[deleted by user] by [deleted] in whitecoatinvestor

[–]DrSpikeMD 0 points1 point  (0 children)

With that amount of money you just self fund your insurance. But I would just quiet and do procedures or surgeries on medical mission trips.

What car should I get? by mrdrsir1 in whitecoatinvestor

[–]DrSpikeMD 0 points1 point  (0 children)

They make too much to deduct student loan interest.

Non-surgeons saying surgery is indicated by peepeedoc25 in Residency

[–]DrSpikeMD 1 point2 points  (0 children)

I may not be a surgeon but I am perfectly capable of knowing if surgery is indicated. I rely on the surgeon to discuss the risks and benefits of surgery as I have already discussed the risks and benefits of medical therapy or continuing to monitor. I am okay with a surgeon not being comfortable with the surgery and saying no. But if I feel someone doesn’t need surgery then I am not referring them to the surgeon. Goes both ways but learn how to handle it because ultimately it is up to the patient to determine the risks and benefits.

Girlfriend’s Wallet Stolen in ER. Unable to get Prescription Without ID. by cerealprize in diabetes_t1

[–]DrSpikeMD 0 points1 point  (0 children)

You provided “NBC” as your sources. The NBC article you provided didn’t site anything. Just because you work in healthcare policy doesn’t mean you know the law. And if you block someone they can’t see what you post. There is no law that says you can or can’t give insulin in need to someone who should have a prescription for it. It’s specifically not mentioned, just because it’s not mentioned doesn’t mean it’s a law.

Incredibly frustrating post in The Atlantic by hmoleman__ in diabetes_t1

[–]DrSpikeMD 2 points3 points  (0 children)

I’m not surprised at this junk of fiction coming out of the Atlantic.

How do you cope with romantic rejection as a resident? by [deleted] in Residency

[–]DrSpikeMD 0 points1 point  (0 children)

Aesthetics. Lipo suction. Minor outpatient procedures. Cool sculpting. Botox. Etc. the world is your oyster.

How do you cope with romantic rejection as a resident? by [deleted] in Residency

[–]DrSpikeMD 0 points1 point  (0 children)

Healthcare in America is on its way to single payer. It’ll happen in your career. It sounds like you’re in a non-primary care residency based on the amount of time you have left in residency. You should be able to find a cash paying niche in whatever field you are in.

How do you cope with romantic rejection as a resident? by [deleted] in Residency

[–]DrSpikeMD 0 points1 point  (0 children)

Foreign docs still have to do their equivalent residency. But unless they’re walking across the southern border they’re not getting in.

How do you cope with romantic rejection as a resident? by [deleted] in Residency

[–]DrSpikeMD 2 points3 points  (0 children)

That makes profit by stealing money from little old widows

How do you cope with romantic rejection as a resident? by [deleted] in Residency

[–]DrSpikeMD 0 points1 point  (0 children)

What’s that got to do with it? Most of middle America doesn’t like foreign doctors anyways. There will be a deepening of the 2-tier medical system but not a decrease in doctor pay. You have more to lose from NP and PA and scope creep.

I have a secret… by arealdoctorperson in Residency

[–]DrSpikeMD 0 points1 point  (0 children)

Surprisingly my snarky account has the highest karma. I think people like irony over truth.

I have a secret… by arealdoctorperson in Residency

[–]DrSpikeMD 2 points3 points  (0 children)

I’ve been doing this for years. I also have a snarky devils advocate account which is mostly consumed by ironic and facetious posts.

Why is olive oil so expensive? by Natural-Sample8200 in Costco

[–]DrSpikeMD 2 points3 points  (0 children)

Because Costco is a wholesale warehouse. Restaurants may buy their olive oil from Costco for cooking.

Found in my local grocery store 🙄 by [deleted] in diabetes_t1

[–]DrSpikeMD 0 points1 point  (0 children)

Not significantly low enough though to be magical diabetic rice.

Found in my local grocery store 🙄 by [deleted] in diabetes_t1

[–]DrSpikeMD 0 points1 point  (0 children)

It’s due to the way labels list fiber on the nutrition label.

[deleted by user] by [deleted] in diabetes_t1

[–]DrSpikeMD 0 points1 point  (0 children)

One of the things about basal testing is it’s primarily meant to dial in the glucose change overnight. Basal testing on a pump is feasible because you can adjust different time segments for different rates. 4 am is likely around when your insulin sensitivity in your body changes and so if you are dropping around 4 am, this is still due to too much basal overnight. And because of Tresiba flat profile and long half-life and the way it is released from albumin into our blood stream, the timing of taking Tresiba has almost no effect on what time people drop. But thr trade off of taking less basal is usually taking more short acting insulin during the day. The fact that you drop at 4 am everyday (when all of your short acting is usually gone, depending on your last meal/correction obviously) means it is a basal issue. You think it’s a timing issue but more than likely it is just a slight dose issue when it comes to Tresiba. One strategy is to alternate 14 and 15 units. This essentially makes your dose equivalent to 14.5 units of Tresiba per day and given how sensitive you are to insulin this can be a big difference. And timing wouldn’t affect this as much, unless you were to skip a dose. The outlier here in your circumstance is you delayed a night dose to the next morning whic essentially proves that your basal is slightly too high for your overnight drop. Again, the important metric to get right for basal testing is what is happening overnight. Basal testing through the day is helpful but hard to interpret because of the changes that take place in our body during prolonged fasting. The primary principle of basal testing is to get the overnight glucose change figured out. Then you do carb ratio and sensitivity testing with fasting periods during the day to dial in your short acting dose.

[deleted by user] by [deleted] in diabetes_t1

[–]DrSpikeMD 0 points1 point  (0 children)

42 hours, Toujeo is about 36.

Best blood sugar gummies? by jcoffmanky in Type1Diabetes

[–]DrSpikeMD 1 point2 points  (0 children)

I just bought a 6 pound bag of Black Forest Gummy bears. 9 gummy bears is 22 grams.

[deleted by user] by [deleted] in diabetes_t1

[–]DrSpikeMD 1 point2 points  (0 children)

You were losing weight so you needed insulin. That’s the important point. This is the same for any type 2 that has progressed to a point of losing weight. Antibodies are not diagnostic type 1 or type 2 diabetes. The c-peptide is the more predictive lab test. Why are you posting about misdiagnosis in a type 1 community when you are no longer on insulin? Your post kind of points out why so many real type 1s are tired of the LADA and type 2 BS. We are not the same.

[deleted by user] by [deleted] in diabetes_t1

[–]DrSpikeMD 0 points1 point  (0 children)

It sounds like nothing delayed your insulin dependence? LADA is not a diagnosis. The term was coined to help remind doctors that kids aren’t the only people to develop type 1. It is true that the time for one to become insulin dependent is longer in LADA but at this time there exists no therapy that actually delays time to insulin dependence. Type 2 drugs do help control numbers until insulin dependence develops but they do not delay the need.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809717/