Aetna PPO and HMO
Anthem Blue Cross
Tricare
Medicare
Universal
CDS
St Mary’s Preferred Health and HealthFirst
Hometown Health PPO and HMO
Senior Care Plus
Health Plan of Nevada PPO
Sierra Health and Life HMO
Sierra Spectrum HMO
Senior Dimensions HMO
State of Nevada Health Choice
For new patients please keep in mind that my panel may be full and therefor I’m not accepting new patients under that plan.
Thursday, December 22, 2011
Wednesday, December 21, 2011
Continuous Glucose Sensor talk
Learn about continuous glucose monitoring for diabetes to improve your blood sugar control. The Diabetes Center at Renown welcomes Chris Davis of Dexcom will be presenting information and answering your questions. This is scheduled for January 11 at 6 pm. The location is 1500 E Second St, room 402.
Friday, December 16, 2011
If you prefer Facebook...
I have a page by the name Dan Caruso MD to keep people updated on office hours, holiday and vacation closure, insurance plan coverage, etc. It's easier for me and my staff to update on Facebook than the blog. For your privacy I recommend NOT adding yourself to the page unless you want everybody on Facebook to know that you are my patient. Please do not request medical information, prescription refills or scheduling on the Facebook page. It is best to text or email me for these needs.
Wednesday, December 14, 2011
Fewer carbs=less breast cancer?
It sounds very exciting, but the study doesn't actually show a reduction in breast cancer. It shows an improvement in risk factors associated with breast cancer. The main risk factors analysed were weight loss and body fat reduction, the same factors associated with type 2 diabetes mellitus. This sounds like a simple diet that may easily be followed long term.
Medpage Today
Kristina Fiore, Staff Writer, MedPage TodayPublished: December 11, 2011Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco andDorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
SAN ANTONIO -- Limiting carbohydrate intake just two days a week can mitigate some risk factors for breast cancer by burning body fat and improving insulin sensitivity, researchers said here.
Over three months, eating fewer carbohydrates alone or combining that reduction with severe caloric restriction two days per week was associated with significant changes in body fat and insulin resistance, Michelle Harvie, PhD, of Genesis Prevention Center at University Hospital in South Manchester, U.K., reported during a poster session at the San Antonio Breast Cancer Symposium.
"Both diets showed improvement in insulin sensitivity, compared with a regular calorie-restriction diet alone," Harvie told MedPage Today. "It's an interesting finding, but we need more research. This isn't ready to be recommended to patients yet."
In an earlier study, Harvie and colleagues demonstrated that two days per week of calorie restriction was comparable to daily calorie restriction in terms of weight loss, but it wasn't any easier for patients to follow because the choice of food was limited to fruit and vegetables on restricted days.
The present study allowed for more food choices during calorie restriction, Harvie explained.
They randomized 115 overweight or obese patients who, based on their weight were at risk of breast cancer, to one of three diets over a three-month period:
1. A calorie-restricted (600 kcal), low-carbohydrate (less than 40 g) diet for two days a week
2. A low-carbohydrate diet for two days per week, plus an ad-lib Mediterranean (healthy fats, fruits, and vegetables) diet the other five days
3. A daily calorie-restriction Mediterranean diet (1,500 kcal) all week
Harvie told MedPage Today that enforcing the diet two days per week, rather than three days, or one week on and one week off, was "just pragmatic; two days is achievable."
The women met monthly with a dietitian and had bi-weekly motivational phone calls. Eighty-eight of them completed the three-month trial, plus an additional month of follow up to assess whether restricting carbohydrates one day a week could help maintain weight and metabolic changes.
Harvie and colleagues found that after three months, patients on either of the low-carbohydrate diets had significantly greater declines in insulin resistance as measured by HOMA-IR (P=0.023) and in body fat (P=0.004) compared with those who just restricted their calories every day.
Those declines were maintained over an additional month of limiting carbohydrate intake to just one day per week, Harvie said.
Three months of the low-carbohydrate diets also led to better weight loss and lower levels of insulin, both risk factors for breast cancer, compared with standard caloric restriction. Those changes were maintained after an additional month, Harvie added.
"Weight loss and reduced insulin levels are required for breast cancer prevention, but are difficult to achieve and maintain with conventional dietary approaches," Harvie said.
None of the diets, however, had any effects on several other metabolic parameters, including adiponectin, insulin-like growth factor-1, interleukin-6, or TNF-alpha.
Harvie said the diets did reduce the levels of leptin, which is the hormone that tells the brain that the body is satiated, but not significantly so.
Overall, she called the intermittent low-carbohydrate diets a possible alternative to full-blown calorie restriction "for potentially reducing the risk of breast cancer and other diseases."
The researchers reported no conflicts of interest.
Primary source: San Antonio Breast Cancer SymposiumSource reference:Harvie M, et al "Intermittent dietary carbohydrate restriction enables weight loss and reduces breast cancer biomarkers" SABCS 2011; Abstract P3-09-02.
Medpage Today
Kristina Fiore, Staff Writer, MedPage TodayPublished: December 11, 2011Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco andDorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
SAN ANTONIO -- Limiting carbohydrate intake just two days a week can mitigate some risk factors for breast cancer by burning body fat and improving insulin sensitivity, researchers said here.
Over three months, eating fewer carbohydrates alone or combining that reduction with severe caloric restriction two days per week was associated with significant changes in body fat and insulin resistance, Michelle Harvie, PhD, of Genesis Prevention Center at University Hospital in South Manchester, U.K., reported during a poster session at the San Antonio Breast Cancer Symposium.
"Both diets showed improvement in insulin sensitivity, compared with a regular calorie-restriction diet alone," Harvie told MedPage Today. "It's an interesting finding, but we need more research. This isn't ready to be recommended to patients yet."
In an earlier study, Harvie and colleagues demonstrated that two days per week of calorie restriction was comparable to daily calorie restriction in terms of weight loss, but it wasn't any easier for patients to follow because the choice of food was limited to fruit and vegetables on restricted days.
The present study allowed for more food choices during calorie restriction, Harvie explained.
They randomized 115 overweight or obese patients who, based on their weight were at risk of breast cancer, to one of three diets over a three-month period:
1. A calorie-restricted (600 kcal), low-carbohydrate (less than 40 g) diet for two days a week
2. A low-carbohydrate diet for two days per week, plus an ad-lib Mediterranean (healthy fats, fruits, and vegetables) diet the other five days
3. A daily calorie-restriction Mediterranean diet (1,500 kcal) all week
Harvie told MedPage Today that enforcing the diet two days per week, rather than three days, or one week on and one week off, was "just pragmatic; two days is achievable."
The women met monthly with a dietitian and had bi-weekly motivational phone calls. Eighty-eight of them completed the three-month trial, plus an additional month of follow up to assess whether restricting carbohydrates one day a week could help maintain weight and metabolic changes.
Harvie and colleagues found that after three months, patients on either of the low-carbohydrate diets had significantly greater declines in insulin resistance as measured by HOMA-IR (P=0.023) and in body fat (P=0.004) compared with those who just restricted their calories every day.
Those declines were maintained over an additional month of limiting carbohydrate intake to just one day per week, Harvie said.
Three months of the low-carbohydrate diets also led to better weight loss and lower levels of insulin, both risk factors for breast cancer, compared with standard caloric restriction. Those changes were maintained after an additional month, Harvie added.
"Weight loss and reduced insulin levels are required for breast cancer prevention, but are difficult to achieve and maintain with conventional dietary approaches," Harvie said.
None of the diets, however, had any effects on several other metabolic parameters, including adiponectin, insulin-like growth factor-1, interleukin-6, or TNF-alpha.
Harvie said the diets did reduce the levels of leptin, which is the hormone that tells the brain that the body is satiated, but not significantly so.
Overall, she called the intermittent low-carbohydrate diets a possible alternative to full-blown calorie restriction "for potentially reducing the risk of breast cancer and other diseases."
The researchers reported no conflicts of interest.
Primary source: San Antonio Breast Cancer SymposiumSource reference:Harvie M, et al "Intermittent dietary carbohydrate restriction enables weight loss and reduces breast cancer biomarkers" SABCS 2011; Abstract P3-09-02.
Monday, September 26, 2011
Protein for athletes: how much is enough?
I'm cautious when I receive e-mails touting specific products for exercise performance. I was impressed that this one isn't pushing anything in excess. The recommendations do have research to back up the claims. Here it is:
When winning is on the line, make sure nutrition is on your side. Athletes faced with the pressure of regular workouts and performance have increased nutritional needs, especially when it comes to protein. With Isagenix products, athletes can gain an edge. These step-by-step guidelines are full-proof for helping strength and endurance athletes meet performance goals.
Step 1: Get enough protein daily with help from high-protein IsaLean® Shakes, Bars and Soups
Protein is major in sports performance.
Without enough protein intake, athletic potential can be seriously hampered. This is because the body doesn’t store protein well. Continual replenishment is needed for repairing muscle breakdown and building new muscle tissue.
The average adult needs about 0.6-0.8 grams protein per kilogram (about 2.2 pounds) daily. Active adults should keep protein up to about 0.8 grams per kilogram daily. How much do athletes need? It can depend on exercise intensity and type of training. Studies on endurance athletes and strength training athletes suggest they can gain most from intake of 1.4 grams to 1.8 grams per kilogram daily, respectively.
Athletes can make sure they’re getting enough protein daily with IsaLean Shakes, Bars and Soups. These meal-replacements are high in protein and are balanced with healthy amounts of carbs and fats as well as a full spectrum of vitamins and minerals.
Step 2: Maximize muscle gains by drinking IsaLean® Shake in the morning and spacing protein intake throughout the day
Protein intake daily is less important than time of intake. Studies show the biggest muscle gains come from regular protein intake throughout the day. Consistent increases in plasma levels of amino acids support muscle recovery and growth.
Athletes on a typical Western-style diet may find their protein intake varies too much throughout the day. An athlete needing 90 grams of protein intake daily, for example, may eat breakfast of just an egg, toast and coffee (approximately 10 grams of protein), then a chicken sandwich for lunch (approximately 20 grams of protein), and, to make up the difference, steak for dinner (approximately 60 grams of protein).
Best advice for these athletes to make the biggest impact on muscle gains is to switch to a diet that provides quality sources of protein throughout the day. Athletes needing 90 grams of protein per day should have the same level of protein at breakfast, lunch and dinner at approximately 30 grams (see graph below). To help cover protein requirements in the morning, athletes should drink an IsaLean Shake for breakfast or with breakfast.
Plus, the combination of proteins in the shake can make a profound difference. Dairy whey is quickly absorbed protein giving athletes a large increase in amino acids. Milk protein is more slowly absorbed providing a sustained increase in plasma amino acids.
Step 3: Never end workouts without IsaPro® whey protein mixed into an IsaLean Shake
The one- to two-hour period right after a workout is prime time for muscle anabolism. It’s this time when you need protein most. The body is craving nutrients for muscle recovery and protein is highest on the list, especially if the protein is high in branched-chain amino acids (BCAAs).
Whey protein is rich in all the BCAAs: leucine, isoleucine, valine. Research studies show that extra fast-absorbing whey protein after workouts boosts muscle growth in active adults and athletes.
Enter IsaPro® Vanilla flavored whey protein: one scoop of IsaPro to one and a half scoops of IsaLean Shake provides a whopping 35 grams of protein per serving. The extra protein along with the extra nutrients from the shake makes for best muscle recovery
And don’t think it wrong to add in some fruit to your ultra-high protein shake after exercise. Studies show that some sugar during and after workouts induces an insulin response that helps drive protein synthesis along with helping to replenish muscle glycogen (carbs stored in your muscle for quick energy).
If you are interested in ordering any of theses products please click on the link to www.dancarusomd.isagenix.com
When winning is on the line, make sure nutrition is on your side. Athletes faced with the pressure of regular workouts and performance have increased nutritional needs, especially when it comes to protein. With Isagenix products, athletes can gain an edge. These step-by-step guidelines are full-proof for helping strength and endurance athletes meet performance goals.
Step 1: Get enough protein daily with help from high-protein IsaLean® Shakes, Bars and Soups
Protein is major in sports performance.
Without enough protein intake, athletic potential can be seriously hampered. This is because the body doesn’t store protein well. Continual replenishment is needed for repairing muscle breakdown and building new muscle tissue.
The average adult needs about 0.6-0.8 grams protein per kilogram (about 2.2 pounds) daily. Active adults should keep protein up to about 0.8 grams per kilogram daily. How much do athletes need? It can depend on exercise intensity and type of training. Studies on endurance athletes and strength training athletes suggest they can gain most from intake of 1.4 grams to 1.8 grams per kilogram daily, respectively.
Athletes can make sure they’re getting enough protein daily with IsaLean Shakes, Bars and Soups. These meal-replacements are high in protein and are balanced with healthy amounts of carbs and fats as well as a full spectrum of vitamins and minerals.
Step 2: Maximize muscle gains by drinking IsaLean® Shake in the morning and spacing protein intake throughout the day
Protein intake daily is less important than time of intake. Studies show the biggest muscle gains come from regular protein intake throughout the day. Consistent increases in plasma levels of amino acids support muscle recovery and growth.
Athletes on a typical Western-style diet may find their protein intake varies too much throughout the day. An athlete needing 90 grams of protein intake daily, for example, may eat breakfast of just an egg, toast and coffee (approximately 10 grams of protein), then a chicken sandwich for lunch (approximately 20 grams of protein), and, to make up the difference, steak for dinner (approximately 60 grams of protein).
Best advice for these athletes to make the biggest impact on muscle gains is to switch to a diet that provides quality sources of protein throughout the day. Athletes needing 90 grams of protein per day should have the same level of protein at breakfast, lunch and dinner at approximately 30 grams (see graph below). To help cover protein requirements in the morning, athletes should drink an IsaLean Shake for breakfast or with breakfast.
Plus, the combination of proteins in the shake can make a profound difference. Dairy whey is quickly absorbed protein giving athletes a large increase in amino acids. Milk protein is more slowly absorbed providing a sustained increase in plasma amino acids.
Step 3: Never end workouts without IsaPro® whey protein mixed into an IsaLean Shake
The one- to two-hour period right after a workout is prime time for muscle anabolism. It’s this time when you need protein most. The body is craving nutrients for muscle recovery and protein is highest on the list, especially if the protein is high in branched-chain amino acids (BCAAs).
Whey protein is rich in all the BCAAs: leucine, isoleucine, valine. Research studies show that extra fast-absorbing whey protein after workouts boosts muscle growth in active adults and athletes.
Enter IsaPro® Vanilla flavored whey protein: one scoop of IsaPro to one and a half scoops of IsaLean Shake provides a whopping 35 grams of protein per serving. The extra protein along with the extra nutrients from the shake makes for best muscle recovery
And don’t think it wrong to add in some fruit to your ultra-high protein shake after exercise. Studies show that some sugar during and after workouts induces an insulin response that helps drive protein synthesis along with helping to replenish muscle glycogen (carbs stored in your muscle for quick energy).
If you are interested in ordering any of theses products please click on the link to www.dancarusomd.isagenix.com
Monday, September 19, 2011
What's different at my new office
There are number of practice changes evident at my new office.
I do not practice primary care.
I do not draw or run lab tests at Riggins Ct. I do not have any vaccines at this office. No infusions at this office. No bone density test. No nurse, no nurse practitioner, no certified diabetes educator, no medical assistant.
Because of limited staff any procedures, tests, referrals or medications requiring prior authorization may take longer to get approved.
The office is only staffed on Tuesdays and Thursdays. If you need a full time endocrinology practice to help you with your condition you need to be seen elsewhere. If you call on a Tue or Thu and get voice mail it means all the lines are busy. When you get voice mail on Mon, Wed and Fri it means I am seeing patients at the Renown Diabetes Center and I have no one to answer the phone number you called.
I am not accepting new diabetes patients insured by Medicare. It doesn't matter what your secondary insurance is.
I will see patients transferring from Renown Diabetes Center only if your insurance has changed and no longer pays for visits there.
If you wish to see an endocrinologist with full-time staff I suggest the following:
I have full time staff at the Renown Diabetes Center.
Dr Claude Lardinois sees people with diabetes at the Renown Diabetes Center 775-982-5073. He see non-diabetes endocrinology patients down the hallway at 775-982-6130.
I'm not sure if Dr James Atcheson is seeing new patient consults at this time. You can call his office at 775-982-6130 and find out.
Dr Lisa Abbott is accepting referrals for endocrine consults. 775-786-6770.
Dr Robert Fredericks has relocated his practice to the Wittemore-Peterson Institute at the University of Nevada Medical School campus. His nurse practitioner Pat McDonald is there as well. 775-682-8250.
Dr Evan Klass and Dr Stan Shane see patients at the University of Nevada Department of Internal Medicine clinic. Phone 775-784-7500.
There are also endocrinologists in practice in Carson City:
John Sutton, DO: 775-841-6333
Quang Nguyen, DO 775-883-9003
Carol Cheney, MD 775-883-9003
I do not practice primary care.
I do not draw or run lab tests at Riggins Ct. I do not have any vaccines at this office. No infusions at this office. No bone density test. No nurse, no nurse practitioner, no certified diabetes educator, no medical assistant.
Because of limited staff any procedures, tests, referrals or medications requiring prior authorization may take longer to get approved.
The office is only staffed on Tuesdays and Thursdays. If you need a full time endocrinology practice to help you with your condition you need to be seen elsewhere. If you call on a Tue or Thu and get voice mail it means all the lines are busy. When you get voice mail on Mon, Wed and Fri it means I am seeing patients at the Renown Diabetes Center and I have no one to answer the phone number you called.
I am not accepting new diabetes patients insured by Medicare. It doesn't matter what your secondary insurance is.
I will see patients transferring from Renown Diabetes Center only if your insurance has changed and no longer pays for visits there.
If you wish to see an endocrinologist with full-time staff I suggest the following:
I have full time staff at the Renown Diabetes Center.
Dr Claude Lardinois sees people with diabetes at the Renown Diabetes Center 775-982-5073. He see non-diabetes endocrinology patients down the hallway at 775-982-6130.
I'm not sure if Dr James Atcheson is seeing new patient consults at this time. You can call his office at 775-982-6130 and find out.
Dr Lisa Abbott is accepting referrals for endocrine consults. 775-786-6770.
Dr Robert Fredericks has relocated his practice to the Wittemore-Peterson Institute at the University of Nevada Medical School campus. His nurse practitioner Pat McDonald is there as well. 775-682-8250.
Dr Evan Klass and Dr Stan Shane see patients at the University of Nevada Department of Internal Medicine clinic. Phone 775-784-7500.
There are also endocrinologists in practice in Carson City:
John Sutton, DO: 775-841-6333
Quang Nguyen, DO 775-883-9003
Carol Cheney, MD 775-883-9003
Monday, September 12, 2011
new feature at my office
Massage Therapy
Kelsey Taelour and Gennea Lane
Call Kelsey For:
Sports Massage
Deep Tissue Massage
Medical Massage
Call Gennea for:
Swedish/ Relaxation Massage
Aromatherapy/ Prenatal
5605 E. Riggins Ct.
Reno, NV 89502
Kelsey- (775)240*5252
Gennea- (775)842*0179
9 A.M. to 6 P.M. By appointment only
Friday, August 26, 2011
More information about my new office
The office is small and quiet. There is no paperwork. Your information is reviewed with you and entered electronically or scanned.
When your phone call is answered it is by one of three people: me, my wife Toni or my daughter Ariana. We will introduce ourself when answering.
Appointments are for 60 minutes for a new patient, 30 minutes for follow up. Please be on time so you can receive the full benefit of your scheduled time. If you are going to be late or can't make an appointment please call and leave a message.
I do not have your records from Endocrine Associates. You need to sign a written request releasing your medical records to me and fax it to Dr Robert Fredericks at (775) 682-8502. I can e-mail or fax you a form, or you can wait until your appointment to sign the release at my office.
I do not draw or run lab tests at Riggins Ct. I do not have any vaccines at this office. No infusions at this office. No bone density test. No nurse, no nurse practitioner, no certified diabetes educator, no medical assistant.
Because of limited staff any procedures, tests, referrals or medications requiring prior authorization may take longer to get approved.
The office is only staffed on Tuesdays and Thursdays. If you need a full time endocrinology practice to help you with your condition you need to be seen elsewhere. If you call on a Tue or Thu and get voice mail it means all the lines are busy. When you get voice mail on Mon, Wed and Fri it means I am seeing patients at the Renown Diabetes Center and I have no one to answer the phone number you called.
I am not accepting new diabetes patients insured by Medicare. It doesn't matter what secondary insurance you have. I see new Medicare diabetes patients only at Renown Diabetes Center (775) 982-5073. No referral is necessary to be seen at Renown.
I will see patients transferring from Renown Diabetes Center only if your insurance has changed and no longer pays for visits at Renown.
I do not practice primary care.
If you wish to see an endocrinologist with full-time staff I suggest the following:
I have full time staff at the Renown Diabetes Center.
Dr Caude Lardinois sees people with diabetes at the Renown Diabetes Center 775-982-5073. He see non-diabetes endocrinology patients down the hallway at 775-982-6130.
I'm not sure if Dr James Atcheson is seeing new patient consults at this time. You can call his office at 775-982-6130 and find out.
Dr Lisa Abbott is accepting referrals for endocrine consults. 775-786-6770.
Dr Robert Fredericks has relocated his practice to the Whittemore-Peterson Institute at the University of Nevada Medical School campus. His nurse practitioner Pat McDonald is there as well. 775-682-8250.
Dr Evan Klass and Dr Stan Shane see patients at the University of Nevada Department of Internal Medicine clinic. Phone 775-784-7500.
There are also endocrinologists in practice in Carson City:
Quang Nguyen MD 775-883-9003 (formerly at University of Nevada)
Carol Cheney MD 775-883-9003
John Sutton, DO: 775-841-6333
When your phone call is answered it is by one of three people: me, my wife Toni or my daughter Ariana. We will introduce ourself when answering.
Appointments are for 60 minutes for a new patient, 30 minutes for follow up. Please be on time so you can receive the full benefit of your scheduled time. If you are going to be late or can't make an appointment please call and leave a message.
I do not have your records from Endocrine Associates. You need to sign a written request releasing your medical records to me and fax it to Dr Robert Fredericks at (775) 682-8502. I can e-mail or fax you a form, or you can wait until your appointment to sign the release at my office.
I do not draw or run lab tests at Riggins Ct. I do not have any vaccines at this office. No infusions at this office. No bone density test. No nurse, no nurse practitioner, no certified diabetes educator, no medical assistant.
Because of limited staff any procedures, tests, referrals or medications requiring prior authorization may take longer to get approved.
The office is only staffed on Tuesdays and Thursdays. If you need a full time endocrinology practice to help you with your condition you need to be seen elsewhere. If you call on a Tue or Thu and get voice mail it means all the lines are busy. When you get voice mail on Mon, Wed and Fri it means I am seeing patients at the Renown Diabetes Center and I have no one to answer the phone number you called.
I am not accepting new diabetes patients insured by Medicare. It doesn't matter what secondary insurance you have. I see new Medicare diabetes patients only at Renown Diabetes Center (775) 982-5073. No referral is necessary to be seen at Renown.
I will see patients transferring from Renown Diabetes Center only if your insurance has changed and no longer pays for visits at Renown.
I do not practice primary care.
If you wish to see an endocrinologist with full-time staff I suggest the following:
I have full time staff at the Renown Diabetes Center.
Dr Caude Lardinois sees people with diabetes at the Renown Diabetes Center 775-982-5073. He see non-diabetes endocrinology patients down the hallway at 775-982-6130.
I'm not sure if Dr James Atcheson is seeing new patient consults at this time. You can call his office at 775-982-6130 and find out.
Dr Lisa Abbott is accepting referrals for endocrine consults. 775-786-6770.
Dr Robert Fredericks has relocated his practice to the Whittemore-Peterson Institute at the University of Nevada Medical School campus. His nurse practitioner Pat McDonald is there as well. 775-682-8250.
Dr Evan Klass and Dr Stan Shane see patients at the University of Nevada Department of Internal Medicine clinic. Phone 775-784-7500.
There are also endocrinologists in practice in Carson City:
Quang Nguyen MD 775-883-9003 (formerly at University of Nevada)
Carol Cheney MD 775-883-9003
John Sutton, DO: 775-841-6333
Tuesday, May 3, 2011
New Office
I have an office address for my private practice. The location is:
5605 E. Riggins Ct. #206
Reno, NV 89502
The mailing address is
PO box 18537
Reno, NV 89511
Please e-mail me if you are interested in an appointment at my new office.
I expect to be seeing patients at this address by June 7 and possibly earlier.
If you are an established patient at another office please know that I do not have any of your records. Please contact that office to have your records released to me.
Monday, April 4, 2011
Change in my medical practice
I am no longer at Endocrine Associates so I will not be seeing my patients at that location. No, I'm ot retiring or moving. I am here to stay. All appointments with me at Endocrine Associates are cancelled. If I see you for diabetes then I will be glad to see you at the Diabetes Center at Renown. To make an appointment with me there please call 775-982-5073. The address is 1500 E. Second St. Suite 402. If I see you for something other than diabetes I will be opening up my own private office sometime in May and I will be glad to make you an appointment once it gets open. Please check this blog for updates on my office location and phone number. Thank you for your understanding. If you wish to remain a patient at Endocrine Associates please call 348-1811 to reschedule with Dr. Fredericks or Pat McDonald, APN.
Friday, March 4, 2011
Sleep deprivation takes a toll
Sleep deprivation is a widespread phenomenon in this country. I see a number of people who are tired and hope that some thyroid hormone will make them feel better. When fatigue, forgetfulness and inability to concentrate is caused by sleep deprivation there is no medication that will correct these symptoms, except maybe a sleeping pill.
Beyond daily dysfunction, sleep deprivation as well as excessive sleep is associated with systemic inflammation and heart disease. If you are chronically sleeping too little or too much discuss your health status with your primary care physician.
Beyond daily dysfunction, sleep deprivation as well as excessive sleep is associated with systemic inflammation and heart disease. If you are chronically sleeping too little or too much discuss your health status with your primary care physician.
Monday, February 28, 2011
Can heart attack and stroke be prevented?
Current 'risk reduction' standard of care reduces the chance of heart attack and stroke by 30-50%. That still leaves a huge number of people at risk for one of these events. Heart attacks (myocardial infarction) is the number one killer in the U.S. and stroke (CVA- cerebrovascular accident) is number three.
The Bale-Doneen method proposes that risk can be close to zero with proper evaluation and treatment. The method goes far beyond the 'consensus' recommendations for blood pressure and cholesterol and goes as far as genetic studies to further evaluate risk and best treatments. There are short videos discussing the program here and there.
Dr. Lardinois and I attended the preceptor course in Las Vegas on Feb 25-26. We will be instituting a heart attack and stroke prevention program in the near future. Stay tuned to this blog for further information.
The Bale-Doneen method proposes that risk can be close to zero with proper evaluation and treatment. The method goes far beyond the 'consensus' recommendations for blood pressure and cholesterol and goes as far as genetic studies to further evaluate risk and best treatments. There are short videos discussing the program here and there.
Dr. Lardinois and I attended the preceptor course in Las Vegas on Feb 25-26. We will be instituting a heart attack and stroke prevention program in the near future. Stay tuned to this blog for further information.
Wednesday, February 16, 2011
If you are going to see your car mechanic...
because your car was making a funny noise; you describe what it sounds like, when it happens etc. The mechanic says 'I have some ideas about what may be wrong. Let me take a look'. You are shocked that he might actually want to look at the car itself to figure out what needs fixing.
Sounds silly, doesn't it? It happens every day at my office. People come in for diabetes care, they tell me what the blood sugars are running but they don't bring in the log book or meter. For some they remember only the highest blood sugars and are surprised that the A1c is so good. Others remember only the good blood sugars and are surprised when the A1c comes back high. Some remember testing frequently when the meter has only 1-2 tests per month.
I like helping people with diabetes. I can't help much if I don't have enough information. If the A1c is above target range and I don't have any home glucose values to guide my treatment decision then I take an educated guess on what will work best.
Some people are fortunate enough to have amazingly stable blood sugars with A1c consistently under 7% without having hypoglycemia. These people don't need to test every day. If you are one of these people, congratulations on doing so well and disregard the next comments. If you are not one of these fortunate people, please consider these recommendations.
Help yourself out the folowing ways:
1. The best data is a log book with space for date, time, glucose values, medication doses and food. One commercial product is called 'my other checkbook'.
2. If you think that level of effort will not provide equivalent benefit, then record the date, time and blood sugars. The manufacturer of your meter will provide/sell such log books that fit nicely in the meter carrying case. Call the toll free number on the back of your meter to order them.
3. If writing down information is not your style, bring in you meter. Please have the correct date and time in it. If the date and time are incorrect, call the toll-free number on the back of the meter to get instructions on correcting the date and time.
4. If you are in to digital data, get a download cord and software to generate some data for your visit. Don't forget to print it and bring the results with you.
If none of this matters to you, ask yourself why you are seeing a specialist for your diabetes.
Sounds silly, doesn't it? It happens every day at my office. People come in for diabetes care, they tell me what the blood sugars are running but they don't bring in the log book or meter. For some they remember only the highest blood sugars and are surprised that the A1c is so good. Others remember only the good blood sugars and are surprised when the A1c comes back high. Some remember testing frequently when the meter has only 1-2 tests per month.
I like helping people with diabetes. I can't help much if I don't have enough information. If the A1c is above target range and I don't have any home glucose values to guide my treatment decision then I take an educated guess on what will work best.
Some people are fortunate enough to have amazingly stable blood sugars with A1c consistently under 7% without having hypoglycemia. These people don't need to test every day. If you are one of these people, congratulations on doing so well and disregard the next comments. If you are not one of these fortunate people, please consider these recommendations.
Help yourself out the folowing ways:
1. The best data is a log book with space for date, time, glucose values, medication doses and food. One commercial product is called 'my other checkbook'.
2. If you think that level of effort will not provide equivalent benefit, then record the date, time and blood sugars. The manufacturer of your meter will provide/sell such log books that fit nicely in the meter carrying case. Call the toll free number on the back of your meter to order them.
3. If writing down information is not your style, bring in you meter. Please have the correct date and time in it. If the date and time are incorrect, call the toll-free number on the back of the meter to get instructions on correcting the date and time.
4. If you are in to digital data, get a download cord and software to generate some data for your visit. Don't forget to print it and bring the results with you.
If none of this matters to you, ask yourself why you are seeing a specialist for your diabetes.
Wednesday, February 9, 2011
Glucagon excess in diabetes- what to do?
Gucagon is a hormone produced in the pancreatic islet alpha cell. glucagon stimulates the liver to release sugar into the blood. Glucagon is normally produced as blood sugar drops in an effort to prevent hypoglycemia. In people without diabetes glucagon drops to zero when eating. However, in diabetes glucagon is increased when the person eats. The blood sugar goes up not only from the food but also from abnormal glucagon increase causing the liver to release glucose. Treatment for this abnormal glucagon is limited.
Symlin is a medication for people on insulin to take at meal time to reduce glucagon. It is only available by injection. It is effective but can be difficult to adjust to since it lowers mealtime insulin requirements. I have used Symlin when it originally came out as a vial-and-syringe treatment. I used it again when it was released in a pen device. It curbed my after-meal blood sugars and also reduced my appetite. However when it wore off in 3 hr I was hungry again. A physician suggested I try it in a pump. I absolutely loved it! I had a basal rate of Symlin as well as bolusing at meals. Blood sugars were very even and I didn't have rebound hunger. My daily insulin dropped form 28 to 24 units. When I was on a long bike ride I would suspend the Symlin so I could maintain hydration and nutrition without feeling full. The downside was keeping track of two pumps, when each one was due for a change, different alarms for batteries, low reservoir, etc. I considered using an Omnipod for the Symlin. I decided against it because the Omnipod requires 80 units minimum fill. I was using less than 20 'units' of Symlin in 3 1/2 days. I suppose I could run insulin in the 'pod and Symlin in a tubed pump but the overall hassle is huge regardless.
Byetta and Victoza are glucagon-like peptide 1 (GLP-1) replacements that increase GLP-1 by 6-10x the normal blood level. These are both approved for treating T2DM but not with insulin. They are potent in keeping glucagon low after meals. In clinical trials about 75% of patients lose weight on these products. I chose to try Victoza because it is once daily compared to Byetta twice daily.
Victoza hit hard at the beginning. On the lowest dose I felt full most of the time. It was hard for me to stay hydrated I felt so full. My mouth was dry most of the time. After a few weeks the side effects eased up dramatically. I could eat little and not be excessively hungry. Blood sugars after meals have generally been under 170. Insulin dose is around 25 units daily, down from 28-30. I've yet to take it during hot weather so I don't know how well hydrated I can stay on long bike rides.
I have prescribed Byetta and Victoza for T2DM patients on insulin and they generally work well. I've tried both in a few T1DM patients with variable effectiveness. One of the greatest difficulties is cost. Because neither product has FDA approval for use with insulin the insurance companies use this as an excuse to not pay for the product. Please keep in mind that this 'off-label' use is not forbidden; it means that there has not been sufficient data submitted to the FDA for that use to be 'indicated'.
What is next? I am hoping that Byetta or Victoza seek approval for use with insulin. I don't know if either company will go to the trouble of performing necessary studies to gain approval. It would be ideal if Symlin could be mixed with insulin but the current formulation is not stable with insulin. Maybe Amylin Pharmaceuticals will cook up an alternative recipe that is stable with insulin in a pump. There are many new GLP-1 agonists in development. Maybe one of them will start with insulin compatibility.
Symlin is a medication for people on insulin to take at meal time to reduce glucagon. It is only available by injection. It is effective but can be difficult to adjust to since it lowers mealtime insulin requirements. I have used Symlin when it originally came out as a vial-and-syringe treatment. I used it again when it was released in a pen device. It curbed my after-meal blood sugars and also reduced my appetite. However when it wore off in 3 hr I was hungry again. A physician suggested I try it in a pump. I absolutely loved it! I had a basal rate of Symlin as well as bolusing at meals. Blood sugars were very even and I didn't have rebound hunger. My daily insulin dropped form 28 to 24 units. When I was on a long bike ride I would suspend the Symlin so I could maintain hydration and nutrition without feeling full. The downside was keeping track of two pumps, when each one was due for a change, different alarms for batteries, low reservoir, etc. I considered using an Omnipod for the Symlin. I decided against it because the Omnipod requires 80 units minimum fill. I was using less than 20 'units' of Symlin in 3 1/2 days. I suppose I could run insulin in the 'pod and Symlin in a tubed pump but the overall hassle is huge regardless.
Byetta and Victoza are glucagon-like peptide 1 (GLP-1) replacements that increase GLP-1 by 6-10x the normal blood level. These are both approved for treating T2DM but not with insulin. They are potent in keeping glucagon low after meals. In clinical trials about 75% of patients lose weight on these products. I chose to try Victoza because it is once daily compared to Byetta twice daily.
Victoza hit hard at the beginning. On the lowest dose I felt full most of the time. It was hard for me to stay hydrated I felt so full. My mouth was dry most of the time. After a few weeks the side effects eased up dramatically. I could eat little and not be excessively hungry. Blood sugars after meals have generally been under 170. Insulin dose is around 25 units daily, down from 28-30. I've yet to take it during hot weather so I don't know how well hydrated I can stay on long bike rides.
I have prescribed Byetta and Victoza for T2DM patients on insulin and they generally work well. I've tried both in a few T1DM patients with variable effectiveness. One of the greatest difficulties is cost. Because neither product has FDA approval for use with insulin the insurance companies use this as an excuse to not pay for the product. Please keep in mind that this 'off-label' use is not forbidden; it means that there has not been sufficient data submitted to the FDA for that use to be 'indicated'.
What is next? I am hoping that Byetta or Victoza seek approval for use with insulin. I don't know if either company will go to the trouble of performing necessary studies to gain approval. It would be ideal if Symlin could be mixed with insulin but the current formulation is not stable with insulin. Maybe Amylin Pharmaceuticals will cook up an alternative recipe that is stable with insulin in a pump. There are many new GLP-1 agonists in development. Maybe one of them will start with insulin compatibility.
Friday, February 4, 2011
Osteoporosis treatment extends life
A study published in the Journal of Clinical Endocrinology and Metabolism (and summarized in the LA Times Booster Shots ) reports that bisphosphonate therapy reduces mortality in women and men. Mortality was not reduced by vitamin D + calcium therapy compared to no treatment. Bisphosphonates include Fosamax, Actonel, Atelvia, Boniva and Reclast. Even though these medications can cause a rare condition called osteonecrosis of the jaw the benefits of fewer fractures and longer life would appear to outweigh the risk of side effects.
Wednesday, February 2, 2011
Sprinting to prevent hypoglycemia
I found some interesting articles during a literature search on interval training. The most interesting was controlled observations that in type 1 diabetes, a 10 second all-out sprint either at the beginning or end of 20 min moderate exercise reduced hypoglycemia after exercise. The sprint did not prevent blood glucose from dropping during exercise.
Additional tidbits: (1) High intensity interval exercise (HIIE) releases more weight than prolonged low intensity exercise. This may be due to increased adrenaline and its tendency to burn fat. (2) HIIE improves aerobic performance as much as intermediate intensity exercise performed for a much longer time. (3) HIIE improves anaerobic capacity and this does not occur with intermediate intensity exercise.
If you are interested in adding HIIE to your exercise program it would be prudent to work with a trainer who has familiarity with this type of exercise. There are many web sites promoting various HIIE protocols. You want to pick one that has research data to demonstrate its efficacy.
Additional tidbits: (1) High intensity interval exercise (HIIE) releases more weight than prolonged low intensity exercise. This may be due to increased adrenaline and its tendency to burn fat. (2) HIIE improves aerobic performance as much as intermediate intensity exercise performed for a much longer time. (3) HIIE improves anaerobic capacity and this does not occur with intermediate intensity exercise.
If you are interested in adding HIIE to your exercise program it would be prudent to work with a trainer who has familiarity with this type of exercise. There are many web sites promoting various HIIE protocols. You want to pick one that has research data to demonstrate its efficacy.
Subscribe to:
Posts (Atom)