll
repeat the questions just in case you missed them. Do answer them because
I'm sure the readers in the alt.support and sci.med groups that Andrew has
been abusing would love an answer.
Why do you support the repeated net abuse of Andrew B. Chung ?
Why do you support his use of many sockpuppets ?
Why do you support his posting off-topic?
Why do you support his spamming ?
Andy is Evil, but jb is a cunt.
(I've read that using the c-word really gets the zealots jumping up and
down - tee hee)
Quiet Neighbor
Schizophrenia is a tragic illness, and some pity or compassion would be in
order.
I have seen Chung posts, and he may, indeed, be schizophrenic.
Most schizophrenics are harmless.
QN
<Flying Rat>; "consultant in Earthquackery" <chung.i...@privacy.net>
wrote in message news:MPG.2112f6ccb...@news.readfreenews.net...
Cary Kittrell
> 194.177.96.78> <0Ocqi.84$jo5...@nlpi061.nbdc.sbc.com>
> NNTP-Posting-Host: k/EY7C4e/OBQ2SBMNI5oTw.user.aioe.org
> X-Complaints-To: ab...@aioe.org
> User-Agent: Xnews/5.04.25
> Xref: news.arizona.edu sci.med.cardiology:93054
>
> jb <j...@dallas.global.net> wrote in
> news:0Ocqi.84$jo5...@nlpi061.nbdc.sbc.com:
>
> > Andy is Evil wrote:
> >> jb <j...@dallas.global.net> wrote in
> >> news:Zb2qi.53210$5j1....@newssvr21.news.prodigy.net:
> >>
> >>> Andy is Evil wrote:
> >> a thoroughly delighful summary of one of Andrew's posts.
> >>>>
> >>>> **NJ-->NutJob,WOKA-->Winner Of K00K Awards,SCM-->Sad Counter Monkey
> >>> And this is called stalking.
> >>
> >>> I have collected several of your posts now harrassing this man, and
> >>> you have failed on a constant basis to prove anything against him.
> >>
For some reason I thought that `jb's post to this thread might
be of interest to you: