社會中有疑問,為什麼先替老弱打疫苗?可以看看邏輯和外面例子。
香港疫苗供應,依賴外來供應,一句到尾,無人敢保證。
社會是我們市民的家,老人家與長期病患者,中了新冠肺炎,死亡率比其他人高,是大家都知道的。
因此,若茂叔只可以偷運幾劑的疫苗,到自己家中,被執法者拘捕之前,一定先替風險高的家人注射。
美國也是先幫老弱、醫護、和部分維持社會運作人員打針。CDC 公佈: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations.html
還有,在外國,煙民爭取打針,不是離開,也不是「被離開」。
Here’s Chicago’s full list of health conditions that qualify recipients for a COVID-19 vaccination starting March 29:
Cancer (current diagnosis)
Cardiac, cardiovascular, and cerebrovascular disorders (including heart disease, coronary artery disease, and hypertension or high blood pressure)
Chronic Kidney Disease
Chronic respiratory disorders (including cystic fibrosis, moderate to severe asthma, pulmonary fibrosis, and chronic obstructive pulmonary disease/emphysema [COPD])
Diabetes (Type 1 and Type 2)
Disability: physical, developmental, visual, hearing, or mental
Neurologic conditions (including dementia)
Down Syndrome
Immunocompromised state (weakened immune system) including from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
Liver disease (including hepatitis)
Pregnancy
Obesity: BMI ≥30 kg/m2
Schizophrenia spectrum disorders
Sickle Cell Disease
type 2 diabetes diagnosis 在 劉漢文醫師 Facebook 的最佳解答
潛伏性成人自體免疫糖尿病 (LADA),一篇來自不同國家的專家會議共識。
https://pubmed.ncbi.nlm.nih.gov/32847960/
✔ 所有新診斷第 2 型糖尿病的病人,都篩檢 GAD 抗體 (GADA)。
如果有經濟考量,就選有第 1 型糖尿病或自體免疫疾病家族史、BMI 小於 27、發病年齡小於 60 歲和血糖控制不好的。
如果 GADA 是陰性,但是真的很懷疑 LADA,應該再驗其他抗體 (ICA、IA-2A、ZT8A)
✔ GADA 陽性的病人,驗 C-peptide 來決定不同治療方向。C-peptide 的抽血時間可以是空腹、隨機、或餐後,只要血糖是在 80-180mg/dL 之間即可。
🔹 C-peptide 小於 0.3 nmol/L
建議胰島素治療。如果是新診斷的話,應該就當作是第 1 型糖尿病。
🔹 C-peptide 在 0.3 和 0.7 nmol/L 之間
屬於灰色地帶,用口服藥 metformin,血糖高的可以合併使用胰島素。
不要用 sulfonylurea (SU),因為可能會使得胰島素分泌能力下降。
至少每隔 6 個月追蹤 C-peptide 濃度。
許多成人發病的第 1 型糖尿病的 C-peptide 也在這個範圍,所以血糖真的很高的,可能就需要開始使用胰島素治療。
🔹 C-peptide 大於 0.7 nmol/L
跟一般第 2 型糖尿病的治療一樣,只是避免用 SU。如果血糖變差,就要追蹤 C-peptide 濃度。
有些人的 GADA 是假陽性,是單純的第 2 型糖尿病。
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LADA 因為發病年齡比典型的第 1 型糖尿病晚,初期又不須用胰島素治療,常常會被當作第 2 型糖尿病。不過隨著病程進展,β 細胞分泌胰島素的能力越來越弱之後,就會變成依賴胰島素才能控制血糖。
這篇專家共識只是給大家參考,目前不同醫師應該還是以病人的臨床狀況來決定。
type 2 diabetes diagnosis 在 DR. SIMON MSH Facebook 的最讚貼文
The continuum of health problems ranging from mild insulin resistance and overweight to obesity and diabetes. Diabesity is the underlying cause of most heart disease, cancer, and premature death in the world.⠀
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Research shows insulin resistance is one of the major factors that starts the brain-damage cascade, which robs the memory of over half the people in their 80s, leading to a diagnosis of Alzheimer’s disease.⠀
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Millions of people worldwide suffer from this condition we call insulin resistance. It affects many varieties of people and is not exactly the same in everyone, but the ultimate consequences can be similar. ⠀
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Balancing blood sugar and correcting insulin resistance is well within our reach.⠀
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Steps to reverse diabesity:
1. Stop eating flour and sugar products.
2. Stop all processed, junk or packaged foods.
3. Eat plenty of soluble fiber.
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4. Move your body.
5. Find an active relaxation practice. ⠀
6. Eat balanced meals with protein, fats, and vegetables⠀
Join me on Feel Good Friday to know how to become healthier and happier.
For more info click the link in my Instagram profile @doctors.bulletin or whatsapp me from my Facebook page DR SIMON MSH
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