Breast Feeding, Diabetes and Explaining the Unexplainable

Random orienteering photo

Big news this week is that I have a job lined up for later this year! If all goes to plan I'll be starting work at the Victoria Infirmary, Glasgow in July.

Several interesting articles in the BMJ this month and alot to talk about. Here's a brief overview of some of the features which caught my eye:

Six months of exclusive breast feeding: how good is the evidence? - Back in January this year, Fewtrell et al published a review article which questions the advice to mothers to breast-feed exclusively for the first 6 months of life. This has unsurprisingly led to some uncertainty among mothers, medics and families internationally. A letter to the BMJ this week however criticises the article and some of the references cited. Public health groups have spent years promoting the benefits of breast feeding and it seems to me that before releasing an article such as this which throws all of the advice info doubt, more scrutiny should have been placed on the original evidence.

Is the NHS failing elderly patients? - This story hit the news in a big way this week with reports of poor standards of care of elderly patients (in England). Pain control, discharge arrangements, communication with patients and their relatives and nutrition are areas which are not being done well. Indeed just recently whilst on my medical shadowing block a complaint was made because a patient had been sent home on the wrong medications. It is improtant to know areas where we need to improve and what this helps to do is to highlight the simple things which can be done much better. Several of these measures are in areas where the FY1 is directly involved eg. discharge scripts for patients therefore its good to know areas where mistakes are more likely to be made.

Islet transplantation in type 1 diabetes - Is this the answer to finding a cure for type 1 diabetes? Back in 2001 this was the prediction however 10 years on it is only suitbale for a small number of patients who have severe glycaemic lability, recurrent hypoglycaemia and hypoglycaemia unawareness. Most patients do not in fact fit the criteria for islet cell translplantation and it is not a possible treatment for type 2 diabetes. Interestingly although insulin independence can be achieved in some cases, many patients will need to resort back to insulin treatment. Patients with islet cell transplantations must also be given long term immunosupressant agents whose long term dangers are somewhat unclear. The authors conclude that while progress in this field has not been as quick as was once anticipated, more is now known about the technique and advances in transplantaiton and patient management are likely to further improve clinical outcome of islet cell transplantation procedures in the future.

Type 1 Diabetes in Children - Is it easily missed? - The incidence of childhood type 1 diabetes in Europe is increasing and the diagnosis is often delayed. Often teachers and parents may not be aware of noticing children who may be drinking alot or peeing frequently. A child may present with quite non-specific symptoms and the question of new onset diabetes should be raised. Children can develop dehydration and acidosis, deteriorating rapidly on first presentation.

Explaining the Unexplainable - A Glasgow GP writes in to say that doctors are not very good at understanding and explaining the unexplainable. He writes that when he started work, people would say things like "If the symptoms don't make sense then there is nothing wrong with them", "Frequency of attendance is inversely proportional to likelihood of pathology" and that "referring the anxious only makes them more anxious". I think that the difference between him and myself is that he writes with years of experience of medicine under his belt. With more practice I hope that it will be possible to sort the serious from the insignificant, however until that becomes the case, it will be important to stick to what I've been taught at medical school!