#a physician may recommend that you visit diabetes nurses who will give you the necessary tips for a healthy lifestyle. They will also teach | Explore Tumblr Posts and Blogs

tightwadspoonies · 3 years

Text

Emergency Department vs Urgent Care vs Primary Care vs DIY

Disclaimer: This post is meant to be informative and it’s wording often assumes that you have access to all of the above as choices. We do, however, understand that the US healthcare system sucks, rural areas exist, lack of insurance is a thing, unexpected things happen, and unfortunately sometimes we don’t get all that much of a choice in where we seek our healthcare. If you need healthcare, please seek the healthcare you can access, even if that means using the emergency department for things that are not emergencies.

Also, please get your healthcare advice someplace besides tumblr.

If the above statement confused you, congratulations- you live in a place with reasonable healthcare. If you nodded right along with it, I’m very sorry to say you live in the United States of America, where pressures outside the severity of illness are often in play when deciding where and when to seek care for medical problems. Things like whether care will be available to you without insurance (or with any certain insurance plan) and, if you can actually get care with the coverage (or lack of coverage) you may have, whether the price for that care will be something you can afford.

Hopefully, not only will this post tell you a little about the options available to you and what problems they’re most designed to take care of, but also give you a few tips and tricks for getting the care you need in a way that works both for the system providing the care and does not literally bankrupt you.

When to go to the Emergency Department:

An emergency department is a part of the hospital. It is equipped and staffed to respond to the most emergent and life-threatening medical problems. It is designed to perform an initial evaluation of the patient, provide stabilizing care, and determine whether the patient should be admitted to the hospital for continuing care, or be referred to their primary care doctor for follow up. Patients are seen in order of severity, which can cause very long wait times for those who are otherwise stable.

Go to the Emergency Department for something that would either A, cause you to die without medical care, or B, requires a level of testing capabilities/care that is not possible outside of a hospital.

Things that could kill you or cause permanent disability without medical care:

Difficulty breathing

Chest pain

Uncontrollable bleeding

Seizures that last longer than 5 minutes, or stop and start without the patient going back to “baseline” in-between

Severe allergic reaction/anaphylaxis

Suicidal ideation with plan or inability to care for self due to mental health problem

Loss of consciousness

Poisoning

Spinal injury

Stroke symptoms

Severe trauma (car accident, gunshot wound, etc...)

Large burns

High fevers that don’t go down after taking over the counter medications

Things that require a higher level of testing capabilities and/or care than could be provided elsewhere:

First-time seizure or sudden onset of unexplained neurological symptoms like confusion

Abdominal pain

Broken bones (with obvious deformity or protruding from skin)

Coughing up blood

Head injury

Swallowing a foreign object

Severe dehydration

Active labor

Burns covering more than about a hand-size area

A US law called EMTALA (Emergency Medical Treatment and Active Labor Act) makes it illegal for an emergency department to refuse care to someone who is experiencing a medical emergency, regardless of their ability to pay. This does not cover continuing care, however, just the initial stabilizing care, and the patient will still get billed.

If you go to the ED and get billed, and you are under 400% of the federal poverty level, call the hospital and ask to speak with a financial counselor. They will often be able to write off part or all of you bill and set up a payment plan if needed so your account does not go into collections.

When to go to Urgent Care:

Urgent care is a lower level of care than an emergency department, but an urgent care often has things like x-ray machines, EKG machines, and an on-site lab. They can also do minor procedures like casting, inserting a catheter, removing a small/minor foreign body, and giving IV fluids. Urgent care clinics can be expensive without insurance and may or may not have the same ability as a hospital to write off unaffordable bills. I would always recommend calling ahead to make sure they take your insurance.

Go to an urgent care if you need primary care services outside of normal primary care hours or if your primary care office cannot see you soon enough for your needs. They often do not require you to call ahead or make an appointment. You can go to an urgent care for things that require a slightly higher level of care than a primary care office, but are not immediately life threatening.

Things like:

Broken bones (without obvious deformity), dislocations, and sprains

Sinus, ear, and eye infections

Minor allergic reactions

Cuts, burns, large splinters

Bronchitis, pneumonia, mild-moderate COPD and asthma exacerbations

Nausea/Vomiting/Diarrhea/Dehydration

Fevers

Rashes

Sports or occupational physicals (if you don’t have a primary care physician)

Doctor’s notes for work or school (if required same day as call-off)

When to see your Primary Care Physician:

If at all possible, you should have a primary care physician (PCP). If you don’t have insurance, find one that offers a sliding scale, meaning you only pay what you can afford based on your income and household size. PCPs are especially important if you have any ongoing medical or mental health needs, but most younger, otherwise healthy folks will still need their PCP for routine/sports/job-related physicals, screenings, medical documentation, referrals if necessary, and vaccinations. It will greatly help in the long run to keep up on these things. Swearsies.

PCP offices require an appointment, but many have some same- or next-day openings for acute medical conditions that need prompter evaluation. Many offices now offer virtual visits as well, either over the phone or through a videoconferencing platform.

Primary care offices offer care for:

Physicals (sports, annual, job etc...)

Chronic disease (diabetes, hypertension, heart failure, COPD, asthma, etc...) monitoring and ongoing care (meds and med changes, referrals to specialists, etc...)

Screenings and tests (blood pressure, diabetes, TB, strep, basic bloodwork, urinalysis etc...)

Vaccines

Prescription refills

Sinus, ear, and eye infections

Minor allergic reactions

Mental healthcare (some offer counseling services, many are comfortable prescribing medications for things like anxiety, depression, insomnia, and ADHD)

Impacted earwax

Birth control, including implants and IUDs

Cuts, burns, large splinters

Bronchitis, flu, pneumonia, etc...

Nausea/Vomiting/Diarrhea

Fevers

Rashes

Sprains/strains

When to DIY:

Sometimes you have a problem you’re pretty sure you can deal with on your own. This is a different level of comfort for everybody, and I would always recommend you reach out for help if you’re having a problem you’ve never had before or if you’re uncomfortable. Do not DIY purely for financial reasons.

Many larger hospital systems and insurance companies have a nurse triage phone number, where you can speak with a nurse who can direct you in self care or recommend you go to one of the above options. These are often 24/7 and free to use.

If you have a PCP, you can also often call their office or ask a question through an online portal like MyChart. This is also generally a free service.

Common DIY medical situations:

Minor sprains/strains

Colds

Splinters/small cuts/scrapes/bruises

Minor allergies

Infrequent, mild headaches

#medical care #USA #healthcare #insurance #emergency department #urgent care #primary care #DIY

76 notes · View notes

healthtech102 · 3 years

Text

After Hours Medical Advice

As you know, and certain have in mind every day, nursing is a career that carries a huge amount of duty. Be sure to guard your self, especially when asked for advice in an informal setting.

No, Uncle Bob has cornered you within the hallway after Christmas dinner. In trying back, I realize that not as soon as during this experience did anyone INVITE me into a discussion of what could be best for my mother.

She spent two nights in the hospital beneath remark, with IV hydration. Now, admittedly, she has varying levels of dementia even on a good day, but she reached the point of getting severe hallucinations and paranoia.

Having a whole remedy group looking out for you and preparing a discharge plan that is going to set you up for achievement. 90 days of therapy allows for the affected person to work via many of the above mentioned considerations and we treat it using an American Society of Addiction Medicine dimensional assessment.

The general size of keep in remedy that is really helpful is often ninety days. Health safety and prevention is the key to staying healthy for the long haul. From easy blood checks and vaccines now to mammograms and colonoscopies later, your doctor might help you turn into the healthiest model of you.

Although it might appear to be a problem now, one hour in a physician’s workplace now can add years of health to your life. When we have well being questions and considerations, it’s easy to show to good ol’ WebMD for answers. And even though the Internet can be a great well being useful resource, reading about your health points online can usually lead to pointless fear and fear. Remember, you might be unique and deserve a customized evaluation.

So instead of browsing the web for a generic, or even worse, incorrect answer, talk to a doctor in particular person to get the total image—and to cease dropping sleep over your questions (see reason number 5!). While I’ll be the primary to confess that a trip to the gynecologist’s workplace isn’t my favourite way to spend a day, annual pelvic exams are a important a part of any girl’s preventative health care.

Will we have to battle the battle of keyword voids at a grassroots degree, wrangling with the asymmetry of passion by tapping folks to search out these voids and create counter-content material? Do we need to arrange counter-GoFundMe campaigns to pay for ad campaigns that promote real science?

Do not rely on a form’s basic remark that “risks of leaving were discussed with the patient,” he says. That doesn't negate the value of those documents, however they should not be the sum complete of the hospital’s evidence displaying efforts to provide care.

First, the hospital must reconcile any excellent diagnostics, as a result of if any checks had been ordered, the hospital is still liable for checking the results to make certain nothing critical was identified, he says.

Despite our protests, she saved making an attempt to pull out the IV fluid line from her arm and the gizmo , and tugged at her gown. The paper-thin pores and skin on her arms was black and blue from a number of blood attracts. Successful treatment begins with an correct diagnosis, and our experts take the time to get it right.

A team of specialists will listen to your needs and evaluate your condition from each angle to make the very best plan for you. Every year, more than one million individuals come to Mayo Clinic for care.

If witnessed by RN, have them doc the time the patient left in addition to the standing of their IV. If an IV is still in place, first try to contact the affected person after which their emergency contact.

From all the information you've gathered from the Internet and your research, it's time for you to go to your physician with this data and get to know the details. It is important to decide on doctors with whom you're feeling snug.

The level of questioning I got in response to my advice was almost insulting at times. In my head, I advised these callers, “If you trusted me sufficient to name me together with your ailment, why aren’t you trusting my opinion?

Our highly specialized experts are deeply skilled in treating rare and complex circumstances. I actually have been put in this identical position so many times, that I lastly, like you, needed to tell them to contact their supplier or go to the ER/Urgent Care.

I owned a small household follow clinic and some would actually present up there quite than going to their PCP or ER. I do perceive how onerous it is to tell them to go to their PCP’s, but I believe that is the proper motion. We love our family and pals and do not need to see them ill or in ache, however we additionally want them to obtain goal care.

I actually have been practicing as a Nurse and APP for over 15 years now and have found, for me, robust boundaries come with time. You don’t have a look at them as patients, but as whomever they are to you.

YOUR ability to want them to be OK and not be as goal as you'd be with a affected person. Another disagreeable facet effect of trying to assist was the pushback I received.

doctor certification, from the Membership of the Royal College of General Practitioners, and checked performance towards historic outcomes from an independent 2015 examine that evaluated several symptom checkers. symptom checker seems as a chatbot that users can work together with by way of an app or web site. When the consumer varieties out their primary symptoms as a quick sentence or phrase, the symptom checker asks questions about possible related signs.

According to the NIH, 30-40% of Americans report having occasional symptoms of insomnia and 10-15% report persistent issue sleeping—with ladies representing nearly all of those affected.

While you could assume that a poor night’s sleep simply means you’ll need an extra cup of espresso in the morning, chronic sleep problems can actually improve the lengthy-time period threat of hypertension, melancholy, and diabetes. treatment medical disclaimer A physician’s visit can help identify attainable underlying causes for your restless nights—and get you the help you should truly get some zzzs.

Does your family have a history of diabetes, excessive cholesterol, heart disease, cancer, or another significant illness? If so, you could be at risk for these conditions, too—and there are likely issues you can do to decrease that danger. A doctor may help you find out and work with you to determine which screening exams you want.

"Casual" could exit the window, if the individual you advise feels you have triggered them harm; together with your recommendation or deeds. State legal guidelines differ greatly and litigation can truly change the legal guidelines as time passes. So as a nursing skilled, even if your action or advice was justifiable, there isn't a safety from being sued . You might prevail and be discovered "not liable" if sued, but by then you'll have gone by way of plenty of wasted time and pointless stress.

They might help detect vaginal infections, together with sexually transmitted ailments , and should often embody a PAP smear for cervical cancer screening. Although you might have heard about some current adjustments to screening recommendations, the U.S. Preventative Services Task Force nonetheless wants women between the ages of 21 to 65 to get a Papanicolaou test (a.k.a. PAP smear) a minimum of each three years (or more incessantly when you’ve ever had abnormal results).

The lawsuit claimed that Dr M had failed to recognize the patient’s skull fracture and improperly released him when he was intoxicated, and that the delay in treating the fracture was attributable for approximately half of the affected person’s neurological deficits. Later that day, a hospital radiologist learn the affected person’s x-ray and famous a markedly depressed left parietal cranium fracture.

Or will the tech platforms where that is occuring start to grasp that giving legitimacy to health misinformation by way of high search and social rankings is profoundly dangerous? Getting excessive-quality, fact-based well being information shouldn’t be dependent on the result of SEO video games, or on who has extra assets for pay-to-play content promotion. few hours of a newborn’s life, medical doctors administer a vitamin K shot.

This is as a result of infants are born with out sufficient of the vitamin, and the child wants a boost to prevent any potential bleeding. The documentation also should detail the discussion with the affected person regarding potential risks from leaving AMA, Merkrebs says.

The reasons for refusing additionally may be wide-ranging, every little thing from worries about the price to concern about ache or dying, or dislike of being touched, photographs, surgical procedure, or drugs. Once a affected person is examined beyond triage and exams are ordered, a departure at that time could be classified as left without completing remedy , Klauer notes.

Patients leaving the emergency room too soon “are intentionally putting themselves at extra danger for morbidity and even mortality,” Polevoi stated — a degree echoed by other physicians. Ko stated the column will proceed as long as individuals want to study totally different health subjects. Connect with a medical skilled everytime you need one, 24/7, for customized recommendation and prescription, if deemed necessary.

At the end, the symptom checker identifies possible causes and recommends a course of action, similar to reserving a video consultation with a human physician or going to a hospital. The patient and his family consulted with a plaintiff’s attorney who agreed to take the case. Dr M was shocked to find out that he was being sued for medical malpractice.

Within each of these kinds of AMA, there may be further breakdowns when it comes to why the person is leaving, he notes. The affected person might not want any care of any type, or the refusal could also be extra limited — refusing the particular kind of care being provided, as an example, but still willing to be handled.

That's to not say all of the internet is unhealthy, it is okay to make use of Google for health questions when you use a credible supply and if it prompts you to go to your doctor should you could have considerations. Without limiting the generality of the foregoing, the Author makes no representations or warranties with respect to any Information offered or offered within or via the Site relating to treatment of medical circumstances, motion, or software of treatment.

“When sufferers convey themselves into the ED, they are seen in about 5 minutes by a qualified registered nurse and, on common, are seen by a supplier within 30 minutes of arrival,” Thomas mentioned in a press release.

From 2012 to 2017, the variety of emergency room encounters in Fresno County elevated by nearly ninety five,000, or 37%. At Fresno’s Community Regional Medical Center, about 9% of ER encounters ended with a patient leaving too quickly, greater than 3 times the statewide fee.

If no success, contact the police non-emergently to aid in finding the affected person. In this situation, the patient has not but interacted with a doctor. There isn't much to do here as long as the provider by no means met the patient, if so, they might be in a different category.

There are no known instances the place the ED, or ED Providers, have been sued and located to be at fault or responsible for an end result. We recognized people ages with International Classification of Diseases, 9thRevision prognosis codes for infective endocarditis within the National Inpatient Sample, a representative pattern of United States hospitalizations from January 2010 to September 2015.

We plotted unadjusted quarter-year developments for AMA discharges and used multivariable logistic regression to establish elements associated with AMA discharge among IE hospitalizations, evaluating IDU-IE to non-IDU-IE.

The police were notified, and the patient was taken from jail back to the hospital. At the hospital, he was monitored for a number of hours and then taken to surgical procedure where the depressed fracture fragments have been elevated. However, Mr G ended up suffering a brain injury from the fracture which affected his cognitive talents, and which prevented him from with the ability to hold down a job. The police knowledgeable Dr M that the patient, a 24-yr old named Mr G, had been the perpetrator of an assault and in the process was hit within the head with a blunt object by a bystander.

The police had been called, and found him mendacity on the street, clearly intoxicated and with a bloodied head. They took him to the ED, however Mr G was uncooperative and initially refused any treatment. When most individuals hear these words, they're whispered by an overcoated stranger on the bus or a counterfeit Prada peddler gesturing towards the trunk of a car.

1 note · View note

etsaydaraz · 4 years

Text

Viagra Tablets Side Effects In Urdu, Viagra In Pakistan Lahore Karachi Islamabad - 03000023915

Biggest Shopping website Cash on delivery all over Pakistan Contact Number 03000023915

Visit my website

https://www.etsaydaraz.com/viagra-tablets-in-pakistan.html

Viagra Tablets Price In Pakistan

Pfizer Viagra Tablets For Man Available in Pakistan

Viagra Tablets Price In Lahore | Viagra Tablets Price In Karachi

Viagra is a treatment for erectile brokenness. The dynamic fixing in Viagra is sildenafil, which is a PDE-5 inhibitor. Initially planned as a

circulatory strain treatment, Viagra was seen as a compelling treatment for erection issues.

Viagra upgrades erections by loosening up your veins and improving the blood stream to your penis. It possibly works on the off chance that you are

explicitly invigorated, so you will possibly have an erection on the off chance that you are stimulated. Viagra is the brand name of the

prescription delivered by Pfizer.

What is Viagra for?

VIAGRA® (sildenafil citrate) | Pfizer

Viagra is utilized to treat erectile brokenness, a typical condition in men. Most men experience erectile issues at some phase in their lives,

which can have physical or mental causes. On the off chance that you find that you routinely battle to get an erection you might be analyzed as

experiencing feebleness. Conceivable basic reasons for erectile brokenness can incorporate physical conditions, for example, diabetes or mental

factors, for example, uneasiness and stress.

How Can I purchase Viagra online ?

Viagra is being sold on various sites, a large number of which are ill-conceived. Purchasing from an unlicensed source puts your wellbeing in

Doctor, so you should ensure you request from a reliable supplier, for example, EtsayDaraz Online Doctor. It is essential that you check whether

the site you are utilizing has been endorsed by the General Medical Council and that it is normally surveyed by the Care Quality Commission. Avoid

cures sold as "home grown Viagra" - they don't work and they could be unsafe to your wellbeing.

Viagra is a solution just medicine. Any online drug store which is set up to sell it without a remedy is deceitful. Online specialist

administrations like the EtsayDaraz Online Doctor administration are the main safe alternative in the event that you need to purchase Viagra on the

web. Our primary care physician will survey your data and issue a medicine for a proper treatment. We can send your request by post or you can

gather it from your closest EtsayDaraz Pharmacy.

Reviews of Viagra

Reviews of Viagra treatment utilizing EtsayDaraz Online Doctor's administration show that, by and large, our patients discover our administration

'incredible'.

Viagra Dosage

Taking Viagra just because

Viagra can take 30 minutes to 1 hour to work, so you should ensure you enable time for it to work before you engage in sexual relations. A few men

find that it works snappier. At the point when you take Viagra just because, you should attempt to remain loose and abstain from putting yourself

under tension. Frequently, men are pushed and anxious when attempting an erectile brokenness treatment just because, which decreases the impact of

the treatment.

Which Viagra dosage should I take?

Viagra is accessible in an assortment of measurements, including 25mg, 50mg and 100mg. Ordinarily, men start the treatment with a 50mg tablet.

Erectile issues in youngsters are for the most part because of mental elements, as opposed to a physical reason. In this way more youthful men may

wish to attempt the 25mg measurement first, as it is probably going to be adequate to support their certainty and assist them with getting a charge

out of sex. Increasingly senior men may likewise need to utilize a lower dose, as they may not endure the reactions of a higher portion. On the off

chance that the Viagra 50mg dose doesn't have the necessary impact, you may require the 100mg measurement. In any case, it merits attempting a

similar measurement another 2-3 times before expanding it, on the off chance that different factors, for example, uneasiness are at play.

Would I will be able to take more Viagra on the off chance that it doesn't work?

On the off chance that Viagra doesn't have the ideal impact, if you don't mind contact your primary care physician to affirm whether you can change

to a higher measurements. Try not to endeavor to take more than one portion of any quality inside a 24-hour time frame. Be mindful so as not to

overdose, as this can bring about genuine reactions and could make harm your penis. On the off chance that you experience an erection which keeps

going more than 4 hours, look for help from a specialist right away.

Viagra 100mg Price : 1999 PKR

What is Viagra?

Viagra (sildenafil) relaxes muscles found in the walls of blood vessels and increases blood flow to particular areas of the body.

Viagra is used to treat erectile dysfunction (impotence) in men. Another brand of sildenafil is Revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. This page contains specific information for Viagra, not Revatio.

Do not take Viagra while also taking Revatio, unless your doctor tells you to.

Important information

Some medicines can cause unwanted or dangerous effects when used with Viagra. Tell your doctor about all your current medicines, especially riociguat (Adempas) and nitrates.

Do not take Viagra if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as "poppers". Taking sildenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Stop using Viagra and get emergency medical help if you have sudden vision loss.

Before taking this medicine

You should not use Viagra if you are allergic to sildenafil, or:

if you take other medicines to treat pulmonary arterial hypertension, such as riociguat (Adempas).

if you take nitrates.

Do not take Viagra if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking sildenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

To make sure Viagra is safe for you, tell your doctor if you have ever had:

heart disease or heart rhythm problems, coronary artery disease;

a heart attack, stroke, or congestive heart failure;

high or low blood pressure;

liver or kidney disease;

a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;

a bleeding disorder such as hemophilia;

a stomach ulcer;

retinitis pigmentosa (an inherited condition of the eye);

a physical deformity of the penis (such as Peyronie's disease); or

if you have been told you should not have sexual intercourse for health reasons.

Viagra can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking sildenafil, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoked or were over 50 years old. It is not clear whether sildenafil is the actual cause of vision loss.

Viagra is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether sildenafil passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Do not give this medicine to anyone under 18 years old without medical advice.

How should I take Viagra?

Take Viagra exactly as it was prescribed for you. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Viagra is usually taken only when needed, 30 minutes to 1 hour before sexual activity. You may take it up to 4 hours before sexual activity. Do not take Viagra more than once per day.

Viagra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor's instructions.

During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of sildenafil.

Store at room temperature away from moisture and heat.

Related questions

Is generic Viagra available in the U.S.?

Cialis vs Viagra - What's the difference between them?

Are there any drug interactions between prednisone and Viagra?

Can’t I just buy generic Viagra from an online pharmacy?

Does generic Viagra work just like regular Viagra?

Viagra in Pakistan,Viagra Tablets Price in Pakistan,Viagra Tablets side effects, Viagra Tablets review,Viagra Tablets ,Viagra Tablets in

attock,Viagra Tablets in bahawalnagar,Viagra Tablets in bahawalpur,Viagra Tablets in chakwal,Viagra Tablets in dera ghazi khan,Viagra Tablets in

dera ismail khan,Viagra Tablets in faisalabad,Viagra Tablets in gilgit,Viagra Tablets in gujranwala,Viagra Tablets in gujrat,Viagra Tablets in

gwadar,Viagra Tablets in hyderabad,Viagra Tablets in islamabad,Viagra Tablets in jhelum,Viagra Tablets in karachi,Viagra Tablets in kasur,Viagra

Tablets in lahore,Viagra Tablets in larkana,Viagra Tablets in mandi bahaudin,Viagra Tablets in mansehra,Viagra Tablets in mardan,Viagra Tablets in

mianwali,Viagra Tablets in muzaffargarh,Viagra Tablets in nawabshah,Viagra Tablets in nowshera,Viagra Tablets in peshawar,Viagra Tablets in

quetta,Viagra Tablets in rahim yar khan,Viagra Tablets in rawalpindi,Viagra Tablets in sahiwal,Viagra Tablets in sargodha,Viagra Tablets in saudi

arabia,Viagra Tablets in sialkot,Viagra Tablets in sukkur,Viagra Tablets in swabi,Viagra Tablets in usa,Viagra Tablets in vehari,Viagra Tablets in

wazirabad

Viagra Tablet In Pakistan,Viagra Tablets Available in Pakistan,Viagra Tablets Price in Pakistan,Viagra Tablets how to use,Viagra Tablets review,

Viagra Tablets ,Viagra Tablets asli,Viagra Tablets reviews,Viagra Tablets price in pakistan,Viagra Tablets Origin,Viagra Tablets Results,Viagra

Tablets price,buy Viagra Tablets in pakistan,lahore,karachi,islamabad

viagra tablets in pakistan, Viagra tablets in pakistan lahore, Viagra tablets in pakistan online, Viagra tablets in pakistan urdu, Viagra price in

pakistan, Viagra price in pakistan rawalpindi, Viagra price in pakistan lahore, Viagra price in pakistan karachi, Viagra price in pakistani rupees,

Viagra alternative tablets in pakistan, Viagra tablets available in pakistan, Viagra tablets available in lahore pakistan best, Viagra tablets in

pakistan, Viagra capsule in pakistan, Viagra tablets home delivery in pakistan, Viagra price in pakistan faisalabad, female Viagra tablets in

pakistan, Viagra tablets for womens in pakistan, Viagra tablets for sale in pakistan, female Viagra tablets price in pakistan, Viagra herbal

tablets in pakistan, Viagra tablets in islamabad pakistan, Viagra price in pakistan islamabad indian, Viagra tablets in pakistan, Viagra tablets in

karachi pakistan, Viagra tablets price in pakistan karachi, Viagra tablets price in lahore pakistan, lady Viagra tablet in pakistan, Viagra price

in pakistan multan, Viagra tablets name in pakistan original, Viagra tablets in pakistan, Viagra price of pakistan, Viagra tablets online shopping

in pakistan, Viagra tablets online purchase in pakistan, price of Viagra tablets in pakistan, original Viagra tablets price in pakistan, Viagra

tablets in pakistan price, Viagra price in pakistan peshawar, Viagra tablet price in pakistan per tab, Viagra tablets price in pakistan urdu,

pfizer Viagra tablets in pakistan, Viagra 30 tablets price in pakistan, Viagra tablet price in pakistan rupees, Viagra tablet price in pakistani

rupees, Viagra tablet rate in pakistan, Viagra tablet in pakistan price timing, Viagra tablets price in pakistan, Viagra 100mg in pakistan, Viagra

tablet in pakistan, Viagra tablets in lahore, Viagra in pakistan lahore, Viagra pills in lahore, Viagra in pakistan online, Viagra tablet buy

online in pakistan original, Viagra tablets online in pakistan, Viagra 100mg online in pakistan, Viagra tablets in urdu, Viagra in pakistan urdu,

Viagra tablet use in urdu, Viagra tablet how to use in urdu, Viagra price in pakistan 2020, Viagra cost in pakistan american, Viagra price in

pakistan, Viagra by pfizer price in pakistan, Viagra capsule price in pakistan, Viagra cream price in pakistan female, Viagra drops price in

pakistan, Viagra price pakistan, Viagra price in pak, Viagra 100mg price pakistan female, Viagra price in pakistan, Viagra goli price in pakistan,

Viagra gel price in pakistan herbal, Viagra price in pakistan how much price, Viagra in pakistan imported, Viagra price in pakistan, Viagra

medicine price in pakistan male, Viagra price in pakistan, Viagra original price in pakistan, Viagra one tablet price in pakistan price of, Viagra

tablet in pakistan price of pfizer, Viagra in pakistan pfizer, Viagra price in pakistan, Viagra pills price in pakistan, Viagra plus price in

pakistan, Viagra plaster price in pakistan pfizer products, Viagra price in pakistan tab, Viagra pfizer price in pakistan red, Viagra price in

pakistan, Viagra spray price in pakistan, Viagra tablets price in pakistan, Viagra tab price in pakistan, Viagra usa price in pakistan, Viagra with

price in pakistan, Viagra in rawalpindi, Viagra tablets in rawalpindi, Viagra price in islamabad, Viagra price in lahore, Viagra for sale in

lahore, Viagra tablet price in lahore, Viagra availability in lahore, Viagra in lahore price, Viagra online lahore, Viagra lahore

1 note · View note

wescrumptiouslyghostlycollection · 7 years

Text

Why Managing Diabetes And Insulin Resistance Reversal Is Not Difficult- Learn Here

By Richard Campbell Diabetes is a disease with no cure. However, with proper care of the illness, a person with diabetes can live longer. Long before the 20th century, individuals who suffered from the disease never lived long. This is because doctors had not come up with an efficient manner of dealing with two types of diabetes and Insulin resistance reversal. But right after this period,…

View On WordPress

#a person with diabetes can live longer. Long before the 20th century #a physician may recommend that you visit diabetes nurses who will give you the necessary tips for a healthy lifestyle. They will also teach #a study suggested that people that are more obese are falling victim of this deadly disease. Therefore #be sure to check your blood sugar constantly. Otherwise #Blogger #By Richard Campbell Diabetes is a disease with no cure. However #do a laboratory once every two months to know your blood sugar levels. In addition to the excellent advice from the doctor #fatigue #helps to convert the food in the stomach into glucose. The blood then transports it to various cells in the body. This same blood sugar is r #however #including other symptoms that you should check. Additionally #individuals who suffered from the disease never lived long. This is because doctors had not come up with an efficient manner of dealing with #managing diabetic is no longer a difficult thing to do. All you have to do s ensure you keep fit by exercising regularly. Blood sugar determ #one should check on what they eat more. Your diet can help reduce your weight significantly. Also #pregnant women should see an obstetrician. This is adequate for both women who have diabetes and those who do not have the disease. A pregna #the midwife should have a pediatrician nearby to check the baby&039;s health after its arrival. About the Author: Find a summary of the rea #then diabetes comes in. Insulin #which is a bad decision that can cost your life. Thus #which the blood products #with proper care of the illness #you may end up passing out while working in the office or the field. During prenatal care #you need to book an appointment with your doctor as soon as possible. You doctor will not hesitate to give you the necessary advice that you #you need to visit other specialists that deal with diabetes patients. For example #you should keep yourself busy and active to ensure that you are free from fear. Exercise regularly so that you can keep your health in check #you will keep your blood sugar in check when you do the right exercises this help in Insulin Reversal. Hyperglycemia and hypoglycemia are co

0 notes

otaku-sugar · 6 years

Text

Massage in London Taking The Stress Out Of Getting A Thai Massage

Taking The Stress Out Of Getting A Massage Do you want to learn more about how you can give a nice massage? Of course you do, and you're searching for the right tips and tricks that can definitely make that a reality. You're going to be surprised as you continue reading how the small things are what matters. Massage London If you suffer from back pain, especially in your lower back, having regular massages could be very beneficial. Having a professional relax your muscles can really work wonders and prevent you from further back injuries. It can also help with back spasms, which can be very painful and sometimes debilitating.

youtube

When you pay a visit to your masseuse, be flexible about the whole things. Some of the things you experience during your first massage may seem to be a bit odd. However, you should not allow this to turn you away from enjoying a massage. Relax and allow the professional to work their magic. Some good choices as massage oil include almond oil, walnut oil and olive oil. All have healing properties. These massage oils will absorb much better than a lotion or gel. Additionally, olive oil serves as a wonderful lubricant for the body.Massage in London Your massage therapist needs to be capable to get to your skin in order to do the massage, so you need to be prepared to disrobe. You will be able to do this in the room alone, and you can leave on your underwear. Once you are undressed and face down on the massage table under a sheet, then the therapist will return to the room. Giving a great massage is all about feeling out your partner. The best massage therapists will tell you that you need to let your hands read the body. Follow the bodies curves and lighten pressure as you go over bony areas. Modify the shape of your hand to fit in the curves of the body. How long should you massage a spot for? Try to aim for about thirty seconds. If you have many places to rub, this will help to speed along the process. If you find that the spot still aches or is tight, return to it later for another 30 second session. When giving a massage, it is very important that you use oil or lotion. Massage oils can increase the movements of the soft tissue. Using oil will minimize the pinching and tugging feel on the skin. Massage oils come in all different varieties. They include aromatherapy and provide lubrication and nutrients. After receiving a great deep tissue massage, remember to drink a lot of water. Deep tissue massages release toxins from the muscles, and water helps to clear those toxins from your body. By drinking several glasses, you will keep your body hydrated and avoid feeling lethargic after your massage. You should do a belly massage following every meal. Using one or both palms, start rubbing your abdominal area using clockwise circular motions. The clockwise motion is the same direction that your food digests naturally in your intestines. This can help with digestion and prevent gas and intestinal discomfort. Go online for help in selecting a massage therapist. If that doesn't work, talk to your primary care physician. You can also talk to a nurse or a chiropractor in the area whose work you respect. Professional recommendations are almost as good (if not better) than personal recommendations, particularly if you trust the individual. When using creams during a massage, use ones with a minty smell. This scent is refreshing and relaxing, which is exactly what you want. High quality moisturizing lotions and creams are important. One of the biggest mistakes that you can make when giving your partner a massage is to have the room too cold. Your goal should be to make your partner feel as comfortable as possible. This is very hard to achieve if they are shivering from the cold air on their body. Those who suffer from diabetes can really benefit from having a massage. Diabetics tend to have a problem with circulation and blood flow in their feet, lower legs and hands. This is because they are the furthest away from the heart. Massaging the upper arms and legs can really help to get the blood flowing and circulating much better. Make sure you tell your masseuse about any old injuries you may have, or if you have had major surgery in the past. Your massage should feel wonderful and not exacerbate any physical issues you might have! Keep your masseuse in the loop about any medications you are taking, as well. If you are unsure of which massage therapist to see in your area, ask your family members and coworkers. Referrals are crucial. While they don't ensure that you will get a great therapist, they do increase your odds tremendously. After you get a few names, do your own research to see which person you think best fits your needs. Use a massage oil to reduce friction. While baby oil is a popular choice, you may find that a light natural oil is preferable. Apricot seed and sunflower oils are great choices that will benefit skin health as well. Warm the oil between your hands before applying it to your partner. If you often experience back pain, you should consider investing in a vibrating massaging pad. Some pads even have an option that allows you to apply heat to your muscles. Compare different products before you purchase on and choose one with different speeds so you can easily adjust it in function of your needs. Drink plenty of water after your massage is done. Because massage detoxifies the body, you need some water to help flush your system. Be sure to drink only pure filtered water after a massage. Water is necessary for the detoxification process.

Get a chair massage if you do not have the money or time for a full massage. Grabbing a chair massage only takes roughly 10 minutes, without the high cost of the full body version. Most chair massages are under $20 and can be done on your lunch break. Now it's time to put what you've learned into action. Start out small, and work at perfecting the techniques. You are going to be surprised at just how much they work and how people will love your new found talent. Keep learning more, and you will continue to amaze them.

London Massage

massage london

0 notes

nicholassean · 6 years

Text

Massage in London Taking The Stress Out Of Getting A Thai Massage

youtube

London Massage

massage london

0 notes

hardbarbariancomputer · 7 years

Text

Lifestyle Tips For Managing Various Type Of Diabetes And Insulin Resistance Reversal

By Richard Campbell

Diabetes is a disease with no cure. However, with proper care of the illness, a person with diabetes can live longer. Long before the 20th century, individuals who suffered from the disease never lived long. This is because doctors had not come up with an efficient manner of dealing with two types of diabetes and Insulin resistance reversal. But right after this period, managing diabetic is no longer a difficult thing to do. All you have to do s ensure you keep fit by exercising regularly. Diabetes arises from an increase or decrease of blood sugar. When you consume food, the blood produces insulin, which helps to break down and distribute energy for the proper functioning of the body. There are two types of diabetics. Type 1 diabetics and Type 2 diabetics. Both diseases require you to know how to manage them differently and accordingly. Soon after noticing substantial changes, seeing a doctor should be your first step. Most people ignore this step. For instance, if you notice that you get tired quickly, you have lost a lot of weight, including other diabetic symptoms, then it is the right time to make an appointment with your doctor. They offer the best advice on how you can live with the illness. It is also proper to do a laboratory test after every one or two months. In addition to the excellent advice from the doctor, you need to visit other specialists that deal with diabetes patients. For example, a physician may recommend that you visit diabetes nurses who will give you the necessary tips for a healthy lifestyle. They will also teach you about diet and which exercises to do. Stress is a common factor among diabetes patients. Some of the stress arises from the fact that they lack knowledge on how to deal with their life. Scientists also state that stress can lower your chances of living when you have the disease. This is because it can cause your blood pressure to shoot upwards or downwards. Blood pressure can cause a stroke or cause the heart to fail. Keeping yourself busy will help to tackle every amount of stress. Also, you should exercise more frequently so that your health does not deteriorate. Bad eating habits cause obesity. People become obese because of increased cholesterol or fat amounts in your body. Scientists also say that obesity makes it easy for one to get diabetes. Therefore, you should take the time to change the way you eat to deal with the excess cholesterol in your body. You can also exercise to help burn additional fat that the body does not require this will help to Insulin Reversal. Hyperglycemia and hypoglycemia are conditions of high and low blood sugar respectively. As you work during the day, be sure to check your blood sugar constantly. Otherwise, you may end up passing out while working in the office or the field. Women with pregnancy should be careful as well. Either you can have diabetes during the pregnancy (gestational diabetes), or you may have the disease initially. Consequently, it is important for pregnant women to see an obstetrician who can help them deal with the disease. During childbirth, a diabetic pediatrician should be a part of the team that helps the midwife to deliver the baby. Remember that the illness is genetically passed on. She should be there to check the blood of the baby sugar conditions.

About the Author:

Find a summary of the reasons why you should follow an insulin resistance reversal diet and more info about a great diet program at http://ift.tt/15ahezi now.

Lifestyle Tips For Managing Various Type Of Diabetes And Insulin Resistance Reversal from Blogger http://ift.tt/2vDcPFD via IFTTT

0 notes

nadiadalouh · 7 years

Text

Why Managing Diabetes And Insulin Resistance Reversal Is Not Difficult- Learn Here

By Richard Campbell

Managing diabetes was difficult during ancient times. However, this changed after the year 20th century. Doctors managed to come up with the way forward to deal with the disease. Because diabetes has no cure, managing diabetes by insulin resistance reversal diabetic is no longer hard. A fit lifestyle and doing exercises regularly will do you good and make the victim live longer without much bother from the disease. People with diabetes have irregular rising and falling of the blood sugar. When ingesting food, insulin, comes in to convert that food into blood glucose for easier distribution through the blood. This blood sugar goes to the various cells to help produce the energy that your body needs to operate your body organs. Soon after noticing substantial changes, seeing a doctor should be your first step. Most people ignore this step. For instance, if you notice that you get tired quickly, you have lost a lot of weight, including other diabetic symptoms, then it is the right time to make an appointment with your doctor. They offer the best advice on how you can live with the illness. It is also proper to do a laboratory test after every one or two months. In addition to the excellent advice from the doctor, you need to visit other specialists that deal with diabetes patients. For example, a physician may recommend that you visit diabetes nurses who will give you the necessary tips for a healthy lifestyle. They will also teach you about diet and which exercises to do. One things that kill most diabetes patients is the fact that they do not see themselves living for long. A high amount of stress may creep in because they do not know the way forward. However, this should not worry you. You should always be active and learn to do exercise as part of a healthy lifestyle. Remember that acute levels of stress can cause blood pressure. Thus, causing your heart to fail or even end up in a stroke. According to relevant studies, obese people become easily susceptible to diabetes. This is because of the increased cholesterol that is present in their body. You should take the time to analyze your eating habits and your diet hence preventing unnecessary weight gain. Adopt a diet and exercises that will help you lose all the cholesterol in your body. You will also have a healthy heart as cholesterol can cause the heart to fail. Hence exercise will help to Reversal of resistance insulin. Carrying out regular blood sugar checks as you perform your daily duties are proper. This prevents hyperglycemia and hypoglycemia, which comes because of having high and low blood sugar respectively. These conditions can be dangerous to the body. Also, this regular checks will prevent unusual cases of passing out while working in the field or office. During prenatal care, pregnant women should see an obstetrician. This is adequate for both women who have diabetes and those who do not have the disease. A pregnant is susceptible to diabetes during the pregnancy that is why it is necessary as well. During childbirth, the midwife should have a pediatrician nearby to check the baby's health after its arrival.

About the Author:

Find a summary of the reasons why you should follow an insulin resistance reversal diet and more info about a great diet program at http://ift.tt/15ahezi now.

from weight loss http://ift.tt/2uUoNNI Why Managing Diabetes And Insulin Resistance Reversal Is Not Difficult- Learn Here . via IFTTT

0 notes

zapata46martinez · 7 years

Text

Lifestyle Tips For Managing Various Type Of Diabetes And Insulin Resistance Reversal

By Richard Campbell

Managing diabetes was difficult during ancient times. However, this changed after the year 20th century. Doctors managed to come up with the way forward to deal with the disease. Because diabetes has no cure, managing diabetes by insulin resistance reversal diabetic is no longer hard. A fit lifestyle and doing exercises regularly will do you good and make the victim live longer without much bother from the disease. Blood sugar determines whether you have the illness or not. If your sugar rises or is lower than the recommended levels, then diabetes comes in. Insulin, which the blood products, helps to convert the food in the stomach into glucose. The blood then transports it to various cells in the body. This same blood sugar is responsible for providing energy that your body needs. You can manage the disease by how you live whether you have type I or type 2 diabetes. Do not be ignorant when you notice signs of diabetes. Most people keep quiet, however, which is a bad decision that can cost your life. Thus, you need to book an appointment with your doctor as soon as possible. You doctor will not hesitate to give you the necessary advice that you require. Some of the diabetes symptoms include weight loss, fatigue, including other symptoms that you should check. Additionally, do a laboratory once every two months to know your blood sugar levels. In addition to the excellent advice from the doctor, you need to visit other specialists that deal with diabetes patients. For example, a physician may recommend that you visit diabetes nurses who will give you the necessary tips for a healthy lifestyle. They will also teach you about diet and which exercises to do. Most diabetic patients are so prone to stress. Most of them do not know the right approach to living a better life and end up feeling horrible. Stress is a major killer of many people with diabetes. However, you should keep yourself busy and active to ensure that you are free from fear. Exercise regularly so that you can keep your health in check. Stress may cause you to fall into high or low blood pressure. This may cause indefinite heart failure or even a stroke. People who become obese have a high chance of becoming diabetic. This is because of the high levels of cholesterol within their body. In fact, a study suggested that people that are more obese are falling victim of this deadly disease. Therefore, one should check on what they eat more. Your diet can help reduce your weight significantly. Also, you will keep your blood sugar in check when you do the right exercises this help in Insulin Reversal. Carrying out regular blood sugar checks as you perform your daily duties are proper. This prevents hyperglycemia and hypoglycemia, which comes because of having high and low blood sugar respectively. These conditions can be dangerous to the body. Also, this regular checks will prevent unusual cases of passing out while working in the field or office. Pregnant women should visit Obstetricians during their gestational period to help them know how to deal with diabetic conditions. Additionally, during birth, a diabetic pediatrician should be there to check the baby when it arrives.

About the Author:

Find a summary of the reasons why you should follow an insulin resistance reversal diet and more info about a great diet program at http://ift.tt/15ahezi now.

Lifestyle Tips For Managing Various Type Of Diabetes And Insulin Resistance Reversal from 1BetterOf2http://1betterof2.blogspot.com/2017/07/lifestyle-tips-for-managing-various.html

0 notes

speedilyironpirate · 7 years

Text

Lifestyle Tips For Managing Various Type Of Diabetes And Insulin Resistance Reversal

By Richard Campbell

Diabetes is a disease with no cure. However, with proper care of the illness, a person with diabetes can live longer. Long before the 20th century, individuals who suffered from the disease never lived long. This is because doctors had not come up with an efficient manner of dealing with two types of diabetes and Insulin resistance reversal. But right after this period, managing diabetic is no longer a difficult thing to do. All you have to do s ensure you keep fit by exercising regularly. Diabetes arises from an increase or decrease of blood sugar. When you consume food, the blood produces insulin, which helps to break down and distribute energy for the proper functioning of the body. There are two types of diabetics. Type 1 diabetics and Type 2 diabetics. Both diseases require you to know how to manage them differently and accordingly. Do not be ignorant when you notice signs of diabetes. Most people keep quiet, however, which is a bad decision that can cost your life. Thus, you need to book an appointment with your doctor as soon as possible. You doctor will not hesitate to give you the necessary advice that you require. Some of the diabetes symptoms include weight loss, fatigue, including other symptoms that you should check. Additionally, do a laboratory once every two months to know your blood sugar levels. In addition to the excellent advice from the doctor, you need to visit other specialists that deal with diabetes patients. For example, a physician may recommend that you visit diabetes nurses who will give you the necessary tips for a healthy lifestyle. They will also teach you about diet and which exercises to do. Most diabetic patients are so prone to stress. Most of them do not know the right approach to living a better life and end up feeling horrible. Stress is a major killer of many people with diabetes. However, you should keep yourself busy and active to ensure that you are free from fear. Exercise regularly so that you can keep your health in check. Stress may cause you to fall into high or low blood pressure. This may cause indefinite heart failure or even a stroke. People who become obese have a high chance of becoming diabetic. This is because of the high levels of cholesterol within their body. In fact, a study suggested that people that are more obese are falling victim of this deadly disease. Therefore, one should check on what they eat more. Your diet can help reduce your weight significantly. Also, you will keep your blood sugar in check when you do the right exercises this help in Insulin Reversal. Hyperglycemia and hypoglycemia are conditions of high and low blood sugar respectively. As you work during the day, be sure to check your blood sugar constantly. Otherwise, you may end up passing out while working in the office or the field. Women with pregnancy should be careful as well. Either you can have diabetes during the pregnancy (gestational diabetes), or you may have the disease initially. Consequently, it is important for pregnant women to see an obstetrician who can help them deal with the disease. During childbirth, a diabetic pediatrician should be a part of the team that helps the midwife to deliver the baby. Remember that the illness is genetically passed on. She should be there to check the blood of the baby sugar conditions.

About the Author:

Find a summary of the reasons why you should follow an insulin resistance reversal diet and more info about a great diet program at http://bit.ly/2j2eddR now.

Lifestyle Tips For Managing Various Type Of Diabetes And Insulin Resistance Reversal from learn 2 made money http://bit.ly/2vGQg25 via IFTTT

0 notes

type2diabetestreatments-blog · 7 years

Text

FDA to OK Insulin Without a Prescription? Or...?

New Post has been published on http://type2diabetestreatment.net/diabetes-mellitus/fda-to-ok-insulin-without-a-prescription-or/

FDA to OK Insulin Without a Prescription? Or...?

A new regulatory debate about whether certain medications should require prescriptions makes me reflect on how good things used to be when it comes to obtaining my own diabetes meds over-the-counter.

Insulin, in particular.

Two decades ago when I was on second-generation insulin like Regular and Lente, I could walk into a pharmacy and pick up a bottle of insulin without needing a prescription. That was helpful during those times when I forgot my insulin vial at home. Or dropped the last bottle in just the right way for it to shatter, just when it was needed the most.

Yes, back before I was constantly connected to a continuous drip of insulin via my pump, and before the days of rapid-acting insulin or the many pens that are now available with a doc's Rx, I could just buy insulin at the drugstore; no doctor's orders were needed to just pick up an extra bottle.

I thought that was a good thing. So it made me happy to hear not long ago that the Food and Drug Administration (FDA) announced it was exploring the idea of "expanding the availability" of certain medications, like modern insulin -- possibly opening them up to the over-the-counter (OTC) market where you wouldn't need a doc's prescription to get this stuff.

You probably know that there are two types of drugs at the moment: those that require a doctor's prescription and those that don't. The latter are assumed to be safe enough for patients to treat themselves without a doctor's guidance. What the FDA is proposing now is that a third class be created, allowing those drugs that would normally require an Rx to be sold OTC under the condition of "safe use." That term could mean a pharmacist assessing whether a patient might need or can use a particular medication, and in certain cases the FDA might require a doctor's visit after a patient obtains a refill or small initial amount of the medication.

To those of us in the Diabetes Community, one of the big questions comes down to what this might mean for access to insulin, which is mostly a prescription-required medication despite some older-generation insulin still being offered OTC.

For those without an endo or who aren't frequent visitors of their regular docs, and especially for those people without insurance coverage, this expanded availability of a life-sustaining medication would be a very welcome change.

Of course, opinions vary and not everyone is open to this change. The American Medical Association (AMA) and other medical societies offered the FDA plenty of comments opposing this move, basically claiming in not so many words that this could be the beginning of an end-run around physician authority. They're pushing back hard.

Surprisingly, the other group of doctors pushing back equally hard is endocrinologists, via the Endocrine Society — representing roughly 15,000 endos worldwide. They also provided the FDA with an earful of protest. Not singling out insulin, the Society states that all diabetes drugs are tricky with respect to "conditions of safe use" because patients may suffer from, or develop, complications. Huh? So why shouldn't they have easier access to the meds they need?

And I quote...

"The Society appreciates that the FDA is evaluating which drugs might be appropriate to designate as nonprescription in an effort to improve access and health outcomes, but strongly believes that diabetes medications should not be considered under these new paradigms."

A recent discussion among the Diabetes Advocates group had quite a few folks riled up about this. After all, shouldn't endocrinologists, supposedly passionate about diabetes care, be at the forefront of making sure people with diabetes can easily access the medications they need to survive?

The Society goes on to state that since "diabetes is an extraordinarily complex disease," only docs are qualified to assess what meds are needed, not the PWD thanks to a whole host of factors such as medical history, lifestyle considerations and more. And any non-physician or pharmacist might not understand the full picture, or be able to offer additional advice if and when it's needed.

So only the endos are qualified to prescribe insulin and no one else — in any situation — is able to make that assessment? No matter what length of time someone has been living with diabetes, and regardless of the type?

Their statement reads like an obvious play of self-preservation — in which the Endocrine Society is basically trying to ensure that people who need insulin and other diabetes drugs can only get access to it by coming through their offices. This resembled moves by the AADE, in not doing enough to allow more people become certified as educators, and the school nurses who pushed for policies mandating that only they are qualified to administer insulin and no one else can be trained to give necessary injections at school because of the "complex medical knowledge" one needs.

I scoffed, and solidified my negative thoughts about the Endocrine Society.

But then, I had a conversation with Dr. Jason Wexler that changed my views to some degree.

This endo at Washington Hospital Center in D.C. chairs the clinical affairs core committee studying these kind of issues, and he says the opposition was not about protecting endos' status. "Self-preservation arguments don't hold, that isn't where this comes from," Wexler said.

Rather, the Society is pushing for safeguards to "make sure people with diabetes aren't making decisions in isolation and there's an ongoing dialogue with their endo or primary care physician."

So there are people out there who just might think they need certain meds or insulin, and go out and buy them without a diagnosis or doctor's consult? Is that really a concern? I asked. Wexler answered: Yes, it is.

He told me about how a half-dozen times a year, he gets patients in his office that say they have a grandmother or parent at home who has some type of diabetes. That individual uses a glucometer and sees a higher-than-recommended number, and decides to just start taking medication or insulin. This kind of medication-sharing is one example of behaviors that could become more common with relaxed FDA regulation on prescriptions, Wexler worries.

"It's about empowering patients to make their own informed decisions, not about getting one more patient in the door," he says.

With a large amount of the population poor and under-insured, Wexler says the danger of blindly taking drugs without a doctor's consultation is even greater — particularly during tougher economic times.

Still, Wexler says the FDA comment period was just a starting point. More information and recommendations could come down the road. Maybe the Endocrine Society would be open to discussing certain exceptions, allowing some restrictions or "safe use conditions" on certain medications, like insulin. At least until a person is able to get with a doctor to talk.

Protocols could be established between pharmacies and clinics where this medication is available, so that consumers have an ongoing dialogue with their doctors.

Nothing's official, as these rules would have to go up the ranks of the Endocrine Society and also be considered by the FDA, of course. But the possibility is there and at least they're willing to talk about it.

This was a useful conversation for me, as I realized I'd been looking at this issue only through the lens of a longtime type 1 whose been taking insulin as long as I can remember and who regularly visits an endo. But there's the other side, of those who might actually be self-medicating based on little knowledge about life with diabetes.

Unfortunately, this whole debate came up after the FDA docket closed May 7, so public comments are no longer being accepted. Jay Leno joked (at the 4:05 mark) about the issue a few days before the docket closed, taking it to the mainstream but offering little time for interested people to object if they hadn't known about it earlier.

The process is still underway, as the FDA hasn't made any decision. The agency isn't obligated to listen to the Endocrine Society, or even to holding a public hearing on this issue. But it could.

And that's where we come in. Taking this discussion to the Endocrine Society (and others who have similar views) is the next move on the chessboard here. So, we in the DOC should let them know what we think on this!

The Endocrine Society's comments to the FDA are available to review online in PDF form here. Their PR guy Aaron Lohr tells us we can all submit our own reaction and comments to them by sending emails to [email protected].

After all, this is about eliminating barriers — in a safe way — to restrictive health care and policies and practices, and giving PWDs more access to the meds they need to manage their health.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.

Type 2 Diabetes Treatment Type 2 Diabetes Diet Diabetes Destroyer Reviews Original Article

0 notes