Walter A Stoller | PubMed Health

PubMed2006

Changing paradigms in the surgical and medical management of acromegaly.

Acromegaly is a serious, but rare, form of pituitary tumor. This review will discuss recent progress in surgical and medical care, highlight data on choosing the order for primary and secondary therapy and preview emerging drugs. Several controversial areas will be discussed, including the role of preselecting subjects for drug responsiveness, whether or not a brief course of medical therapy before surgery improves outcomes, and trials of combination drug therapy. It is hoped that earlier diagnosis, referral of patients to dedicated pituitary surgeons or neuroendocrinology teams, development of more effective and affordable drugs, and further advances in surgery and radiotherapy will continue to improve the morbidity and mortality from acromegaly.

Acromegaly↗

PubMed2002

Individualizing insulin management. Three practical cases, rules for regimen adjustment.

Many patients with diabetes become frustrated by the tedium of inflexible insulin instructions and unpalatable dietary restrictions. They lose confidence when their blood glucose levels fluctuate widely, and they may begin to think of themselves as "bad diabetics." Therefore, choosing the appropriate insulin and injection regimen for each patient is essential. Coordinated efforts by a concerned team of diabetes educators, dietitians, and physicians enhance the effectiveness of treatment. Patients should be taught how to count carbohydrates, select foods with a low glycemic index, and adjust their insulin regimen by using sliding scales based on the 1500 or 1800 rule. Regular exercise and solid emotional support from family and friends also are helpful. By teaching patients the rules for insulin management, physicians can empower them to be much more actively involved in their own care and to lead healthier lives.

Blood Glucose↗