#it seems like hyperglycemia again

[froody]

Tommy doesn’t seem to be doing well this evening.

[vulnera-sanentura]

Cat Facts: Diabetes and DKA

Diabetes can often get a bit overwhelming in physiology and info, so here’s the short and sweet of it:

Affects 1:200 cats (similar rate for dogs)

Caused by an insulin deficiency (effectively)

Clinical signs include - polyuria, polydipsia, and polyphagia (eat, drink, and urinate a lot, abbreviated as PU/PD/PP), and weight loss

Treatment is - insulin, special diet, +/- weight loss

DKA is - metabolic derangements secondary to insulin deficiency. VERY serious, often VERY sick kitties

So breaking that down, let’s start with the physiology: Specific cells, called beta-cells, in the pancreas create insulin. Insulin is anabolic (think anabolic steroids that bodybuilders use), decreases blood glucose, and facilitates tissue uptake of glucose while inhibiting breakdown of tissues.

In diabetes, cats have what’s called a “relative” insulin deficiency (whereas dogs have a “true” insulin deficiency). Which means they’re producing insulin, but due to a combination of beta-cell dysfunction and insulin resistance in the body tissues, there isn’t enough to do the job of what a normal, healthy body would need. This also means it’s often later in life when symptoms show up, and there’s a potential for them to go into remission and no longer have to be treated for diabetes.

Who gets diabetes? The typical diabetic feline patient is an older, neutered male. Weirdly, Burmese are also predisposed but only in Australia is there a correlation. Because this is a relative insulin deficiency and not a “born with it” disease in cats, there’s also risk factors, which increase the likelihood of developing diabetes due to increasing insulin resistance:

Obesity

Pancreatitis (beta-cells are in the pancreas!)

Steroids (either due to medications or steroid hormones created by the cat)

Progesterone

Infection (UTI, periodontitis)

Stress

Why did I highlight infection? It’s important to remember because if your patient is on a high dose of insulin but not responding, it may be due to an infection! Check for a UTI, clean their teeth if they need it, it could help enormously in management.

How do you diagnose it? Clinical history helps: cat often comes in with the owner complaining that they’re peeing so much they’re flooding the litterbox, and eating a ton but they’re still losing weight. If you read my other posts, you’ll recognize this sounds a bit like hyperthyroidism too, but it narrows down the differentials!

Diabetes in dogs is easy to diagnose. Check a blood glucose, it’s sky high out of reference range? Well, you’ve got diabetes! The problem in cats, however, is they can get stress hyperglycemia. This means coming into the vet for a visit can jump up their glucose out of reference range and initially make it seem like diabetes. The good news is you can often differentiate it by how high the glucose is above normal. Stress hyperglycemia is often <250mg/dL, and cats with diabetes will present much higher than that on initial visit, generally >350. Diabetic cats will always have glucose in their urine, while it’s less likely (though not impossible) for a stressed cat to have glucosuria.

And treatment? Insulin! The goal of diabetic management is the reduction of clinical signs, and improving quality of life of both the cat and the owner. Remission is possible, and a bonus, not a true goal as it’s not achievable in all patients.

You can also pair this with a diet of increased protein and decreased carbs (Hill’s DM is a common choice). NO RAW MEAT. Diabetes leads to immunosuppression and they’re much more likely to contract an infection from raw diets.

Vets should ask owners to monitor clinical signs at home (drinking more or less than normal, eating more or less, gaining or losing weight), and the dose at recheck should be adjusted based on those clinical signs.

So, onto DKA. DKA, or diabetic ketoacidosis, is a serious metabolic disorder caused by insulin deficiency or resistance, leading to excess liver production of ketoacids and progressively worsening metabolic acidosis, hyperosmolality, serum electrolyte derangements, and systemic signs of illness.

That’s... a lot of big words and I’m not a vet. Come again? DKA is when diabetes has been so uncontrolled or thrown out of whack that it leads to an acidification of the bloodstream, and due to that low pH, starts a snowball effect of changing other physiologic mechanisms like the electrolytes in the blood. These cats come in often very sick, potentially only able to lay on their side, almost comatose.

How do you diagnose this one? DKA is diagnosed by high blood glucose, glucose in the urine, as well as ketones in the urine. They generally have a history of diabetes, though some are undiagnosed at presentation.

Additionally, bloodwork will show a metabolic acidosis, and maybe hyponatremia, hypokalemia, hypochloremia (all the low e-lytes!), pre-renal azotemia (high BUN), increased liver enzymes, and hypercholesterolemia.

This is serious, what do I do?! DKA can be scary, especially when you know the ~30% mortality rate. For treatment goals, you want to:

Provide adequate insulin to maintain BG between 100-300 

Restore fluid and electrolyte losses

Correct the metabolic acidosis

Identify and treat concurrent illness

Provide dextrose and food as need to avoid hypoglycemia

Avoid overly aggressive therapy!! Correct the problems slowly over 24-48 hours

I won’t go too much into the ICU workup since that can get long and complicated, lots of math, but essentially you’ll start fluids, add some potassium if indicated, start them on insulin, and monitor them. While stabilization of the critical patient is most important, it’s also important to know that DKA doesn’t occur in a vaccuum. Pancreatitis, cholangiohepatitis, hyperthyroidism, or a number of other diseases may be underlying that pushed them from a regulated diabetic patient into DKA. Look for the cause!

That was long but I hope you all enjoy it :)

[sweetdejun]

medical!au x dream, sungchan and shotaro

I wrote a medical!au x nct 127 and I was like,,, it only makes sense if I do the rest of the members, too! mark and haechan are going to be in the nct 127 version here. medical!au x wayv’s coming soon!

I feel like renjun is the type to consider something a little more artistic in the medical field, which is why I feel like he’d be an orthotist. he’d design prosthetic limbs in the labs for children, veterans, or adults, and whenever he’d get an order, he’d spend days on it. his friends went out those weekends, but renjun stayed in, his espresso steaming on his work desk and his glasses perched on his nose as he scrolled and edited his prosthetic design. he never made the same one twice. of course, if someone damaged their old one, renjun repaired it instead of creating a whole new one, but these prosthetics were designed for permanent-use. he’d finish off with his signature emblem before giving it one last check then giving it to the hospital.he’d insist the doctors to invite him when they wore it for the first time, just to see the look on their faces and the absolute joy they’d receive from being able to use it for the first time. it’s not a steady job, sure, but it sure as hell is fulfilling and that’s all renjun would ask for.

so I kinda just imagine jeno being a psychiatrist… I imagine him taking notes as he carefully listens to his patients. jeno’s very attentive to detail, and just shortly after his undergrad, he interned with a psychiatrist who helped him learn more about what goes on behind the scenes, and he really impressed the interviewers at his medical school with all that he learned. soon after earning his degree, he went to work for the same psychiatrist that he’d interned with and his patients loved him. the one moment that jeno will never forget is when he had a patient who was battling severe depression. it wasn’t until jeno arrived on their case that they began to show improvement. they smiled for the first time in months, and within a year the patient was miraculously much better. before they left, they thanked and hugged everyone, but jeno received the biggest thanks and the tightest hug. 

okay, the reason I think jaemin would be interested in becoming an orthopedic surgeon ever since he had back problems in high school. he was fascinated by all the cool diagrams of skeletons, and his doctors had explained his injury so well to him, that it inspired him to strive for orthopedics as a specialization. he did really well on his entrance exams, and he managed to come full circle, and become a resident at the hospital he was treated in. as an orthopedic surgeon, jaemin makes sure to inform his patients as much as he can. sometimes, he’ll even call them at odd times to let them know if there are any changes he’s decided to make regarding the surgery, or aftercare, whatever. jaemin’s a trustworthy doctor, and his patients never seem to forget him, even if it’s a while after he’s healed them.

chenle as a medical technologist is a little unexpected. when he hangs around his friends during his free time, and you can hear his laughter down the hallways, you wouldn’t think he’s the guy who is counting blood cells under a microscope. but he’s very detail-oriented, and always impresses his supervisor. it’s also not a job that is as demanding in the knowledge of science, since he really needs to be able to distinguish what is normal over what is not, which he loves. in his free time- which there’s not too much of, but in the rare occurrences he does- he likes to either visit his friends, resident!jisung or physicaltherapist!mark who’s in the next building. another admirable thing he’ll do, though, is he’ll stop at the pediatrics floor and play with the kids that come in for blood transfusions or testing, since he’ll have their blood supply to give to the doctors, or he’s there to collect the samples. and sometimes, a parent will thank him for all his help and he can’t help but blush because, well, it makes him happy to help others.

jisung is totally a resident. no questions, it just makes sense. the fact that he knows people at the hospital was one of the reasons he applied for residency there, because he went to medical school with some of the (now) workers. when he finds out he’s accepted, he’s over the moon. generally hangs around by chenle’s department, where the front office of the hospital is. takes care of checking in patients and directing people to different areas of the hospital, while doing checkups on patients and the other thousand things his seniors assign him. although he enjoys the work he does, he doesn’t know if he wants to specialize or stay as a general physician, which his friends also help him decide down the line. he knows that no matter what, he wants to end up back in this hospital because it's like a second home to him. 

sungchan works as a physician’s assistant. initially also wanted to pursue medicine as a whole but he had this… feeling? that medicine was going to wear him out faster than he wanted to, and he felt that he was the type to burn out easily. not to mention, he also wanted to have free time on the side; conveniently, this job provided him with just what he wanted. the hospital was right outside a neighborhood park that also needed volunteers for coaching little kids. turns out, the way his schedule is at the hospital, he takes the morning shift at the hospital, gets out at 2:30, then stops at his apartment nearby to nap and freshen up before coming to the park and coaching soccer in the evenings. it’s the perfect life for him and hasn’t been happier. 

finally, seeing shotaro as a veterinarian is ideal for him. I mean, have you seen the guy? he’s so gentle and soft, it’s no wonder he’s amazing with animals. he grew up near an animal shelter in japan, where he visited the animals as often as he could. the vet that would visit the shelter often saw him, amused by the way he handled the animals with care. naturally, the vet talked to shotaro about considering veterinary school as a potential career choice, and at first, he didn’t really pay too much attention to the vet’s words. but one day, when one of his favorite pups wasn’t as energetic as she usually was, shotaro took her to the vet’s office, and he learned that the puppy had hyperglycemia. since then, he knew that he never wanted to feel that way again, and persevered to become a vet. now, he lives in korea and runs a clinic there, and that puppy from the clinic? he ended up adopting her and bringing her to korea with him and it’s just the cutest thing.

[hollenka99]

A Deal Gone Wrong

Summary: Jackie’s betrayed the others for the sake of bringing Henrik home safely. The aftermath doesn’t go as he expected.

Warnings: Abuse, Anti generally being an asshole

Jackie looking into ways to get Anti's attention quickly delivers results. He is always watching, after all. It shouldn't have surprised him how easy it was to find himself in the demon's presence. It's been exactly 9 months since Henrik was taken. Jackie promised himself he wouldn't allow the doctor to stay captive for as long as he did. It was getting uncomfortably close now. Times were getting desperate. And well, he wholly agreed with what they said about occasions such as these. His reckless plan works. Jackie's too pleased about winning this victory, too relieved to be granted a few days of freedom before delivering on his side of the bargain. He turns a blind eye to how easy it is. At least he's smart enough to write the specifics on paper. Not like he expected Anti to whip out a pen and sign a 'contract'. If you could call it that. He assumes Anti's amusement was due to the ridiculousness of it. Still, anything to feel he has any sway on the glitch. If Anti says there'll be a swap, Jackie can only hope he keeps his word. Henrik comes home, as promised. The first hour or two following his return are the most eventful. Chase and Marvin can't hug their friend soon enough. Jackie bursts into tears against the doctor's chest. The ten days Anti had granted him disappear quicker than he'd like. There is less stress in the air. It doesn't feel like they are scrabbling for peace or normality quite as much. Marvin's plants are beginning to display an vast improvement in vitality. There is also the relief they have another (more competent) doctor assisting in Jack's care. Jackie is happy knowing he's played a part in bringing this about. It's not all great. Chase won't stop joking that they only need to wake Jack up so things can go back to how they were. He knows life will never revert back to summer 2016 standards. Chase didn't even exist until a year ago. Henrik keeps trying to inspect Jackie's injuries. What is he expecting to find? His legs are barely functional, the scars of the living autopsy are still there and Jackie doubts he's regained much weight, if at all. Sneaking in a visit to Jack's bedside only resurfaces the same feelings of guilt he's experienced this week. He's betraying their trust. For a good reason, he reminds himself. For a good reason. Now here they were, standing feet from each other once more. He's mulled over whether to leave a goodbye note. He decided against it. It would only cause them more heartache to know he went willingly. And Henrik, oh he'd have to live with the knowledge this was for him. Jackie doesn't want that. It's made worse by the prediction he won't be himself the next time they see him. He's made his choice. There's no backing out now. "Well, here I am. You upheld your end so... I guess I'll have to do the same." The demon greets him with a malicious smirk. "That's nice to hear. But you don't have what I want." "What are you talking about? You said you'd let Henrik come home if I gave myself up. We agreed on a swap, myself for Schneep." As if to prove his point, Jackie fishes out the note. He forcefully shows it to Anti. The demon inspects it before promptly ripping it until nothing remains but mere shreds. "You weren't listening. I never said I'd take you. You just assumed. Desperate to come back to me, puppet?" "I am not a puppet." "Aren't you? What are the five largest cities in Ireland?" "Dublin, Cork, Limerick, Galway, Waterford." Caught off guard, he deadpans the list without resistance. "Returning to me reminds you of..?" "The Temporary Discharge for Ill Health Act of 1913, better known as the Cat and Mouse Act." No, don't smile like that. Don't be proud of his ability to answer questions. It's only a few stray facts he can recite. He is Jackie. Remember that. He's not a puppet. Not yet. Maybe it will be easier to give in once he's back to that lightless room. He can fight for a week or two save face then- he's getting ahead of himself. But his corruption hasn't transpired quite yet. "Alright, I can spout random trivia. So what?" "What are the physiological symptoms of fear?" "Hyperventilation, increased heart rate, increased muscle tension, sweating, hyperglycemia and disruption to the digestive system, among others." Jackie lists the symptoms on his fingers. He knew this from his own experience. It had absolutely nothing to do with Biology lessons or the independent research he felt was necessary to complete. "Good. What should your resting heart rate be?" "I'm physically over the age of ten so... somewhere between 60 and 100 beats per minute." "Oh really? That's very interesting to know. I just counted 87." It's only now that Jackie gains awareness of Anti's fingers pressing slightly too harshly against the top of his neck. He flinches as he swats it away. "I told you to stop. And that's still in the range, you dick." "It's very unhealthy to have it so high. Tell me why you're not normal." "I'm a character?" "That doesn't matter." "I'm younger than everyone else?" "No. Try again." Anti growls, impatience growing. "Oh. I exercise frequently which means I-" His glare is aimed at Anti. Well done, you've making him realise his mistake. The glitch must be so proud of himself. Why is Jackie even answering of his own free will? "Which means I should be closer to 60 beats per minute." "Exactly." "Look, it doesn't matter. I made the mistake of dealing with you. Increased heart rate is also a symptom of stress." "That's no way to speak to the one who took the liberty of educating you." That tone. Oh God, it was that exact tone. Please don't let him have a needle and thread handy. He's sorry. He won't misbehave again, he swears. "Sorry, sir." Anti still glowers for a moment. "I see you finally remembered your manners." "Listen, I can't walk. So no more escape attempts. You won't have to worry about that." "That didn't excuse you from lessons, now did it?" "No, exactly, so we can still do that." "Yet you still managed to leave me." How is Jackie meant to respond to that? "I- Well, you were distracted, sir. I was... I was being resourceful. That's a useful trait, right?" Anti's laughter is broken. It morphs into an amalgamation of giggles, cackles and snickers. He scrutinises Jackie once more before turning away. His gaze is directed to the powerlines surrounding the field. Hang on, he can't just leave! God, this culminating panic was so stupid. No matter how much he tries to squash it, the anxiety grows. Within seconds, he can't stop himself from blurting it out. "Wait, don't go!" This attracts the glitch's attention. He abruptly ceases the increase in fragmentation. The air doesn't feel quite as energised. Anti's head whips around. He's beaming as he steps towards Jackie, closing the distance. "You're as pathetic as ever. Perhaps I should take you with me." Anti muses. "That way you can look my new puppet in the eyes and tell him how you betrayed his trust." "I didn't do anything." Don't say that. Please. Just because it's true doesn't mean he wants to be reminded. "What is one of the first lessons I taught you?" "Don't- Don't talk back?" It's a frown now. "You don't sound convinced." "Don't talk back." He answers firmly. "That's better." Anti gives him a gentle smile. It is swiftly followed by a shove that is nowhere near as gentle. "I could leave you in Tasmania and make you swim all the way home. No cheating this time either. I will personally throw you overboard into the Indian Ocean if I see you trying to stowaway again. I'm sure you don't want that." The glitch crouches down. His hand reaches out towards Jackie's head. The teenager flinches. Anti glides his hand through his hair. Don't relax into it. You have better sources of human contact. This subtle resistance seems to irritate the demon as his hair is yanked into position. Jackie has no choice but to look him in the eyes. "I've had my eye on him for months. Now you've given me an excuse to have him all to myself." The grin falls into a pout. The grip loosens too. "But don't worry! We can be together again one day. I know how lonely you've been without me." How long has Anti's eye had that green glint to it? He tsks in sympathy. The hair stroking resumes. "All those bad habits. Give me some time and you won't have to be lonely again. Can you do that?" No. Fuck off. No way is he going to... going to... He will wait for his master, of course he will. "Yes, sir." Anti rises to his feet. "Good boy. Now, why don't you run home? I have better things to be doing than stand here proving you can't deceive yourself." Jackie doesn't need any more incentives. Racing isn't a pace he is able to maintain anymore. Nevertheless, he travels home as rapidly as his body will allow him. He hadn't brought his keys. In his defense, he believed he wouldn't be coming back. Not to mention he was not about to risk Anti gaining unauthorised access to the egos' home. He bangs on the door like he had eight months ago. They're all clearly beside themselves. No words are spoken before Jackie is practically smothered by Marvin while simultaneously being berated for his disappearance. Where had he gone? Why didn't he think to give them a heads up before leaving? Did he not realise how worried they'd been? Also, had Chase said anything to him about staying out tonight? Jackie doesn't understand. What did Chase have to do with him sneaking out? If the guy had gone to drop off a forgotten toy, that wasn't suspicious. Neither was the prospect of traffic delaying him or Chase secretly heading to a pub. Come on, this was Chase they were talking about. There must be a perfectly reasonable- What about a hallway? Why's that significant? Oh. Oh no.

[taetaespeaches]

ok so i may or may not had hypoglycemia today at college hehe but i was wondering what would the boys react if their s/o had diabetes and this happened (just a diabetic girl suffering and thinking wow what if they date someone like me and olivia haha)

Hello my dm1 partner! Squad lol. I hope your blood glucose is good now and that you’re feeling ok :) 

a/n:Oh boy, so Mariana gave me a chance to write something diabetes related and I went OFF. Here is my first reaction ever so I hope you all enjoy it (especially you @newodds) but seriously, I’ve looked for this exact reaction before because diabetes is a struggle and sometimes you just want to know how your bts boyfriend would react to it. Here’s how I see the boys reacting to their s/o being diabetic and hypoglycemic (low blood sugar). Symptoms of hypoglycemia include shakiness, hot flashes, disorientation, light headedness, heart palpitations, hunger, mood swings, plus more. This also mentions hyperglycemia (high blood sugar). Also, I use a continuous glucose monitor, which I included in the Jungkook reaction. Basically the monitor alerts you when you’re hyper/hypoglycemic, and it keeps beeping at you every five minutes until you acknowledge it.  

Seokjin

“Baby, only 15 grams,” Jin gently reminded you as you dug through the cupboard full of various snacks. There were cookies, crackers, granola bars, cereal, and so much more, and fuck you were hungry. Turning your head just enough so your boyfriend was in your sight, you shot him a glare. 

“I’m low and I want food,” you said in frustration.

“I know, but just eat something small first and then we’ll see how you feel in a bit,” Jin told you gently. 

“But I want cookies and a pop tart,” you whined. “And those apple jacks look mighty tasty.“ 

Jin approached you from across the kitchen, his hands meeting your hips as he rested his chin on your shoulder. "I know it all looks good, but if you eat it all, you’re going to be hyperglycemic and then you’ll be mad at yourself and you’ll probably be moody and be mean to me,” he pouted his lips. “Do you really want to be mean to me, baby?”

Pulling your eyebrows together, you glared at him. “Well, you’re denying me food so yeah, I kind of want to be mean to you." 

Smiling at you, he shook his head as he reached up to grab the cookies out of the cupboard. "Ok, have a couple cookies, we know two of these cookies is just about 15 grams of carbs.” Jin dug into the cookie container to pull two out, holding them out to you as he put the container back in the cupboard and shut it. 

“I’m not a child,” you sassily remarked as you continued to glare at him. 

“Are you sure?” He asked, sass evident in his voice. “You’re acting like one.”

Taking the cookies from him, you shoved one in your mouth as you made your way to the living room, plopping down on the couch. 

Jin followed shortly behind, slowly sitting down next to you. “Are you mad at me?” He asked you with a pout on his face. 

Sighing, you shook your head. “No, I’m not mad at you. I’m just frustrated. I hate having to deal with this fucking disease sometimes. And it’s stupid because I’m just mad about not being able to eat everything I want to eat, but it’s annoying,” you ranted. Your boyfriend stared at you, eyes stuck to yours as he listened attentively to your every word. “I’m sorry, it just gets so,” you huffed, “frustrating.” Jin placed his hand on your lower back as he rubbed up and down soothingly.

“Don’t apologize,” he told you sincerely. “You didn’t ask for this disease, it’s not fair, and you’re allowed to be upset about it every now and then.” You slowly nodded at your boyfriend’s understanding words. 

“Thank you,” you crawled into his lap, nuzzling your face into his chest, wrapping your arms around his body. “For being so understanding,” you looked up at him. Leaning upwards a bit, you placed a soft kiss to Jin’s neck. “And for dealing with my bitchy attitude every time I go low or high. I’m sorry my mood gets so unpleasant." 

"Stop saying sorry, I understand,” he kissed your forehead, making you smile adoringly at him. “Besides, your mood is never that bitchy.” You shot him a feigned glare before you burst into a fit of giggles. 

“And you’re not that much of an ass,” you shot back playfully. Jin laughed in amusement as he kissed your forehead again.

Yoongi

As the shakiness started to set in, you knew you were headed towards a low. 

However, you forgot to replace your emergency snacks in your bag despite your boyfriend constantly reminding you to do so, and he was currently looking at new sound equipment. You attempted to play it cool, acting as if you felt fine, not wanting to make him hurry through his shopping. You were going to lunch in no more than fifteen minutes anyway, you’d be fine, you told yourself. “Hey, are you listening?” Yoongi suddenly broke through your thoughts and disorientation. 

“Huh, yeah, sorry,” you responded, shaking your head as if you were shaking off your seeming aloofness. 

Yoongi’s eyes on you became more intense as he scrutinized your face. “You look out of it,” he told you, his tone teetering on knowing. 

“I just got tired all of a sudden,” you said nonchalantly. Raising his eyebrows at you, Yoongi reached for your hand. 

“Jesus, kid, you’re burning up,” he pointed out. “How long have you been feeling low?" 

"I’m not low,” you lied to him, despite knowing you were busted. Holding you by your wrist, he lifted your hand up to your eye level to show you both how shaky you were. Cocking his head at you, he waited for your answer. “It’s only been like five minutes–”

“Dammit, y/n,” Yoongi grumbled, dropping your hand and walking around you until he was positioned behind you. You felt tugging on your back as Yoongi dug into your backpack that was hung off your shoulders. 

“I didn’t restock my snacks,” you told him sheepishly with a pout. Suddenly, Yoongi was zipping your backpack up. Stepping in front of you, he held out a rice krispie treat, just barely looking at you, mostly directing his gaze to the exit door of the store. “I could have sworn I was out,” you told him, quickly taking the treat and tearing the wrapper off. 

“You were,” he told you, annoyance in his tone. “I put more in there before we left the dorm.” You simply stared at him, pouting your lips. Turning to look at you, the corners of his lips twitched upwards just the slightest bit, letting you know he wasn’t really that angry with you. “Eat,” he nodded at the treat in your hands, to which you did immediately. His eyes softened as he watched you eat the treat. With a huff, he grabbed your hand and led you towards the exit, forgetting all about the sound equipment he was considering purchasing. “I also have a whole stash of these in the car, so next time you’re hypoglycemic, tell me." 

"I’m sorry,” you apologized, casting your gaze downwards as you followed him out of the store. 

“Yeah, yeah,” he chuckled. Pulling you into his side, he placed a sweet kiss to your forehead. “Let’s just go get some lunch, you brat.”

Hoseok

Watching you boyfriend in the mirror as he ran through the steps in a slowed down version so you could attempt to pick the choreography up, you nodded when his eyes flicked to yours in your reflections. “Got it?” He asked with a smile. 

“I think so,” you bit your bottom lip. Teaching you BTS’s choreography was something both you and Hoseok enjoyed, and you were actually starting to grasp the moves for “Mic Drop”. 

As Hoseok watched you dance, he chuckled when you nearly tripped over yourself. “Don’t laugh,” you pouted, though a smile was just barely being concealed. 

“You’re just cute,” he told you with a fond smile. As he broke the steps down again, you felt yourself slowly start to lose focus. Hoseok noticed you becoming slightly wobbly as he looked at your reflection with squinted eyes. “You ok?”You shook your head. “I think I’m hypoglycemic,” you told him. “I need to take a break." 

"Do you have something to eat?” He asked, his eyes widened in worry. You nodded as you walked towards your bag. 

“I have some juice,” you told him, pulling out a juice pouch. As you drank your juice, Hoseok pulled two chairs over to you. 

“Here, sit down for a bit,” he told you as he sat in the chair he placed across from yours. Both of you sat, sitting across from each other, your knees knocking into each other occasionally. “Are you ok?” Hoseok asked you again, to which you simply nodded and smiled assuringly. Your boyfriend nodded back at you, reaching forward to clasp his palms over your kneecaps. 

“You’re starting to really get the choreography,” he smiled at you. “You look good doing it,” his sweet smile turned into a teasing smirk. “Really good." 

"Stop,” you giggled. “You horn dog,” you shook your head in feigned disapproval, making him laugh at you and himself. “Just give me a few minutes and we can get back to it.”

“Get back to what?” Hoseok asked, confusion set across his features. 

“The choreo,” you told him as if it was obvious. 

“Flower, maybe we should just call it a day. We’ve been at it for a while and I want to make sure you’re feeling ok." 

"Once my blood sugar is up a bit more, I’ll be ready to go,” you told him shaking your head. Shooting you a questioning look, he smiled softly. 

“Aren’t you tired?” He asked you with a chuckle. “I’m exhausted.” You knew he wasn’t really all that tired, but rather just didn’t want you exerting yourself after your hypoglycemia. You found it sweet how he took care of you and prioritized your health. He wasn’t overbearing, he didn’t over worry, but he expressed his concern in more subtle ways. Hoseok made you feel safe without making you feel babied, and you appreciated it more than he knew. 

“Ok, yeah, I’m a little tired,” you chuckled. “Give me a few more minutes, I don’t want to walk yet,” you said shyly, feeling bashful at how weak you still felt, suddenly feeling foolish for wanting to continue dancing. 

“Take your time,” he smiled with a small giggle, squeezing your thighs just above your knees. 

After gaining enough strength back, you and Hoseok were preparing to leave, packing up your stuff and making sure the dance studio was put together. “Hobi, can we get froyo on the way home?” You smiled sweetly at him, attempting to convince him. 

“Can your body handle froyo right now?” He chuckled at you. Patting your pouch that held your insulin pens, you grinned. “Thank god for insulin, huh?" 

Hoseok laughed at you, shaking his head in disbelief. "Fine, we can get some froyo.” You squealed in excitement, wrapping your arms around his neck as his came around your waist, lifting you off the ground a bit. “But then we’re going home and relaxing for the rest of the day. That’s the deal,” he told you, trying to sound stern. 

“Deal,” you smiled as he set you back on the ground. Standing on your tippy toes, you pressed a short kiss to his lips. “Love you,” you grinned. 

“Uh huh, love you too,” he smiled at you as he started to gently push you towards the studio door.

Namjoon

You and Namjoon were hanging out in his bedroom at the dorm as you both read your own books. You were both reclined on his bed, Namjoon’s head resting against the headboard as you laid on your back perpendicular to him, your head propped up on the side of your boyfriend’s abdomen. One of Joon’s arms was draped across the top of your chest, the other holding his book open. 

You felt yourself become a bit lightheaded, starting to lose focus on your book, but you tried to ignore it, thinking you were just tired. Eventually it started to click. “Jesus, I’ve read this paragraph like five times now and I have no idea what it says,” you complained to your boyfriend. 

“You feeling ok?” He asked you, his full attention switching from his book to you. 

“I think I’m going hypoglycemic,” you told him, sitting up so your back was to him. Namjoon sat up on his knees, his hands coming to your shoulders to massage them soothingly. 

“Really? You haven’t gone low in so long,” he said more to himself than you. “Where’s your glucose monitor?" 

"In my bag,” you gestured to your backpack across the room. Namjoon was up and off the bed within a second, quickly grabbing your bag and bringing it to the bed, digging around the contents of it until he found the pouch that held your monitor, test strips, and insulin pens. 

“Give me your finger,” he told you gently, to which you held out your pointer finger. Taking an alcohol wipe, he cleaned the surface of your finger pad. then he loaded the lancing device with a lancet. Next, he put a test strip in the monitor. Flashing you a close-mouthed grin, his dimples popping out, making you smile bashfully, he wrapped his hand around yours, and pricked your finger.Squeezing your finger lightly, he positioned the blood onto the test strip. About five seconds passed by before it gave you your reading. “Fuck, babe, 40?” You see, anything under 70 milligrams per deciliter was hypoglycemic, meaning you were pretty fucking hypoglycemic. 

“What?” You asked in shock. “I feel low but I don’t feel that low." 

"Ok,” Namjoon popped up, quickly making his way to his bag that was sat on his desk. You watched him as he pulled out a notebook that looked like it had been used quite a lot. You had seen that notebook before but you couldn’t quite place it. “Let’s see,” he said as he searched the contents of the first page. “Ten to fifteen grams, ah, anything under 50 milligrams per deciliter should be treated with 20 to 30 grams of carbohydrates,” he read out loud to himself. “Do you have any snacks or juice?” He asked you, eyes wide, but with determination rather than concern. 

“Yeah,” you started digging in your bag. “I have some juice,” you pulled out a juice box. 

“Perfect, ok, drink twice as much as you normally would. One cup,” he told you. 

“I know,” you said with a small smile, though you were slightly annoyed. After chugging the drink, you looked at him. “I know how to treat my lows, Joon." 

Namjoon raised his eyebrows at the comment, surprised by the hint of annoyance in your tone. "I know you do, babe." 

"Holy fuck, now my heart is racing, yeah I’m definitely low,” you told him, making him slightly panic, quickly approaching you from across the room, crouching in front of you. 

“Shit, do you need more juice?” He asked you frantically looking from your face to your bag. 

“No, I just need to be patient,” you told him. “The sugar will raise my blood glucose, but it’ll take a bit. I’ll check my blood again in 15 minutes and make sure the juice worked." 

"Right, 15 minutes,” he nodded. “I knew that,” he said to himself. Namjoon’s gaze met yours as you looked at him questioningly. 

“What’s going on, babe?” You asked him, to which he shook his head slightly.

“Come on, talk to me. It’ll help distract me from the low." 

With a sigh, Namjoon placed his hands on the tops of your thighs. "Y/n, I know you can take care of yourself. You’re beyond capable, you do it every day, you’re a rock star at managing this,” he told you. “But I just need to know that I can take care of you too,” he said sadly. “Just in case I ever have to. And I’m sorry if I overstepped or made you feel less capable, but–”

“Joonie, that’s really sweet,” you told him. “I appreciate you caring so much about this.”

“Of course I care, babe. It’s you,” he told you sincerely, his eyes serious yet soft. Namjoon lowered his head to kiss your knee as you ran your fingers through his hair. 

“What’s with the notebook?” You asked him with a confused smile. Heat spread throughout Namjoon’s cheeks as he looked over at the desk where the notebook sat. 

“I keep track of everything there is to know about your diabetes. I write down all the information you tell me. Like what fixes your lows best, what foods make you go hyperglycemic, how much insulin you inject for your basal dose, how much bolus you take, what your correction is. I take notes on your typical symptoms for hypoglycemia and I note how you feel when you’re hyperglycemic. I also take notes at your appointments with your endocrinologist, but you know that. I’ve also done a lot of research on my own just online, searching different medical sites and forums. I just want to know everything I possibly can so I can help you take care of yourself,” he explained shyly, feeling very embarrassed. 

However, you couldn’t see his reddened cheeks through your glistening eyes. “Fuck, Joon,” you laughed a little. “You’re amazing,” you told him as you wiped your eyes. “I love you so much." 

"I love you too, babe,” he sat up a bit to capture your lips in a kiss. “I’m in awe of you every day. I’m so proud of how you handle this disease, and I’m inspired by your strength." 

"Stop,” you whined with a small giggle. “Thank you for caring about me, thank you for loving me,” you told him with a pout. 

“Come here,” he told you as he grabbed the back of your head, pulling your forward a bit as he leaned in to kiss you again. “Are you feeling any better?” He asked you, his breath still hitting your lips, concern in his eyes. 

Nodding, you turned your head a bit to place a soft kiss to the inside of his forearm. “Yeah a little. I’m ok, Joon.” Namjoon nodded in relief. You had about 10 minutes still before you needed to check your blood again, so you decided to pass the time by teasing your sweet boyfriend. “So, really? A whole notebook huh?" 

"Stop,” he grinned fondly.

Jimin

Your relationship with Jimin was still slightly new, only a couple months into it, and he had yet to be with you while you were hypoglycemic. However, as your heart started racing and you started sweating, feeling very hot all of a sudden, you knew the low was coming. As Jimin walked beside you through the park, your hand wrapped up in his, he had no idea what you were suddenly feeling. “Hey, Jimin, can we sit down for a minute?” You asked him, to which he looked at you softly. 

“Of course.” He led you to the park bench a few feet away. Right after you both sat down, you started digging in your bag, searching for your glucose monitor. “Hey, is everything ok?” Jimin asked you tentatively. You had told him about your diabetes, and he had seen you check your blood multiple times, but despite you telling him what hypoglycemia is, he really had no idea what to expect still. 

“Yeah, I just think I might be hypoglycemic, so I’m going to check my blood real quick,” you told him almost nonchalantly. 

“Wait, what? That’s not good, right, hypoglycemic is bad, it sounds bad,” Jimin yelled out in worry, turning his body to face you as he searched your face for answers. 

“Jimin, it’s ok, I’m ok. No hypoglycemia is not good, but I don’t feel very low yet so it’s ok. I’ll just eat some candy and then I’ll be good to go,” you told him with an assuring smile. You quickly checked your blood, which turned out to be 72 mg/dl. “See that’s not bad. Under 70 is considered hypoglycemic. I’m just nearing that point,” you explained to your panicked boyfriend. 

“Ok, so you eat candy now?” He asked you, worry and panic still written across his face. 

Nodding, you dug into your bag to find the baggy full of various candy. “Just a few pieces.” As you popped a hard candy into your mouth, you held the baggy out to Jimin. “Want some?" 

Jimin quickly shook his head. "No, you need that." 

"Jimin, baby, I’m ok I promise,” you told him, reaching for his hand to hold and soothingly run your thumb across the back of it. 

“Ok, I know you are, I trust you, obviously you know what you’re doing,” he told you and himself, nodding his head. “It’s just, you told me if your blood sugar goes too low you could pass out or go into a coma or–”

“I have to be really hypoglycemic for that, baby. And that’s why I pay close attention to how I’m feeling, I check my blood often, and I always have something sugary to take in case I do go low,” you smiled at his worried expression. 

Your boyfriend slowly nodded, taking in all of the info, trying to secure it in his memory. “Ok, so you’re good." 

"Yes, I’m good,” you giggled. 

“Ok, good,” he finally cracked a smile, feeling slightly embarrassed for his moment of panic. “I’m sorry I freaked out,” he giggled bashfully. 

“It’s ok,” you assured him. “It was sweet. It showed you care, which I know you do, but still, it was sweet.”

“I’ll get better at this, I promise,” he laughed at himself, pulling you closer to him so he could wrap his arms around your shoulders in a hug. 

“I know you will,” you smiled, wrapping your arms around his waist.

Taehyung 

When your front door busted open, you immediately knew who it was but that didn’t stop the very brief split second of shock and panic that hit you. 

“Shit, Taehyung,” you clutched your chest. “You’re going to give me a heart attack." 

"Sorry, peaches,” Taehyung apologized as he approached you as you sat on your couch. “How are you feeling?” He asked you, leaning down to place a sweet kiss to your forehead, to which you slightly leaned into. 

“Not great. I just ate a cookie hoping it would bring my blood sugar up but it’s still low,” you told him. 

“What was your last reading?” He asked, his eyebrows pulled together making him appear intimidating. 

“58 milligrams per deciliter,” you told him. “But I ate another cookie and I’m about to take another reading." 

"Ok, good, we’re ok,” he assured you, his eyes softening. “We’ll just see what the next reading says." 

You nodded, groaning. "I just feel so weak, I hate it." 

"I know, Peaches,” Taehyung said gently. He stepped closer to you, threading one hand through your hair as he pulled you towards his body, hugging your head against his hip. You wrapped your arms around his legs. 

“Ok, I need to take another test,” you told him, to which he immediately removed his hand from your hair, instead placing it on your knee as he sat down next to you. Checking your blood sugar, you whined at the reading. Turning the monitor to show your boyfriend, he sighed. 

“60. It hasn’t gone down further so that’s good. Eat another cookie,” he told you. He could tell you were about to protest so he cut you off before you could even start. “I don’t care if your blood sugar goes high later, I don’t like you being low for this long." 

"Fine,” you sighed. Eating another cookie, Taehyung ate one with you, munching on it in pout. He was trying to act normal and calm, and he would have had you fooled it if weren’t for the way he way his gaze followed your every move, tongue and teeth worrying against his bottom lip. 

You both mostly sat in silence for the next 15 minutes as you waited to take another blood glucose test. Taehyung occasionally leaned into you to press a sweet kiss to your neck, just barely whispering “we’re ok” to you. 

When you took the next test and it read as 80 mg/dl, you sighed in relief, a huge boxy grin taking over Taehyung’s face. “I told you we’re ok,” he kissed your cheek.

“Thanks for coming over,” you leaned into him, cuddling up against his side.

“Anytime, Peaches.” Taehyung looked down at you, curled up against him, and he couldn’t help but feel overwhelmed by the love and admiration he had for you. “You know you’re so strong, right?” You hummed in question. “You’re strong and capable. You said you felt weak, and I know that’s because of your low blood sugar, but I also know you hate feeling weak, so I need you to remember that you’re strong. You’re the toughest person I know.”

You smiled into his chest, sighing in content. “Thank you, Dearest. I needed to hear that.”

Jungkook

Jungkook groaned in his sleep, rolling over to cuddle you, not yet awake enough to figure out why he had been woken up from a deep sleep. Nuzzling his face into your neck, his arm draped over your waist, he easily fell back asleep. However, about five minutes later, he was awoken again, this time slumber not so heavy that he could identify the source of the disruption. 

“Baby,” he shook you. “Baby, you ok? Wake up,” he shook you harder.

Groaning in your sleep, you swatted at his hands. “What?” you whined sleepily, keeping your tired eyes shut.

“You’re beeping,” he told you. He was met with another groan from you as you rolled over to grab your continuous glucose monitor to check your blood reading.

“Fuck,” you whined, shoving your face in your pillow, still too tired to deal with your hypoglycemia.

“Low or high?” Jungkook asked you.

With a sigh, you pulled the blankets off your body and began crawling out of bed. “Low.” Stepping onto the floor, you made your way out of the room and into the kitchen to grab some juice. As you opened the fridge door, Jungkook was suddenly at your side, reaching in to grab the carton of juice for you. Walking towards the cupboard, Jungkook softly slapped your butt along the way making you chuckle.

Jungkook poured about half a cup of juice into a glass and handed it to you with a sweet smile. You quickly chugged the drink, and as soon as you were done, Jungkook was taking the glass from you and rinsing it in the sink. “Go sit down,” he gently told you. Just as you sat down on a stool at the kitchen island, Jungkook was at your side, sitting in the seat next to you. “Have you had any fun dreams so far tonight?” He asked you, trying to fill the 15 minutes you had to wait to see if your blood sugar was rising. 

“Yeah,” you yawned.

“Tell me about it,” he requested, wrapping his arm around your waist and kissing your temple just as you rested your head against his shoulder. As you went into the details of your dream, he could hear your voice become more lethargic as you drifted off into sleep, mid-talking.

Jungkook simply listened to your even breaths, enjoying the warmth radiating from your body. He would stay awake for the remaining ten minutes, letting you sleep before he woke you up to make sure your glucose was good so you could go back to your shared bed.

“You amaze me,” he whispered to you as you slept. He was so lost in his thoughts of admiration for you that he didn’t realize your breathing pattern change as you slowly awoke. “I hate that you have to go through this, but you’re so admirable,” he kissed the top of your head. “I love you.”

“I love you too,” you whispered through an amused grin. “Now stop being cheesy and let’s go back to bed.”

“You’re good?” He asked with wide doe eyes, his cheeks slightly reddened from the embarrassment of being caught professing his love for you.

“I’m good,” you smiled, standing up and taking his hand to lead him back to bed. “So cheesy,” you teased again, both of you wearing love struck grins as you walked towards your bedroom.

[burbidgtfds-blog]

bottled water

Water is the most important element in sustaining life on Earth and without water all life would most likely disappear. It's an amazing fact that the human fetus is 97% water at two months gestation and still 75% when born. So it's easy to not only see the benefits of drinking water in our lives, but to understand the actual importance of drinking water to our very existence.

Beyond the necessity of water in our lives there are so many benefits of drinking water, including helping us to maintain our body's energy levels while removing toxins and wastes and giving us a healthy glowing complexion. Drinking water also aids in weight reduction. Water is a natural hunger suppressant simply due to the fact that it can fill you up which helps reduce overeating and therefore helps you to maintain your weight. It is also an interesting fact that often when you feel hungry, your body is really telling you that you need water and not food.

The benefits of drinking water go beyond just making healthy people look and feel good. Water also plays a special role for those with certain medical conditions such as some forms of high blood pressure where drinking water can help to stabilize blood pressure.

Also if you are diabetic, hyperglycemia dehydrates the blood cells which cause blood sugar to rise. So drinking water is important in maintaining blood sugar levels.

A lot of people aren't in the habit of drinking water except when they're thirsty, but it's important to develop a routine to make sure you are drinking enough. It may take some conscious thought at first. Setting up prefilled bottles of water where you can see them all day provides a great reminder to get your daily supply of H20.

Eight glasses of water a day is really drinking water  just a simplified way of giving us a general idea of how much water we need. The amount actually depends on a number of factors such as the climate where we live, our level of physical activity, as well as our interior environment. If we're in an office or home where there is air conditioning or heating or if the weather is too hot or if we exercise obviously we will need to drink more water.

Remember that you will only get the benefits of drinking water if you actually drink it. So don't wait until you're thirsty before you decide to get a drink of water. By then your body is already dehydrated. It is better to drink small amounts of water as opposed to gulping down a large quantity at once and your stomach will thank you. Make sure you do not drink too much water just before any strenuous activity and of course before bed time or you'll be awake all night running to the bathroom.

If you're thinking you're getting the benefits of drinking water through teas, colas, sports drinks or other sugary drinks, think again. Despite what advertisers would have you believe sports drinks won't hydrate you any better than water; colas and other sweetened soft drinks simply aren't good for the body and the acids used to carbonate these beverages can damage your teeth and in large quantities can even weaken bones. You also won't get any benefits of drinking water if you fill up on soft drinks. You're just packing on a lot of empty calories due to the high sugar content. Coffee and teas have an added disadvantage as they actually work against hydration. Both of these high caffeine drinks act as diuretics, meaning the more you drink, the more your kidneys will pull fluids from your bloodstream.

The importance of drinking water seems obvious. Water contains some very unique qualities that no other beverage can replace. It may mean making some life changes to make sure you you're getting the full benefits of drinking water, but it will change your life in return.

[kaepop-trash]

Diagnosis

Rated: Fluff

Pairing: SichengxReader

Summary: Your supervising doctor really disliked you.

(A/N): It’s Winwin’s world and we’re all just living in it. This is small and stupid but we sometimes need one of those.

“He's had two seizures in the span of four hours and he's sweating profusely. Muscles have lost control, probably due to nerve damage.” Sicheng pushed his glasses up the bridge of his nose as he read from his notes, “There is–” He continued but a figure pushed him aside, he looked around for the disruption, looking down to spot a resident doctor he recognised. When she realised everyone was looking, she looked up, eyelids twitching with realisation.

“Oh I didn't mean to interrupt you, please continue.” She gave him a thumbs up for motivation and went back to looking at the patient's arm closely.

“There is a significant loss of body heat. I'm certain.” He looked up at the doctor with determination, pushing his glasses back again with a small smug grin, “It's epilep–” His eyes sparkled.

“Wrong.” The girl scrutinizing the body stood up, brushing her coat and turning to him, “Sorry for the second interruption, but it's not. Epilepsy.” She dug under her nail bed. As a rule residents weren't allowed to have nails, and she usually picked on that.

“What makes you so certain?” He asked with knitted brows.

“He's heaving because his gag muscles are contracted, his lips are blue. It's alcohol poisoning.” She clicked her pen and scribbled into her notepad.

“All of those can easily be signs of epilepsy.” Sicheng defended. She looked back at him wordlessly.

“Yes, but he's sweating profusely, and it smells of liquor, tequila I think. So I'm sure my diagnosis is correct.” She said professionally, “An IV drip and some activated carbon should do it I think.” The doctor seemed impressed.

“Yes, but you completely bypass the rules of determining a diagno–” He started.

“But I'm right am I not?” She looked at the professor who nodded and Sicheng gripped his jaw.

“If you interrupt me one more time, so help me god.” He growled suddenly, she turned to him with wide eyes at the unexpected intensity. He turned his red face away, missing her amused smile.

It was that moment, she really could single out that one single moment as she ran across the ER at 4am in her pajamas and a half worn lab coat. She pushed the doors of the unit and rushed in, gazing around and catching a familiar figure, she scurried to his side.

“You asked for me?” It was the first time she spoke since waking up and her voice came like a croak, taking her a little by surprise.

“There's a patient who came in with chest pains. You're training to be a cardiac surgeon aren't you?” He looked at her momentarily before turning to the clipboard in hand and pretending to check.

“Yes, but I don't have a shift now.” She said hesitantly. He looked up, taking a second to asses her words and then look away.

“I wasn't aware of that.” He coughed uncomfortable, “Since you're here anyway, you should go ahead.” He encouraged and she nodded obediently but there was clear exasperation in her eyes. She turned to the sedated patient.

“I think it was a textbook heart attack, but you already knew that. You've given him Nitroglycerin.” She turned to him with sleepy eyes and raised a brow.

“How can you be sure?” He tilted his head and she scoffed.

“He'd be dead by now otherwise. I'll scrub in on the surgery since I'm up anyway, let's go.” She turned away from him, not giving him the satisfaction of seeing her complain.

“He thinks you undermine him.” One of the residents said matter of factly as she ate her cereal. (Y/N) looked up at her with sleepy eyes and frowned.

“We’re just the same specialisation you know, he got his PhD last year. Now he's a doctor and I still have a year left of my residence. What part of me undermines him?” She sighed and rested her head of the table.

“Maybe he's just tired and pissed from his new job and he takes it out on you.” Someone else on the table offered and she frowned deeper.

“That's not fair.” She turned to him and he shrugged.

“It doesn't need to be, you answer to him now. Just bite your tongue and bear with it. This is your last year as a resident.” He gave helpful advice that she nodded to with understanding.

She didn't understand how things turned out like this. As she sat silently beside Sicheng and both of them quietly ate ramen. It had become a ritual now, both had their break at the same time and ended up at the convenience store across the hospital. It was better than eating alone, but by no means was the silence between them a comfortable one. Her very skin seemed on edge around him, but inevitably he would come sit beside her to finish his mediocre meal.

It was one such evenings that she was sitting at the window, more tired than usual. She had scrubbed in on a nine hour surgery. Sicheng sat in front of her, wordlessly as usual. But this time he wordlessly placed a cup of coffee in front of her. She only looked up with part confusion from tiredness and part from the new situation.

“You look tired.” He said, inspecting his noodles, before he turned to her.

“Plus, I have already added your name for a surgery scheduled in an hour. It’s a unique case, you might be interested.” She wasn’t aware that her scowl was bad enough to make him cough and look away.

“I just finished up with one.” She whispered with defeat, Sicheng hesitated.

“The transplant?” He asked and winced when she nodded, having heard of it’s duration. He bit his lip.

“I’m sorry I wasn’t aware.” He looked away, cheeks dusted pink.

“It’s okay.” She said insincerely as she toyed with her ramen.

“You’re an idiot.”

“I'm sorry?” Sicheng lifted his sleepy head with a squint.

“If we find a girl cute Sicheng, we don't bury them in work.” Taeil said knowingly and Sicheng only furrowed his brows harder.

“How do you know she doesn't appreciate it? I call her for the rare cases you know.” He mumbled as he scooped more porridge into his mouth. Taeil smiled in amusement, he didn't even deny it.

“I may not be an expert, but I'm going to put myself out there and say that there is a possibility that she might think you're picking on her.” Taeil sipped on his burned coffee with a slightly prideful expression, he was, at the very least, better than Sicheng when it came to things like this. In fact Taeil was excited to tell the others, Sicheng had a crush and he was on the way to getting some liquid thrown at him by her.

“I'm telling you, I know what I'm doing. She's good at diagnosis.” He leaned in a little and his voice dropped, “Better than Dr. Oh.” He whispered and Taeil's eyes went wide.

“Yeah. She gives a basic diagnosis after just looking. It's like watching tv or something.” Sicheng was wide eyed in wonder as he explained and his friend was interested.

She wasn't sure what happened in the past week, but it seemed like her pager buzzed every other minute.

“You called?” She rushed into the ICU room, raising her brow at the crowd of first year residents.

“I was wondering if you would help with this diagnosis.” Doctor Seo asked politely, like it wasn't the same question every time. She buried her disbelief and walked up to him, taking the chart in his hands.

“It's head trauma of some kind?” He asked placing his index finger on his lower lip and looking down at the chart in her hand, “She might be brain dead from a lack of oxygen supply to the brain.” He conjectured further. She turned to him and listened carefully, when he finished she leaned forward and checked her pupils.

“Her pupils are dilating fine, she's not brain dead.” Her face was heavy in scrutiny as she glanced at the person carefully, before reading the chart.

“It says here that she was feeling very thirsty before she collapsed. I think she might have untreated hyperglycemia, it's not outlandish for a lady in her age. I think a test should determine that easily.” She reminded herself to smile politely and bow, before making her way towards the door.

“I'm sorry Doctor Seo, but Doctor Kim asked for me urgently.” She bowed again and made her way out.

She truly felt at her wits end, it was frankly the last straw. She stood in front of the schedule put up and saw her name included in a surgery that was scheduled tonight. It was too bad that tomorrow was the Lunar New year and she had intended to go home for the weekend. Her head dropped as she walked through the halls.

“Ah, Dr. (Y/L/N). Dr. Kim informed that he wants you present at the surgery tonight. He usually doesn't take residents, you must be excited.” There seemed to be smug tone in his voice but she was too tired to care. Having been acknowledged by another person, she had no choice but to stop. Then, the moment she looked up to try to give a disingenuous reply but her head spun when she picked it up too fast. Her vision blurred for a second but she put a hand on the wall to straighten herself.

“I just have to check on a patient Doctor, then I'll be on my way.” Her voice seemed light and it took her a moment to realise that the wall she was holding onto was cloth and the person in front of her was Doctor Sicheng.

“Are you okay?” His voice was small but concerned, she thought she tried to smile.

“Perfect, thanks for asking. I have a surgery, maybe we should get ramen after.” She laughed, but her head seemed to heavy and kept trying to fall back.

“Right. (Y/N) I'm going to pick you up now, please try not to move.” His voice seemed to ring in her ears and she pouted with pity, it was probably the longest sentence he'd said to her.

The neon lights of the cafeteria made her squint her eyes as she sat with her legs propped up with hand on her temples and her elbow on her knee. Her tongue felt salty as she felt the pressure of the IV in her left arm, she quietly sipped on her lemonade as Sicheng watched her.

“You're dehydrated and your blood pressure was frightfully low. Something dangerous could have happened if I–” He paused eyes growing a little wide before he sat back, “If someone wasn't there. You should take better care of yourself.” His voice showed genuine concern but she looked up exasperated.

“I haven't slept more than 3 hours each day in the past month.” She mumbled, looking away.

“When is your next day off?” He asked and she turned back to him.

“Today. But I got scrubbed in.” She raised a knowing brow at him and he looked away.

“I'm sorry if I did anything to offend or undermine you. I was just doing my job, but you're being unfair to me.” She said a little softly and Sicheng seemed to turn back speechless.

“I'm sorry?” His voice was a little too quick and she winced.

“You think I give you work to prove my authority over you?” He asked, looking a little hurt and she was raised to silence. Said like that, she definitely heard how ridiculous it sounded. She turned to her left arm and winced.

“I think the flow is too rapid.” She lightly tugged on the Catheter and he put a swift hand on hers.

“You'll dislodge it, let me check.” He said without looking at her and she nodded.

She felt too awkward to apologise, but still wondered if at least part of her rationale was true.

“I thought you'd appreciate been given more responsibility. I suggested your name to Dr. Oh for residents to hire next year, but he said he'd never noticed you. I'm sorry, I realise I should have at least informed you. I thought I'd sweep you away.” He laughed awkwardly as he fumbled with the clamp, “I guess I also wanted to spend time with you.” When the pressure felt comfortable she lifted her other arm and tugged on the sleeve of his coat. He looked up with large lost eyes and hers seem to mirror his.

“Would you like to go for dinner with me? It's the New Year now, we didn't need to scrub in for the surgery.” He said a with a sudden rush of bravery, she could tell he was bracing himself when her face fell.

“I was hoping I'd take the night train home.” She smiled sheepishly, but a moment later his words rang in her head again and her cheeks turned pink.

“Did you just ask me out?” She looked up back at him again and he looked away.

“No.” He said too quickly, only when he looked back did he see her face fall.

“Oh.” She said a little insincerely.

“No, I mean yes. I am.” He groaned internally at his smooth ways, externally he gave her another smile.

“I've never met someone who knows as many symptoms as you. It's kind of hot.” He admitted and she took a moment of being wide eyed to adjust to his words before she laughed.

“You're trying to flirt with me!” She said like it only just occurred to her, he was a little hurt.

“Doctor D–” She smiled.

“Call me Sicheng. That's my name.” He mumbled again and she stuttered.

“Sicheng. I promise to go on dinner with you tonight if you find less exhausting ways for us to spend time together.” She smiled, before she thought over something.

“And if you drop me to the station in the morning.” She added quickly, he had a car.

Sicheng seemed almost excited at the idea, and he had to admit: so attracted to her as she confidently asked what he had failed to this entire year.

“Nothing would make me happier.” He assured her

[t1np]

MINIGLUCAGON!

I discovered mini-glucagon or mini-gluc as med staff at DYF Bearskin camp a few years ago. As a kid who lost her low blood sugar awareness early and ended up needing glucagon on more than a few occasions, this, like diabetes camp,  was another thing that I wish I had known about earlier.

First, to refresh, glucagon is a hormone that acts as the counterpoint to insulin. Insulin takes sugar out of the blood stream and puts it into our body. Glucagon takes glycogen stored in the liver and releases it as sugar into the bloodstream. When for whatever reasons, our blood sugars are low and we can’t take sugar by mouth, glucagon gets the sugar we need into our bloodstream without it.

Glucagon is traditionally administered as an intramuscular (IM) injection, the dose is either 1mg or 0.5mg. The needle is enormous and terrifying to everyone involved and because it’s an IM injection, it hurts. I am unclear why this method stuck because: 1. The dose of .5mg is way higher than necessary for children and adults and causes unnecessary side effects. 2. IM and subcutaneous injections are absorbed at the same rate.  

This is why many people have adopted mini-glucagon as the preferred method of administration. Here’s an outline:

Mix the saline and glucagon powder in the vial as you normally would. Swirl, don’t shake, until all the powder is dissolved in solution

Take an insulin syringe which you more than likely still have from early diabetes days. The dosage is 1 unit per year of age your child is. If your child is <2, give 2 units. Otherwise give 3 if your child is 3 up to 15 units if your child is 15. After 15, the dose stays exactly the same, 15 units.

Give as a subcutaneous injection, the exact way you would give an insulin injection. Pull up a small amount of fatty tissue and inject.

Blood sugar should rapidly and reliably rise.

One of primary side effects of glucagon is hyperglycemia, lower doses make this better. Other common side effects are nausea, vomiting and the worlds worst head ache. I call it the glucagon hangover and it is rough. Again, the lower dose reduces these side effects.

Needing to give glucagon is a terrifying event for any parent and if this adds another layer of panic, ignore it. If EMTs are involved they will happily ignore you, IM glucagon works just fine and will do the trick.

Finally, if you ever have a night, or day for that matter, when it seems like no matter what you do, you can’t get a blood sugar up no matter the quantity of sugar you force your child to eat or drink- try a mini-glucagon. Especially if it’s the middle of the night. As camp medical staff I got a taste of being on the other side of lows that won’t come up and I can’t tell you how overjoyed I was to discover mini-glucagon in those cases. It hasn’t failed at camp yet, I use them myself, I find otherwise they all end up expiring when they can be helpful even if you don’t have an emergency.  

NOTE: GLUCAGON, once mixed into solution, EXPIRES AFTER 27 hours. So sadly you have to waste the rest of the solution in most cases.

[nekojitachan]

Im sorry i feel like im bugging you with all these messages all the time, i know i suck. But please consider stuart meeting andrew in the Clouds universe 😍😍😍 omg he would flip, no one touches his nephew

Aww, never fear in that regard. :)

And here you go! Clouds universe, Andrew and Stuart meeting up! As previously stated, this is a fic I want to ‘flesh out’ more once RP is finished, so there will be more backfill on Neil and Andrew’s relationship at some point, but this will shed light on some things for people and yes, be that Stuart&Andrew interaction.

Just some vague past mention/rough summaries of Neil and Andrew’s childhoods (more Neil than Andrew).

*******

Andrew sipped his coffee while a middle-aged man in a plainblue sweatshirt and a cap pulled so far down his brow he kept having to tilthis head back to see shuffled back and forth in front of the counter while Neilfetched one of those parcels for himand nearly forgot to take his coffee with him. Andrew exchanged a look withhis… his boyfriend (that still took some getting used to), where Neil gave hima slight smile and a shrug before he resumed cleaning the counter.

Andrew worked a little more on yet another essay for his onehistory class while Neil dealt with two older ladies who had apparentlystumbled onto The Bolt-Hole in their wanderings that day and might becomeregulars judging from the pleased noises they made over their tea and desserts.Still, they weren’t too loud or bothersome and Andrew supposed the place neededcustomers other than him to keep up some air of legitimacy – that and theydidn’t stay too long.

Neil cleaned their table then came over to his with thatslight smile on his face and a new cup of mocha in his hands. “Almost finishedwith your homework?” he asked while he set the mug down by Andrew’s laptop andpicked up the empty one.

“Just another page, so I’ll be done by the time you closeup,” Andrew said, which made the smile strengthen. Giving in to impulse, hehooked a finger into one of the straps of Neil’s black apron and tugged himcloser. “Yes?”

“Yes,” Neil said without any hesitation as he leaned in alittle closer for a kiss that was little more than a press of lips, not whenthey were in a shop where anyone could walk in at a given moment.

Still, there was Neil inviting Andrew back to his apartment mostweekends and nights to sit and talk, to cook meals together (Andrew had workedin a restaurant in Charleston, Neil knew the basics after living alone) andventure out a little (Stirling for Andrew’s class, a couple of the local parksjust to walk around).

To slowly map out something between them, to deal with theirvarious issues; Neil accepted Andrew’s need for borders, for consent, in a waythat made Andrew wonder if he was real at times (and want to track down hisparents and everyone else who hurt him at others). It hadn’t gone far beyondkissing and his hands beneath Neil’s shirt yet, but it was enough to make himkeep bringing up the link about registering full time at the University ofManchester, just like Professor Anton had been arguing for him to do the lastcouple of months.

It wasn’t like Aaron didn’t have a life of his own now.

He’d gotten through half a page more (and Neil had droppedoff a brownie for him, complete with whipped cream and a wink) when his phonerang, which was a rare occurrence. He almost ignored it when he saw the callerbefore he figured he might as well get it over with. “Go away,” he told hiscousin.

“Aw come on, is that the way you greet someone you adore?”Neil wailed, ever the dramatic bastard.

“Yes, and I don’t adore you.”

“You know you do,” Nicky grumbled. “So… how are thingsgoing? I assume since you’re not coming for a visit that you and your sweetieare doing well?” He sounded hopeful for some reason, which Andrew toleratedsince he wasn’t whining about him coming to Cologne for a weekend anymore.

Andrew glanced over at Neil, who was busy mopping the floorin preparation of the coffee shop closing for the weekend; Neil seemed tonotice the attention and glanced up at him, his dark-dyed hair falling onto hisridiculously big eyes and a tentative smile on his face. “They’re going,” wasall he said as that damn fluttering sensation filled his chest.

“Andrew….” Nicky sounded exasperated for a moment and thenhe chuckled. “Okay, I’m going to take that as a ‘good’ because I know you. Am Iever going to get the chance to meet him? Erik and I can come visit for-“

“No.” Andrew didn’tmean for it to come out that harsh, enough for Neil to give him a worried lookor for Nicky to go silent on the other end. “I… let me talk to him,” he said ashe fumbled for his cigarettes, well aware of everything Nicky had done for him– him and Aaron. “Don’t pull your surprise shit, okay?” He didn’t want Nickyand Erik to just show up out of the blue and freak Neil out, especially withhow extreme Nicky could be.

“All right.” Nicky sounded happy again. “I promise, no ninjaattacks on you and your sweetie! Just let us know when we can finally meet thisprecious unicorn who-“

“Nicky, shut up,” Andrew told his cousin. “And don’t ever call him that again – any of those things. Now leave me alone,I’m busy.” He hung up and put his phone on silent.

Neil was quiet until he came over to Andrew’s table. “Whatdoes Nicky want?” He’d heard Andrew’s story about his cousin, about Nickystepping in to keep him and Aaron out of Luther’s hands, about what Nicky’sfather had done to him and how Nicky now lived in Germany with Erik.

“To meet you,” Andrew admitted, curious to see how Neilwould react to that. “I told him I’d talk to you first.” They’d only been… whatever was between them, it had onlybeen a few weeks.

“Oh.” Neil chewed on his bottom lip for a moment while he heldon to the mop with both hands then shrugged. “It would be nice? I mean, to meetsomeone related to you who’s talkative?” There was a hint of a smile on hislips as he resumed cleaning the floor. “What a concept.”

“No tip for you,” Andrew called out as he felt an oddtension leave him which he hadn’t realized had been there until Neil hadanswered about Nicky.

“I’m heartbroken. Finish your essay so we can head to theArt Gallery once I close up.”

Andrew pretended to flick ash on the clean floor and got arude gesture in return, then focused on finishing his essay; their plans thatafternoon were to drop his things at Neil’s apartment and feed Pita, then hitthe Manchester Art Gallery for a couple of hours and pick up something to eatbefore returning to the apartment.

He’d never thought he’d look forward to sleeping on a couchand dealing with a possessive demon of a cat, but such things happened when animpossible pipedream of a young man stumbled into one’s life, he supposed. Animprobable, gorgeous young man busy boxing up some brownies and chocolate cakeAndrew liked so he could enjoy them later that weekend.

Perhaps this was all one big joke on his part, one big ‘fuckyou’ where he ended up with hyperglycemia and thirty pounds heavier when hereturned to the States, along with irrefutable proof that he was meant to bealone for the rest of his life.

“Uhm, did you want the torte as well? I know you like it butyou keep complaining about having to work out because of your trousers beingtight.”

Then Neil did that thing where he seemed to read Andrew’smind and Andrew pulled up the damn link again, along with Anton’s office hours….

“No torte,” Andrew told him as he drafted an email to Antonabout meeting on Tuesday.

“Okay.”

Andrew hit ‘send’ before he could second-guess himself then shutdown his laptop so he could pack everything into his backpack; Bren should bethere soon to take them to Neil’s apartment. Everything was put away and he wasdebating another cigarette when the door opened to admit Neil’s chauffer/minder…along with an older man whom Andrew had never seen.

Bren didn’t appear happy for some reason, which immediatelyput Andrew on edge, while the stranger appeared in a bad mood. Yet Neil smiledas he came around the counter, hands busy pulling off his apron. “Uncle Stuart!You didn’t tell me you’d be in town.”

So that was Neil’s ‘Uncle Stuart’ – a middle-aged man just alittle taller than Neil with a slender build as well (though more compact thanleggy runner), pale grey eyes and blond hair touched with grey. Andrew caught asimilar feature here and there – the full bottom lips, the straight eyebrows,the long, slender fingers – but the main resemblance was the lack of height, leanness…and keen intelligence, judging from how ‘Stuart’ kept glancing around in-betweenstudying Neil.

“Had some business in the area so I figured I’d stop by tocheck in on you, kiddo,” he said as he gave his nephew a hug; Neil hesitatedonly a moment in returning it, but Andrew had the impression that it was more acase of his friend being unused to such gestures and not that Stuart botheredhim. “I hear you’re doing a good job and the classes are going well.”

“I’m trying,” Neil said as he hung his head, never one toput himself forward; something seemed to occur to him as he glanced around thequiet coffee shop. “Uhm… do you want something? I can-“

“I’m just stopping by, but you can run to the store and fetchme some smokes, yeah?” He held out a folded bill to Neil. “You know what brand.Bren will go with you.”

Andrew had a feeling he knew why Neil’s uncle had decided to‘stop by’, which was soon confirmed. “Ah, okay.” Neil looked over his uncle’sshoulder at Andrew. “We’ll be right-“

“Just you and Bren,”Stuart insisted. “Me and your friend will wait here.”

Neil was quiet at that while Bren shifted back and forth inobvious discomfort. “Uncle… I don’t… that’s-“

Stuart shoved the money at Neil and clicked his tongue. “He’llbe fine, I promise. Go get the smokes and come right back, Bren tells me youhave a date tonight.” His face twisted at the last two words as if he foundthem distasteful to say.

Neil studied his uncle for a couple of seconds before hesighed. “You promise, right?”

“Yes.” Stuart glanced upward as if beseeching patience for amoment before his expression softened. “I won’t do too much damage.”

“Okay, that’s not helping,” Bren said in a rush as hemotioned for Neil to join him. “He’s just gonna talk, all right? It’s a talk thing, so let’s get going.”

Neil didn’t appear convinced by the two men as he glanced atAndrew again, who gave him a slight nod to show that it was okay; only then didhe pocket the money and leave the shop with Bren. As soon his friend(boyfriend) was gone, Andrew shook out a cigarette and lit it while he stareddown Stuart Hatford.

The man didn’t look all that impressed as he leaned againstthe counter with his arms folded over his chest, dressed in an expensive greysuit as if he was some legitimate businessman. “Andrew Minyard, twenty-oneyears old, criminology major. Born in California and put into the childcaresystem by one Tilda Minyard, nee Hemmick. You bounced around various fosterhomes until you were thirteen and spent three years in juvie for destruction ofproperty and petty larceny, until remanded into your mother’s custody in SouthCarolina.” Stuart didn’t sound pleased as he recounted the ‘highlights’ ofAndrew’s life, his expression flat and eyes sharp as if he waited to provokesome sort of reaction. “When she died less than a year later in a car crash youmanaged to survive, your cousin Nicholas Hemmick assumed custody. Then you and yourtwin brother got scholarships to Palmetto State University, and you end uphere, in Manchester, for a year studying abroad. You, a troublemaker with apast and nothing to your name, end up here,dating my nephew. I’m not happy about that.”

Andrew flicked ash into the small tray on the table. “Really?I couldn’t tell, not when you show up and chase Neil away to talk to me, do thewhole ‘I looked into you’ spiel and everything. What’s next? Threaten to breakmy kneecaps if I don’t leave him alone?” How terribly cliché.

Stuart stared at him for a couple of seconds then snorted ashe pulled out a pack of cigarettes of his own – a full pack, Andrew noted. “Okay,you don’t scare easily. Bren did try to tell me that about you.”

How nice to know; Andrew thought that he got along with thebodyguard and that there weren’t any problems between them. “No, I don’t, especiallynot over anything ridiculous like this.” There was nothing in his past thatStuart could throw at him to scare him off – he’d lived through it after all, bore its scars and dealt with itsnightmares all of the time.

“Ridiculous?” Stuart pushed away from the counter andglared. “This isn’t a joke, you little prick. Has Abr- has Neil said anythingabout his mother to you?”

“Yes, he has,” Andrew gritted out as he smashed his cigaretteinto the tray while a rare spark of anger burned in his chest; he’d caught thestart of Neil’s middle name, the name he’d confessed to Andrew just a week agoas they’d lay on his bed. It had been late at night and Andrew hadn’t wanted togo lie down alone on the couch nor had Neil wanted him to leave just yet, andthey’d been talking about random things that had entered their heads (had triedto find something not too painful for once). Neil told him about how his motherwould call him ‘Abram’, the one constant name among all the aliases, the middlename she’d given him, the name she(and he) didn’t hate.

But Andrew didn’t reveal that he knew about it, didn’tbetray Neil’s trust just because his uncle was being an asshole. “I know shemarried an abusive bastard and ran away with Neil because he was beating theshit out of both of them, and you’re helping him now that she’s dead.” Therewas more to it than that, bits and pieces Neil revealed in trickles as theygrew closer, as the trust strengthened between then, but again, Andrew wasn’tgoing to say anything more just because Neil’s uncle was being overprotectivefor no good reason.

Still, he could tell it was more than Stuart had expected. “Thenyou should realize he doesn’t need some punk in his life who’s just looking fora pretty face to enjoy while he’s overseas for a few months.”

Andrew found himself on his feet before he realized that heintended to move and had to force himself to keep his palms flat on the table;he knew that Bren was armed and he was willing to bet that Stuart was, too, andthat Neil would be more than upset if he came back and found his unclebleeding. “If you think Neil would allow himself to be used like that, you’re afucking imbecile and have no clue at all about your nephew.”

Stuart had twitched at his sudden movement and dropped hisarms to his sides, his gaze intent as he watched Andrew. “What, nothing to sayfor yourself?”

“Why? You’re not going to believe a word I say,” Andrewargued. “You don’t know me, but you should damn well know Neil.”

“Huhn.” Stuart went to drop the cigarette held between hisright fingers then seemed to think better of it; he inhaled deeply from it whilehe regarded Andrew for several seconds. “I don’t like you.”

“I don’t care.”

Stuart’s eyes narrowed at that. “I’m not going to let anyonehurt Neil, including some Yank who’s just fooling around with him to pass thetime. If you do more than that? Broken kneecaps will be the least of yourtroubles.”

Andrew put his cigarettes away while he held the bastard’sgaze. “Get used to me, I’m not going anywhere.”

“Right, you’re headed back to the States in June,” Stuartsaid with a smile. “About two months now. Such a shame to see you go.”

All Andrew did was stare back until Stuart’s expression grewuncertain. It was quiet between them for over a minute. “I’m serious, if youhurt him, I will hurt you,” Stuart said in a low, menacingmanner.

Andrew continued to gaze back at him without any concern.

Stuart had taken to muttering beneath his breath (somethingabout cocky Yanks) when Neil and Bren (the latter panting as if he’d been forcedto run) burst into the shop. “I got them!” Neil waved the pack of cigarettes inthe air as he glanced around, his dark eyes quick to latch on to Andrew. Hisshoulders slumped in relief and he all but threw the cigarettes at his uncle. “Uhm…everything all right?”

Stuart grunted as he caught the flimsy excuse to get hisnephew out of the coffee shop for the damn shovel talk, or whatever the hell ithad been. “Yeah, thanks.” He shoved the pack into the left pocket of his coatand reached out to tousle Neil’s disheveled hair. “I better get going, but I’llbe back this way on Monday. How about dinner then?”

“All right,” Neil agreed, probably because Andrew was busywith stuff on campus that night. “Let me know when you’ll be by.”

“I’ll do that.” Stuart nodded to a still flushed Bren on hisway out and ignored Andrew, which was fine. As soon as he was gone, Neilhurried over to Andrew’s side.

“Are you all okay? What did he do? Nothing bad, right?” The wordscame out in a rush and Neil’s hands flitted through the air as if he wanted totouch Andrew in reassurance but wouldn’t.

“I’m fine,” Andrew reassured his boyfriend (still weird),reaching out to slide his right hand around the back of Neil’s neck to settlehim. “In a rather fucked up way, he’s just looking out for you.”

“By talking to you alone?” Neil appeared confused by that,but then again, he hadn’t been involved with anyone before Andrew so there’dbeen no need for Stuart to do his ‘don’t hurt my nephew’ routine before, hadthere? “All right.”

“Ah, he’s just… uhm, making sure Andrew’s on the up and up,”Bren said as he wiped at his sweaty brow. “I’ll go turn off everything in theback, okay?”

“Okay.” Neil frowned at his friend’s departing back beforehe looked at Andrew. “Why would Stuart do that? I’m the one going out with you and I don’t have a problem withthings.”

Andrew tugged Neil a little closer. “He’s watching out for you,or thinks that he’s watching out for you.”

Neil’s brows drew together for a moment and then he smiled. “Oh,like-“ He seemed to catch himself, leaving Andrew to wonder what he’d beenabout to say. “He doesn’t have to worry, not about you.”

“You sound so certain.” Andrew wasn’t sure he liked that; hehad no intention of hurting Neil, in playing him false, but there were no surethings in life. He wasn’t used to people thinking that he was a sure thing in life.

Once again he was graced with a shy, sweet smile which madehis heart do ridiculous things. “About you? Yes.”

“Don’t be an idiot,” Andrew muttered, yet he tugged Neileven closer and felt his traitorous heart race when the fool murmured ‘yes’ tohim before their lips met.

He hoped that Bren took his time turning off the lights.

*******

I think that’s it for the prompts tonight, things got busy this weekend. But RP22 should be out next Sunday!

Buy me a coffee

[brucebaxter]

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[ezatluba]

How Super Sniffer Dogs Are Helping Detect Disease Around The World

January 25, 2020

JOHN HENNING SCHUMANN

Dogs' olfactory capacity — they can sniff in parts per trillion — primes them to detect disease.

As the owner of a yellow lab named Gus, author Maria Goodavage has had many occasions to bathe her pooch when he rolls around in smelly muck at the park.

Nevertheless, her appreciation for his keen sense of smell has inspired her write best-selling books about dogs with special assignments in the military and the U.S. Secret Service.

Her latest, Doctor Dogs: How Our Best Friends Are Becoming Our Best Medicine, highlights a vast array of special medical tasks that dogs can perform — from the laboratory to the bedside, and everywhere else a dog can tag along and sniff.

Canines' incredible olfactory capacity — they can sniff in parts per trillion — primes them to detect disease, and their genius for observing our behavior helps them guide us physically and emotionally.

Goodavage spoke with NPR contributor John Henning Schumann, a doctor and host of Public Radio Tulsa's #MedicalMonday about what she has learned about dogs in medicine

This interview has been edited for clarity and length.

What led you to look into dogs in medicine?

I've been reading and writing about military dogs and Secret Service dogs for many years now, and it was sort of a natural next step. These are dogs on the cutting edge of medicine. They're either working in research or right beside someone to save their life every day. And really, doctor dogs are, for the most part, using their incredible sense of smell to detect diseases. And if they're paired with a person, they bond with that person to tell them something that will save their life.

By subscribing, you agree to NPR's terms of use and privacy policy. NPR may share your name and email address with your NPR station. See Details. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Serviceapply.

You reported on dogs doing this kind of work all over the world.

Yes, I did go around the world. The first doctor dogs I learned about were in Japan. There's a village about five hours north of Tokyo where scientists were doing some research among a population that has a very high level of stomach cancer. And I wanted to find the best of the best, cutting-edge medical dogs around the world. It was really fun to see these service and research dogs working with their people and how good they are. They're incredibly good at detecting disease.

You also report on dogs that can detect ovarian cancer, which is personal for you.

I do have skin in this game, actually, because unfortunately, we have ovarian cancer in the family. My mom died of it.

With ovarian cancer, there's not much great testing for early detection. I heard about these dogs at the University of Pennsylvania Veterinary Working Dog Center that are able to smell ovarian cancer. They're able to detect it as early as stage one. We're not even talking tumors here. They're able to detect ovarian cancer in one drop of plasma from a woman with ovarian cancer.

The fact that the dogs can do this is exciting to me, and I think for so many people who have hard-to-detect cancers in the family.

What the dogs are doing now is remarkable and it's because their sense of smell is so keen. They can sniff in parts per trillion. They can detect a tablespoon of a substance, like a packet of sugar, in two Olympic-sized swimming pools. Humans have six million olfactory receptors and dogs have up to 300 million. So their noses are really primed.

Another area in which dogs excel in the clinical world is for patients with diabetes.

Yeah. It's amazing. We don't know what the dogs are smelling, but the trainers are training the dogs on the scent of hypoglycemia and also hyperglycemia. The dogs are somehow able to put it together and tell the person 15 or maybe 20 minutes before the person's devices even say, 'Hey, you're going into the low range!' because the dogs detect this in real time. So the person has an extra bit of time to do what they need to do, take glucose or whatever.

I was fascinated to learn that doctor dogs may also have a role in detecting so-called "superbugs," that is, antibiotic-resistant microbes.

Yes. Actually, there are three or four of these dogs working in a hospital in Vancouver who are sniffing out C. diff, which is one of those superbugs that can easily spread in vulnerable populations in hospitals and manifests in diarrhea and all kinds of issues that can actually kill people. And these dogs are stopping it in its tracks. Researchers have found that where these dogs work, the rates of C. diff really diminish. I hung out at this hospital one day and I just watched one of the dogs do his rounds, and he found what seemed to be C. diff -- and before I knew it, they had a whole cleaning team.

How do dogs help people suffering from PTSD?

There are people from the military, war veterans and active duty soldiers even who are suffering from PTSD and who have gotten service dogs who, again, have been game changers. They save lives.

One of the dogs I learned about was placed with a soldier who had been to Iraq twice. He had PTSD and his life was falling apart. His marriage, his health, everything. He was on a cocktail of drugs. It made him a zombie. He hated that feeling. And one day someone told him about doctor dogs for PTSD.

He ended up getting one. Now if he's feeling anxious, he'll say, like, "snuggle" and the dog will just come in for a big hug, or another of various commands. His life changed dramatically for the better. His marriage is really good now. He's a stable dad and he's working. He's down to only one or two meds.

You write about doctor dogs helping people with autism. Can you share an example?

Yeah, it's really beautiful. Sometimes these dogs may be using their nose. Sometimes they're just being highly observant. And dogs are. They watch our body language all the time. But there are now more dogs being used for children on the autism spectrum, and they are remarkable. They can usually tell ahead of time when a child is about to have a tremendous amount of anxiety, panic, meltdown or what have you. When there's too much stimulation for a child with autism and the dog is there, they'll lean into the child.

Dogs change lives not just of these children, but of the whole family.

There is a family I wrote about in Minnesota, with a sweet boy who waited for four years to get a service dog for his autism. He was not able to go to restaurants. The family, therefore, couldn't go to restaurants. He couldn't travel. He could barely leave the house. He did go to school, but that was tough, too. And so they waited four years. They tried to get a regular pet dog in the meantime, thinking, "Oh well, you know, it's a dog. It'll work." But it was a disaster. It did not work at all as a service dog.

So they got a service dog named Lloyd. He's a big black lab. As the boy met him, he started crying. His mother had never seen him cry. Tears of joy.

And right there, boom, everything changed. Lloyd is the super calming presence. He's able to be with the boy and change his behavior. The boy could not go to the barber and get a haircut before Lloyd. Now all he has to do is just have his hand on Lloyd's head.

And the boy and Lloyd like to have their own table at restaurants!

[nefarioussdotcom-blog]

7 Signs You Have a Hormonal Imbalance

Hormones are the most potent chemical messengers in our bodies, telling your body what to do and when. That’s why when your hormones are out of balance, you may be able to feel the effects, whether it be via insomnia, fatigue, weight gain, hair loss, or mood swings. But usually these imbalances are reversible—learn how to balance hormones naturally and turn your hormonal imbalance around.

Produced by our endocrine glands—adrenals, thyroid, pancreas, female or male reproductive system—hormones perform essential functions, relay important warnings and communicate messages throughout the body.

That means, they make sure everything is running smoothly and that your rhythms stay in sync.

Hormones can impact your:

Appetite

Metabolism

Heart rate

Sleep patterns

Reproduction

Mood

Many things can challenge your endocrine system, disrupting hormone balance and function. The longer a system is “out of order” the more difficult it can be to bring it back into harmony. Identifying and correcting the causes of hormonal imbalance early on will help maintain your health and prevent the onset of chronic disease.

Potential causes of a hormonal imbalance:

Underactive thyroid (hypothyroidism)

Overactive thyroid (hyperthyroidism)

Chronic stress

Diabetes

Birth control or hormonal replacement

Poor diet

Cushing syndrome

Exposure to endocrine disruptors

So how do you know if you have a hormone imbalance? Find out the signs of hormonal imbalance to look out for, and natural remedies for hormonal imbalance that can help.

Fatigue, weight gain, insomnia, PMS, or PCOS? We treat the root cause of hormonal imbalance so you can get back to feeling like yourself again.  Check out www.nefariouss.com - Nutrition.  All our listed products, help battle these issues.

7 signs and symptoms of hormonal imbalances

These seven major symptoms can help you determine if you have a hormonal imbalance.

1. Fatigue

Everyone is tired sometimes. But you should recover with adequate rest, hydration, and a healthy diet. If you feel you are taking care of yourself but are still exhausted or just can’t seem to get back to your best, consider having a comprehensive evaluation of your hormone levels. Adrenal fatigue and hypothyroidism are more prevalent in our high-paced society than you may think and a hormonal imbalance test can help diagnose this.

2. Anxiety

Nope, it’s not all in your head. Nearly 18 percent of Americans suffer from an anxiety-related disorder and 7 percent from a major depressive disorder each year. Women may be at a higher risk because changes in estrogen during menstrual cycles, pregnancy, or menopause are associated with worsening depression. A study on the effect of estrogen receptors in the brain found that estrogen calms the fear response and anxiety in both humans and rodents. Higher levels of estrogen were correlated less fearful responses when stimulated by fear-inducing scenarios. Men with low levels of testosterone are more prone to developing anxiety or major depressive discover when compared to those with normal levels.

3. Weight gain or difficulty losing weight

Why do so many people struggle with weight loss and maintenance? Usually, it’s because they are eating too little and working too hard. The body processes this hard work as stress and when the body is stressed, it goes into survival or “fight or flight” mode, producing cortisol. When you’re chronically stressed, your cortisol is always high and in an effort to protect itself from whatever danger it senses, your body holds onto fat as a form of energy.

4. Trouble sleeping

Insomnia can be linked to a dysregulated hypothalamic pituitary adrenal (HPA) axis, which is your central stress response system, where your endocrine system and central nervous system interact. It’s also responsible for regulating the sleep-wake cycle through the release of hormones, such as melatonin and cortisol. Melatonin works on the part of the brain that controls our circadian rhythm, allowing us to fall asleep faster and stay asleep longer. An inability to secrete melatonin may result in difficulty falling asleep or adjusting to a new sleep pattern. Similarly, when your cortisol levels are too high in the evening, you may have trouble falling asleep and feel wired but tired in the evening.

40 percent of women going through perimenopause, the phase in which your body is nearing menopause, also report sleep disturbances, such as waking up in the middle of the night with chills and drenched in sweat.

5. Digestive issues

There are more neurotransmitters in the gut than there are in the brain, so it should be no surprise that anxiety and depression are sometimes accompanied by digestive symptoms. Hormones influence gut function through the microbiome and bacterial system in our intestines, so a hormone imbalance can impact the population and function of the bacteria in your gut, leading to symptoms like bloating, diarrhea, or nausea.

6. Skin and hair changes

Acne. A sudden increase in acne is one easy way to identify a possible hormonal imbalance. One of the few hormones involved is androgens. Androgens, typically referred to as “male hormones,” but found in both males and females, regulate your skin’s sebum production., If your body produces androgens in excess, sebum can build up in your pores and cause a pimple to surface.

Hair loss. The quality and vitality of your hair is also directly related to your hormones. Thyroid abnormalities, for example, may cause dry hair or skin, thinning hair, or brittle nails. Hypothyroidism, hyperthyroidism, and parathyroid disorder can also cause hair loss.

7.  PMS and low sex drive

Low testosterone, estrogen, and progesterone are all associated with a decreased sex drive in both men and women. This is especially common after age 50 when estrogen and testosterone production declines. Since estrogen is one of the main hormones regulating a woman’s menstrual cycle a decrease in production can also lead to irregular periods that are too long, too short, unpredictable, heavy, or painful, infertility, hot flashes, mood swings, or painful intercourse.

At Parsley Health, we work with our members who have hormone imbalances to naturally bring their hormones back into balance without the need for hormonal replacement medications. These are some of our tried and true strategies.

5 ways to balance your hormones naturally

1. Incorporate healthy fats into your diet.

Adding healthy polyunsaturated fats to your diet, such as omega-3 and omega-6 may help reduce your appetite and decrease your risk of obesity. Fatty acids signal the production of leptin, a hormone that reduces appetite by suppressing the area of the brain that controls our appetite and signals to us it’s time to eat. Without adequate healthy fats in your diet, you’re more likely to have low leptin levels, which can induce overeating and an inability to feel satiated. That may be one reason women have been experimenting with seed cycling for hormone balance.

2. Try adaptogenic herbs.

Next time you grab a coffee or matcha try adding in some adaptogenic herbs. Adaptogens have been shown to decrease levels of cortisol, a stress hormone secreted from our glands when we experience stress. Certain adaptogens can help regulate the hypothalamic-pituitary adrenal (HPA) axis which controls cortisol levels. Lowering your cortisol levels can help hormonal imbalance symptoms, such as fatigue or sleep issues. Consistently high levels of cortisol not only impact bodily functions associated with hormones, but can feed the beginnings of hyperglycemia and suppress immune and inflammatory responses. In a study looking at the impact of adaptogens on the central nervous system, Adapt 232/Chisan (a combination of Rhodiola rosea, Schisandra chinensis and Eleutherococcus senticosus extracts) was found to decrease cortisol levels and activate the body’s self defense mechanism in response to stress. Adaptogens that aid adrenal function include ashwagandha, ginseng, jiaogulan, Chinese licorice, reishi, and Rhodiola rosea.

3. Take a high-quality probiotic and incorporate fermented foods.

Taking a probiotic can help balance your gut microbiome and the amount of “good” versus “bad” bacteria that lives in your system. The greater the “good” bacteria, the easier it is on your digestive system to process food. Research has shown that estrogen-related imbalances might be able to be reversed with probiotic supplementation by restoring the set of bacteria known as estrobolome, which is responsible for metabolizing estrogen. Probiotics can also lessen the impact chronic stressors may have on the hypothalamic pituitary axis (our stress response system), which is why probiotics are starting to be considered a form of treatment for those dealing with depression and anxiety. Fermented foods, which also contain live bacteria, can also aid in the regulation of gut bacteria.

4. Supplement with Vitamin D.

A Vitamin D deficiency is more common than you may think, with over a billion people worldwide suffering from either a deficient or insufficient supply of this critical vitamin. Vitamin D plays an extremely important role in a number of bodily functions, such as immune function, cell differentiation, and inflammatory response. Low levels of Vitamin D have been associated with an increased risk in colon, prostate, and breast cancer, as well as tuberculosis, influenza, and heart disease. A relationship has also been found between hypothyroidism and a vitamin D deficiency.

Ideally, we would get our daily dose of Vitamin D from 10 to 30 minutes of uninterrupted sun exposure, but this is unrealistic for most, that’s why it’s important to take a Vitamin D3 supplement and eat foods rich in Vitamin D, such as eggs and salmon. It’s also important to note that as we age, our production of Vitamin D decreases, so make sure you’re monitoring your levels and getting them checked by your primary care provider.

5. Biohack your way to better sleep.

When life is busy, often the first thing we sacrifice is sleep. Sleep or rather inadequate sleep quickly throws our body off balance. This is why it’s one of the first things our doctors ask about when patients come in for their initial visit. In a small study testing the impact of prolonged sleep restriction, participants that slept only 4 hours versus 10 or 12 hours experienced an increase in ghrelin, a hormone responsible for appetite regulation, alongside a decrease in leptin, a hormone responsible for communicating satiation. For many of us, 10 or 12 hours might be hard to achieve. That’s why here at Parsley we recommend getting at least 8 hours of sleep per night. The benefits of adequate sleep will not only increase your glucose metabolism and leptin concentrations but increase your body’s secretion of growth hormones responsible for cell reproduction and regeneration, which all take place during periods of rest.

Final thoughts on hormonal imbalances.

Some of the most common symptoms of hormone imbalances include unexplained weight gain, fatigue, insomnia, and changes in hair, skin, and nails.

Root causes of hormonal imbalances include compromised gut health, high inflammation, and high stress levels.

Natural ways to balance your hormones include eating anti-inflammatory polyunsaturated fats, getting adequate sleep, and using supplements to fill in any nutritional gaps related to gut health and vitamin D levels.

[dispulsion]

Lose Weight with Green Tea! Green Tea 101

Opportunely, tea will be able to help you heal canker sores quickly. It's tempting to think that green tea can function as a protector against cancer, no matter how the studies are mixed. Green tea includes a fair price tag. It has started to make a buzz in the market. While drinking green tea is deemed safe ad natural, it is necessary to take products produced from the herbal extract below the physician's supervision or with care, because like everything else it can generate side results. Any sort of tea on an empty stomach can cause you to feel sick. For many decades green tea was used as traditional medication. It is rich in catechin polyphenols. It can help to get rid of a cold sore with its antiviral benefits. It has become quite a popular beverage in the western world in recent years. Green tea along with almost 6000 other substances comprises the natural pharmacy of conventional Chinese herbal medication. There are many kinds of tea. Some web sites on the Internet claim that it is very high in fluoride content. Additionally, green tea seems to lower overall cholesterol levels, helping reduce one's risk of developing cardiovascular disease. It works effectively in reducing stress and depression. Currently, green teas are commonly sold in numerous distinct forms. It is more widely studied and there is a lot of data out there supporting the benefits of green tea. The main reason why folks are replacing their daily green teas with the match isn't just the wellness benefits. Tea can be consumed in a number of ways. In general, it is a drink that is good for you. While it's the case that green or organic teas are good for weight reduction, you have to be quite careful about the grade of the item you're using. Green tea can apparently also assist you with wrinkles and the symptoms of aging. It is universally referred to as the very best and perfect weight loss tea. It has been called the second-most consumed beverage in the world, behind water. Needless to say, you may be wondering how much green tea has to be consumed in order to have a positive effect on health.

Image Credit Here Green tea is very helpful with intestinal disorders and higher blood pressure. It has also been linked to an increase in the number of calories burned. On the whole, it contains an abundance of antioxidants and vitamins but it's EGCG that has the potential to make great medical breakthroughs. You ought to search for green tea in bags or loose that it is possible to brew at home. For the last 3000 decades, Green tea was part of ancient Indian and Chinese culture. In the end, it delivers the best stress nutrition out there that comes from a natural source. Green tea has just garnered much attention for its capacity to stop disease and safeguard health. It can help your body achieve optimum health and longevity. It controls the postprandial hyperglycemia and reduces the risk of type 2 diabetes. Moreover, it is the best way to lose weight. It has the ability to help release toxins from your body.

Origin and its Types of Green Tea

In some specific cultures, the tea is provided different names based on the height from which it is poured. Furthermore, green tea, like all tea, provides liquid, which will help keep you hydrated, and offers an opportunity to stop in the center of the day and revel in a treat. Green tea and water are the very best kinds of drinks that don't influence the digestive system practice. In India, tea is just one of the most common hot 77beverages. As mentioned earlier, green tea is created from un-oxidized tea leaves, while black tea is completely oxidized. It contains b vitamins as well as tannins and folic acid. It is known as the healthiest form of tea due to its lack of processing, resulting in extremely high nutrient levels. It is one of the most popular varieties of tea in the United States, second only to black tea, which is made from the leaves of the same plant. Green loose tea is often flavored with jasmine whilst Sencha is just one of the most well-known selections of green tea in Europe due to its strong flavor. Harvested just as the plant awakens from winter dormancy, it's minimally processed so as to preserve its normal freshness. Plants are mowed employing the sickles that's a very tiring and tedious job. Moreover, the short plants bear more new shoots that offer new and tender leaves and boost the essence of the tea.

The Number One Question You Must Ask for Green Tea Menu

Real, fresh-squeezed lime complemented with the ideal quantity of cherry sweetness. For different moments during the day, we've developed signature tea blends. Following this re-drying procedure, each crude tea is going to be sifted and graded according to size. Green tea was demonstrated to enhance the flow of blood and lower cholesterol. Having said this, it's important to get an alternate energy drink, like Sonic, that offers many of exactly the same energy benefits without all the side effects to go with this. If you're sensitive to caffeine it's also wise to be mindful when consuming this solution and is encouraged to talk to a physician should you have any significant concerns.

Top Green Tea Brands and Other Green Tea Products:

Green tea is the greatest ayurvedic weight-loss product in India. It is high in caffeine to increase the rate of metabolism and provide extra energy throughout the day. It has been used in many old cultures as medicine and is slowly gaining the attention of the commercial market. Checking where your green tea has arrived from is vital, the very best ones are going to be from Japan or China originally. Budwhite green tea and Tetli green tea is a well-known brand on earth. Tea is among the ancient drink that was an accidental discovery turned in to a whole degree of business. It is also known as the elixir for some people and the amount of tea consumed every day is enormous. The tea provided by Tetley is full of oxidants and is quite helpful for health. Pros Cons Tetley Green Tea is a brand that's known as one of the greatest ones on the planet. The brand is quite old and it's still powerful and satisfactory in its expert services. So, you should know the most effective green tea brands 2019 so that making an appropriate option for you becomes easy. So now the big question is which is the greatest green tea brand readily available on the market amongst the abundance of options. Some of the best and most used Green Tea brand in the United States and Worldwide are:- Kirkland Green Tea

Tea! This can be Japanese green tea. It may state"Kirkland" on the box, however, it's actually Ito En tea (that can be printed on each package ), a renowned Japanese tea firm. I have tried plenty of teas, which is undoubtedly my favorite green tea (and my favorite tea, span ). It's a sleek, and flavor also it is not bitter in any way, even in the event that you allow it to over steep. Folks will not have to include sweetener or lemon to appreciate it. Kirkland Signature Green Tea Matcha Blend Japanese Tea Leaves Bags is created with Sencha Green Tea in the lush green plantations of Japan. This tea is steamed, rolled, then dried in keeping with tradition. This processing keeps the freshness, odor, and color of the tea leaf and sops the chemical. Matcha a green tea powder produced from leaves that were chosen is inserted to boost flavor and flavor. Our superior nylon bag allows throughout the brewing procedure for water flow. Stone from the cool, humid location. Watch box that is interior to get a tea recipe that is chilly. You can also visit Costco.com or search for the string Costco green tea in google or bing search bar and the first result you will get is the Kirkland green tea. Pure Leaf Green Tea Pure Leaf Green Tea Company Said about its product, “ Sip about green tea's crisp taste. Brewed using leaves bottled and chosen without adding shade sugar. It is a taste, just like you want in your home-brewed.”

This is a review of the Pure Leaf Unsweetened Green Tea. I love black iced tea but green is healthier and I wanted a change of pace. This tea is light and crisp. It has a different flavor than I am used to but it is really refreshing. I add a bit of sugar or Stevia and it hits the spot. The bottles are just enough to quench my thirst with no waste. I will repurchase this green tea again. The only better is home-brewed green iced tea but I would much rather pay for it already bottled and done for me. love that the bottles are plastic as well. No fear of broken glass if I drop a bottle and they are recyclable. By: Petty (https://www.amazon.com/gp/customer-reviews/R1WM5MWPVLITHJ/ref=cm_cr_srp_d_rvw_ttl?ie=UTF8&ASIN=B01AT3DRU2) Tazo Green Tea

Tazo green tea or we can say Tazo Zen Green Tea. It’s a product by Unilever, having very good sales and user reviews in the US, Uk, Canada, Australia, India and Internationally Worldwide. As the company said about the product, You do not need to take up at a monastery to gain from our green tea mix infused with notes of verbena, lemongrass, and spearmint. But we suggest hiking into a mountaintop refuge at least that the views are magnificent. But, no doubt that Tazo green tea is one of the best Green Tea available in the market.

Some of the Famous and Widely use Green Tea based Products:

Some of the other plenty of products of green tea, which are not apparent in the traditional form of it is:- Green Tea Shots The drink is sufficiently strong to secure you in the appropriate mood yet gentle such that you're able to knock back a few before you begin to feel the effects. If you're also searching for new drinks and beverages to try all of the moment, you have to have heard about the green tea shot also. You may time a shot prior to a workout or drink one if you are in need of a brain boost for work. There's been some proof that green tea shots can be useful in protecting the liver which, subsequently, ensures better health all around. A normal green tea energy shot comprises green tea extracts, along with beneficial antioxidants. If you've had a green tea shot, then you understand how great it is. Maybe once you hear Green tea shot you believe this is an all-natural green tea drink. A green tea shot is a terrific coffee substitute. It is also a very versatile option if you're looking to scale up your drink recipes. It carries a good amount of l-theanine which is good to fight against anxiety and high blood pressure. The key to making the ideal green tea shot is in the proportion of alcohol... >> Read More >> Read the full article

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The Gut: A Key to the Pathogenesis of Type 2-Diabetes?

Authored by  Holst JJ

Mini Review

The gastrointestinal tract plays a predominant role in the regulation of the postprandial plasma glucose levels [1]. The first regulating factor is the gastric antral motility which, by incompletely elucidated neuroendocrine mechanisms, regulates the rate of emptying and hence exposure of chyme to the small intestine. Thus, it is a main function of the stomach to receive and retain the incoming meal, and eventually to expel the triturated, emulsified and partly digested contents, the chyme, at a slow and surprisingly constant at a rate of maximally 4Kcal per minute. The duration of gastric emptying thereby becomes regulated by the energy content of the ingested meal [2]. The exposure rate of the small intestine is similarly limited and relatively constant. If the regulatory mechanisms are interfered with [for instance with surgical procedures like pyloroplasty or gastric bypass) and the normal emptying rate is exceeded, a so-called "dumping syndrome" may be elicited.

This syndrome which includes nausea, malaise, desire to lie down, maybe fainting, is caused by the increased osmotic load presented to the small intestine which shifts fluid from the circulation to the intestinal lumen via the leaky epithelium in the proximal gut. The more or less constant emptying rate also means that the secretion and thereby the plasma concentration of some of the gut hormones, e.g. the insulin-stimulating hormone, glucose-dependent insulin tropic polypeptide [GIPJ which is dependent on the intestinal absorption rate of nutrients, quickly rises to a certain elevated level which is then maintained as long as there is emptying from the stomach, depending on the total amount of stimulatory nutrients that were present in the meal [and are being retained in the stomach) [2].

It is possible that hydrogen ions in the duodenum [released from the stomach) play a role in the regulation of the emptying rate, but nutrients in the duodenum may also inhibit the emptying rate by neuroendocrine mechanisms. The hormone, GIP, has little effect on gastric emptying, whereas the other incretin hormone, glucagon-like peptide-1 [GLP-1), the secretion of which follows a similar pattern, powerfully inhibits gastric emptying. There is no doubt that the regulation of gastric emptying plays a major role for the postprandial glucose responses, again as illustrated in conditions of accelerated emptying rates, where particularly the early postprandial glucose excursions may be dramatically increased [3]. The increased secretion of GIP and GLP-1 powerfully amplifies the glucose-induced insulin secretion, and thereby also the ability of the organism to limit and restore to normal the increased glucose concentrations-indeed postprandial reactive hypoglycemia [sometimes designated "late dumping") may ensue, and is relatively often observed in individuals with accelerated gastric emptying [4].

The amplifying effect of the gut hormones on the glucose- induced insulin secretion is designated the incretin effect, and this is responsible for the proportional increase in insulin secretion according to the ingested amount of glucose [and other meal components). The effects is small after small meals [small amount of glucose), but increases so that it may be responsible for up to 80% of the elimination of glucose from the circulation after larger meals [corresponding to 100g of glucose) [2,5]. By means of the regulation of gastric emptying and the incretin effect, it is ensured that post prandial glucose excursions are normally moderate and in fact independent of the ingested amount of calories [glucose) [1].

It is likely that these mechanisms are of major importance to prevent complications elicited by hyperglycemia. As mentioned these powerful mechanisms may also lead to severe postprandial reactive hypoglycemia [6]. The question then arises whether the same mechanisms play a role in the development of type 2diabetes mellitus [T2DM)? The gastric emptying rates in patients with T2DM show great variability and a consistent abnormality do not seem to prevail (although abnormalities may very well exist in selected groups).

The early response (0-60min) to ingestion of a mixed meal of the two hormones, GIP and GLP-1, does not seem to be importantly affected in patients with T2D, but GLP-1 secretion is more consistently impaired in the later phase (from 60 minutes and onwards) [7] and this may play a significant role. A similar impairment (and a similar impairment of the incretin effect, see below) is seen in obesity [8,9]. Probably it is of greater importance that the insulin tropic action of both hormones is also impaired. During the progressive development of glucose in tolerance, a gradual loss of the incretin effect, as well as the insulin tropic action of the two hormones are observed [10] and their effect is almost completely lost in full-blown diabetes as far as physiological amounts of the hormones are concerned [11].

However, in contrast to the almost complete loss of insulin tropic action of GIP, regardless of dose, suprahysiological concentrations of GLP-1 may still have considerable effect [12]. Evidently, the loss of the incretin effect is of major importance for the postprandial hyperglycemia of the patients with T2D and restoration of the incretin effect with GLP-1-receptoragonists provides part of the explanation for the antidiabetic effects of these agents. The GLP-1receptoragonistsalso powerfully inhibits the gastric emptying rate, at least acutely and this explains part of the effect on postprandial glycaemia of the short-acting GLP- 1-receptor agonists (eventide and lixisenatide).

Regarding the long-acting GLP-1-receptoragonists, tachyphylaxis rapidly develops regarding their effects on gastric emptying, while their incretin effect is preserved and when during meal intake the plasma glucose concentration rises, they will exert their incretin action, which at the cellular level in essence consists of potentiating of the glucose-induced insulin secretion [13,14]. There is, however, an additional factor which plays a rather important role: patients with T2DM typically have increased plasma concentrations of glucagon, both in the fasting state and postprandial [7].

There is a general misconception that meal intake should lead to inhibition of glucagon secretion; on the contrary, most meals, in particular protein rich meals, will stimulate glucagon secretion, but for patients with T2DM the increase is even larger Because glucagon stimulates the hepatic glucose production, this rise has considerable consequences for the postprandial glucose excursions, as illustrated in experiments with glucagon receptor antagonists, which effective lower both fasting and postprandial glucose levels [15]. But what is the explanation for the elevated postprandial levels of glucagon in the patients with T2DM? Several mechanisms have been proposed and they may all contribute. First of all, there are probably signals from the GI-tract.

Several hormones might be of importance, including GIP and GLP-2, which stimulate glucagon secretion and GLP-1, which inhibits secretion. Their combined influence was investigated in a systematic study where T2D patients received intravenous infusions of each of these hormones (mimicking their postprandial plasma profiles) superimposed on an intravenous glucose infusion mimicking the concentration curves resulting from an OGTT [16]. Individually, it turned out, each of the hormones had the mentioned, expected effects, but infused together the resulting glucagon secretion profile was very similar to that observed after oral glucose alone. Particularly GIP stimulated glucagon secretion. An increased activity of GIP might therefore contribute to the postprandial hyperglucagonemia in T2DM. This together with the loss of its insulin tropic effect in T2DM might therefore suggest that GIP actually has diabetogenic effects [17].

However, it is also possible that the postprandial hyperglucagonemia is derived not from the pancreas but from the GI-tract where some of the endocrine cells, under certain circumstances, which may include T2DM, may be able to produce glucagon. This is clearly seen in individuals after total pancreatectomies, who exhibit a large postprandial glucagon response after oral glucose [18]. It can actually be demonstrated that the response has important effects for hepatic glucose production.

Extra pancreatic glucagon may therefore contribute to the diabetic hyperglucagonemia. Furthermore, there is strong evidence from recent research that circulating amino acids play a predominant role in the regulation of glucagon secretion, and in view of this, it should always be suspected that altered amino acid levels underlie clinical hyperglucagonemia. The reverse also seems to be true: that the plasma level of glucagon plays a predominant role in the regulation of the plasma levels of the amino acids; thus conditions with hyper- and hypoglucagonaemiaare associated with low and high levels of plasma amino acids, respectively [19]. Indeed, amino acid metabolism and the glucagon-producing alpha cells in the pancreas seem to be coupled in a close, negative feed-back loop. Most recently we examined patients with varying degrees of nonalcoholic fatty lived disease and found a correlation between on one hand liver function and amino acid levels and on the other hand the plasma glucagon levels [20].

The hypothesis is that the steatosis impairs liver function which also comprises an impairment of the effects of glucagon on amino acid metabolism and urea genesis. As a consequence, plasma levels of amino acids rise, which in turn results in hyperglucagonemia. Because glucagon also influences glucose metabolism and hepatic glucose production, this will also result in glucose intolerance and increased postprandial glucose excursions. A lot of work still has to be done with respect to unravelling these associations but the recent application of glucagon receptor antagonists and the use of transgenic animals have greatly facilitated these studies in both people and experimental animals Figure 1 [21].

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[drewsdailydose]

Why I Quit The Keto Diet

I decided to try out the keto diet to see what all the hype was about. People claim it is the ultimate fat-loss diet, others say it can reverse type 2 diabetes. I had to put it to the test to see if it would help me manage my type 1 diabetes.

Before I start, I need to make something clear. I respect everyone trying to achieve optimal health. Whether you’re keto, high-carb or anything in between, the choice is yours. My only aim is to improve people’s lives. I feel a duty to share my experiences and highlight the scientific evidence out there supporting it because people need to be aware of the risks and benefits of any diet before getting into it. I’m not selling anything. I’m not promoting anything. I have no hidden agendas. I simply want to find the healthiest way to live which will allow people to feel happy and fulfilled.

My Keto Experience

The thing that makes this experiment so eye-opening is, as someone living with type 1 diabetes I get to see objective insights every day into my blood sugar levels and insulin requirements.

After two months on a ketogenic diet, I was very lean, fit, had great focus and concentration, could go long hours without eating, had flatline blood sugar levels, and achieved my lowest ever insulin requirements. At that point, it seemed like keto was indeed a magic bullet and I was a huge proponent of that way of eating. Fast forward another 2 months, everything took a turn for the worse. 

I noticed that every time I ate foods containing carbohydrates, my blood sugar went very high, and that frustrated me. I also noticed that my cholesterol went up to 6.4 mmol/L. Sure, I was very efficient at burning fat and ketones for energy but my tolerance for foods containing carbohydrate went down noticeably, even after exercise when I’m usually my most insulin sensitive. Not only could I no longer eat the smallest amount of carbs (a banana) without a large blood sugar spike, I noticed that I needed more and more insulin in order to bring my blood sugar back down into the normal range. It would have been easy to demonise carbs as the culprit for the sugar spike, but that would have been a case of mistaken identity. Here’s why: Even if I didn’t eat anything and my own body produced glucose endogenously i.e the liver dumped glucose into my bloodstream via a process called gluconeogenesis, I couldn’t fix my high blood sugar levels because I was resistant to the insulin I injected. It felt like I was on my way to developing type 2 diabetes (type 1 is more than enough, thank you). It was a very frightening reality and a huge wake-up call.

The Keto Diet Does Not Cure Insulin Resistance and Type 2 Diabetes

Just because keto can lead to stable blood glucose levels, low insulin levels, and patients can come off their medications does NOT necessarily mean it reverses type 2 diabetes. It may seem like they’ve reversed their diabetes but really they’re just managing symptoms because the minute they eat a carb-rich meal their blood sugar can go very high.

It’s like a celiac patient removing gluten from their diet and seeing their symptoms disappear. Does that mean they cured their celiac disease? Of course not, they just removed the trigger that leads to symptoms without addressing the actual cause of the disease. As soon as they eat gluten again, their symptoms come back.

The ketogenic diet is a short-term, Band-Aid solution to minimize blood sugar fluctuations but does not reverse the underlying condition of insulin resistance. In fact, evidence-based research shows that eating a low-carbohydrate actually worsens insulin resistance. By almost completely removing carbs from the diet, you’re simply removing the trigger that leads to symptoms (hyperglycemia) without addressing the actual cause. Then when you add carbs back in, your body can’t tolerate them, which makes it seem like carbs are “bad” for you, but really carbs are the victim of somebody else’s crime. After spending hours and hours down a rabbit hole of research, it turns out the real culprit is the very high levels of saturated fat found in meat, bacon, eggs, butter, coconut oil etc, which can lead to a buildup of fat inside the liver and muscle (called intrahepatic and intramyocellular lipids, respectively). When lipids accumulate in tissues where they don’t belong it can cause the cells to become dysfunctional, leading to insulin resistance and impaired glucose tolerance. Sure the human body can convert excess glucose to fat, but the conversion of glucose to lipids via ‘de novo lipogenesis’ happens to a very small degree, and those newly made lipids make up a very small percentage of intramyocellular lipids. Furthermore, insulin has been wrongfully demonised as a ‘fat storage hormone’. Sure, one of the physiological properties of insulin is lipogenesis (fat storage) but when you minimize your intake of dietary fat, the impact is minimal. The reality is, insulin levels in the normal physiological range is required for survival. Insulin is not the enemy that many low-carbohydrate advocates claim.

Insulin resistance is a silent disease. Most people don’t know they have it because they don’t need to monitor their blood sugar levels or inject insulin on a daily basis, but I do. As someone living with type 1 diabetes, I get objective insights every single day. I see first hand the effects of different lifestyle variables on my insulin and blood sugar control. Sure, everyone is different so don’t just take my word for it. Look it up for yourself. The science is out there (and has been for decades). High-fat diets have been shown to induce insulin resistance and reduce glucose tolerance. The evidence is eye-opening. Insulin resistance can affect anyone and everyone, diabetic or not. It doesn’t discriminate.

Low Carb Diets Works But…

There’s no denying that a low carb approach can lead to weight loss, stable blood glucose levels, reduced HbA1c, low total insulin requirements and overall improved diabetes management. In fact, I couldn't agree more! I followed a low carb approach for 8 years with great results. I achieved a 70% reduction in total insulin requirements and very stable blood glucose control. But my point is, those biomarkers say nothing about one’s insulin sensitivity and carbohydrate tolerance. When you become primarily fat-adapted you lose metabolic flexibility and can’t tolerate even small amounts of carbs. To me, that doesn’t sound optimal when some of the healthiest foods known to humans are avoided on a keto diet. Some say the mechanism is insulin resistance, others say it’s enzymatic, regardless of the mechanisms, one thing we all agree on is that carbohydrate tolerance goes down. I’ve even seen world-leading keto experts admit that the keto diet induces a state of temporary “insulin resistance” or “glucose intolerance”.

I don’t have a problem with the physiological state of ketosis. You can achieve ketosis by fasting, following Bernstein’s approach, or even doing a plant-based keto diet. I have concerns with the modern keto diet because it’s very high in saturated fat and I don’t think bacon, eggs, butter and coconut oil should make the bulk of your daily calories especially when they’re replacing known healthy foods like fibre-rich, nutrient-dense, and antioxidant-rich fruit, legumes and starchy vegetables.

The Solution

Having made the connection between poor health outcomes and saturated fats, I knew I had to make a change. So, I decided to embark on a journey to see if removing those foods altogether and eating more carb-rich plant-based foods would reverse the metabolic damage I had caused. I immediately embarked on a strictly whole-food-plant-based journey with the guidance from world-leading plant-based diabetes experts, Robby Barbaro and Dr Cyrus Khambatta at ‘Mastering Diabetes’. They have helped dozens of people successfully reverse their insulin resistance and type 2 diabetes with a low-fat, high-carb, whole food, plant-based diet. 

I dropped my fat intake from 75% of daily energy intake to between 15-20%. I removed all animal foods and oils from my diet. I focused on eating healthy fats from avocados, nuts, and seeds. I also added whole grains and legumes back into my diet (both of which I hadn’t eaten in nearly seven years since following a paleo approach) and an abundance of all types of fruits and vegetables. Within 48 hours my insulin sensitivity started to return to normal. Within 1-2 weeks my carbohydrate intake was the highest it had been since being diagnosed with diabetes, and my insulin use dropped dramatically.

As I write this article, I’ve been strictly plant-based for 4 months and the results have been astonishing. I’ve achieved my best ever insulin-to-carb ratio, and it feels like I’ve regained control of my health. What started as a plant-based journey toward personal development and health has turned into something so much bigger. The positive impact I’m having on myself, the people around me, environmental sustainability, and animal welfare give me so much fulfilment and joy. I cannot wait to see where this journey takes me over the long-term.

The Takeaway Message

The ketogenic diet does not necessarily cure type 2 diabetes but rather it manages the symptoms. Normal insulin and blood glucose levels in the absence of carbs is not an indication of reversing type 2 diabetes. However, normal insulin and blood glucose levels in the presence of carbs is a true indication of gaining insulin sensitivity and reversing type 2 diabetes. 

If you can stick to a keto diet for your entire life and it helps you to manage your diabetes symptoms and ultimately avoid the tragic long-term complications of diabetes then I’m all for it! Good for you. But for most people out there it is unsustainable in the long-term, it may increase your risk of developing other chronic diseases and may even worsen your carbohydrate tolerance. 

The good news is, there's another way! Type 2 diabetes and insulin resistance can absolutely be reversed and cured. I’ve seen it done over and over again on a whole-food plant-based approach. Patients are achieving non-diabetic hba1c results, stable blood glucose levels, normal insulin levels, and are coming off all medication - all while eating an abundance of unrefined healthy carbohydrates. In my eyes, that is the true reversal of type 2 diabetes and insulin resistance.

It is evident that there are two polarising approaches on opposite ends of the spectrum, both of which have their proponents, but the real problem lies in the middle - the standard western diet. The standard western diet which is high in refined carbs, fats, protein and calories (mostly from processed foods), coupled with a sedentary lifestyle is the real reason we are facing an epidemic of insulin resistance and type 2 diabetes. Any deviation away from the middle towards a real food approach will result in improved health outcomes. I’ve experienced this on both ends of the spectrum but according to the evidence, only one of these approaches truly reverses the underlying cause. #WFPB 

References:

https://www.ncbi.nlm.nih.gov/pubmed/10027589 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC507380/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294420/ https://www.omicsonline.org/mechanisms-of-fatty-acid-induced-insulin-resistance-in-muscle-and-liver-2155-6156.1000127.php?aid=715 https://www.ncbi.nlm.nih.gov/pubmed/23122836 https://www.ncbi.nlm.nih.gov/pubmed/10480616 https://www.ncbi.nlm.nih.gov/pubmed/30089335 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1561276/ https://www.nejm.org/doi/full/10.1056/NEJM197103112841004 https://academic.oup.com/ajcn/article/74/6/707/4737384 http://diabetes.diabetesjournals.org/content/58/12/2741 https://www.ncbi.nlm.nih.gov/pubmed/27479196 https://www.ncbi.nlm.nih.gov/pubmed/29425120 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989112/

[lucygriffithpsych]

habits || self para

Lucy knew the tests the doctor ran on her revealed her bradycardia, hypotension, and hyperglycemia-- all telltale signs of the her disorder. She really had let herself go this time. And it wasn't going to go unsaid. Lucy knew this much. She didn't know quite what to expect, but it wasn't Dr. Anthony Holmes himself. 

"So try not to pass out next time you stand up," he half joked, half warned. At least that seemed to mean she wasn't fired. That's what Lucy hoped, anyway. 

"Today, you're going to go home and make yourself some dinner, and get some rest. And tomorrow, you're going to eat breakfast. But you're not going to come in. You're going to take a sick day. And you're going to eat lunch and dinner. The next time I see you here, you're going to look a little more... alive. I don't want to see this, any of this, happening again. How does that sound, Dr. Griffith?"

 Lucy shivered, not completely from the cold. Lucy wasn't easily intimidated but Holmes did a pretty good job at it anyway. She swallowed hard and nodded slowly. "Good. That sounds... yeah."

 Holmes shook his head and sighed, patting her arm. "You know what to do."

 Minutes after Anthony left, a nurse came in and started taking out the IV and disconnecting the heart monitor. He nodded at her and told her she could take the heart monitor stickers above her breasts off. Lucy peeled them off as she swung her legs over the side of the bed, giving her head a moment to catch up. The electrolytes perked her up a little bit, she realized, although Lucy was still a little worried about the effects of the intravenous fluids on her weight. The realization that that was what she was worried about made her stomach lurch and she forced herself to stand and walk out of the infirmary. It was like a walk of shame. All the staff around knew something had happened, and she practically hung her head the whole way to her office. 

Lucy closed the door behind her, taking a seat on the couch and running her hands through her hair, stressed about every single thing that happened in the last 24 hours. The news about Hazel, then talking to Hazel, fainting, waking up in the infirmary, and being given a talking to by the director of Serenity House. She paced around the room, putting off admitting that she had to do what Holmes had said, or at least pretend to.

 Lucy picked up her bag put her things away, giving into leaving. She made her way to the staff housing and when she entered her apartment, she dropped her bag on the floor and lay down on the couch, her knees drawn in close to her chest. She could feel her stomach growling persistently, and she let out a defeated sigh.

 Lucy stood and went to her kitchen, opening the fridge to look at her options. Zero calorie drinks, sliced mango, skim milk... Which was sour, she realized upon opening it. Lettuce, blueberries, ketchup, salad dressing, cucumbers... What was wrong with her? She didn't have anything that provided sustenance, but Lucy was feeling too overwhelmed to think about leaving her apartment. At least the mango would be a little pick-me- up. Then she would nap. And then she would convince herself to go to store.

 Lucy sat down at the small kitchen island and opened the container of fruit. The first few pieces were heavenly, but soon the desire for more began to fill her chest with panic and guilt.

 Before she could convince herself otherwise, Lucy had taken the ketchup from her fridge and squeezed it above the remaining slices of mango, burying it all under a layer of red sauce. She was standing at the island, her ears burning red as she put the ketchup bottle down and stared at the red and yellow mess in front of her. 

 Lucy found herself crying as she realized what she had done and quickly thrust the package of ruined fruit into the garbage, taking in rapid shallow breaths until all the evidence was gone. Only then could she breathe normally again, and Lucy fled the kitchen, shutting her bedroom door behind her and pulling the curtains closed so she could hide under the covers in the dark room.