Lifestyle Before Medication

A pharmacist's perspective on health and metabolic disease

PhD Sucess

Its been a busy few weeks, what with starting a new job at Auckland Hospital but also preparing for my PhD defence.  PhD examinations are a two-part process.  The first part is where your written thesis is examined.  The second part is known as the Defence, (or Vivas).  It is a 60-90 minute oral exam where you discuss aspects of your thesis that may need additional clarification, with your examiners.

It is an interesting process as you really have to think hard about why you chose to do things in a certain way, when you may have made the decision 2-3 years ago.  At least you get the examiners comments a week before the exam to help you prepare.

I’m very pleased to say I passed, subject to some minor amendments.  A big thank you to my supervisors, Grant, Caryn, and Mark, and to The Engineer and our families for all their support.

Here is the short synopsis of my thesis.

“Traditionally metabolic diseases are thought to be due to insulin resistance, where the cells in the body need higher levels of insulin  (hyperinsulinaemia) to regulate blood glucose levels.  Little was known about the effects of hyperinsulinaemia on the rest of the body, nor how hyperinsulinaemia should be diagnosed.  My thesis shows that hyperinsulinaemia should be considered a separate condition to insulin resistance and it is actually the hyperinsulinaemia that is the earliest sign of many metabolic diseases, including obesity.   As measures of insulin resistance, including fasting insulin, could not predict hyperinsulinaemia, I developed a diagnostic test based measuring insulin levels at five time points following a glucose drink and analysed the patterns.  This test was developed based on previous work by, and a database collected by Dr Kraft.  The results showed that fasting insulin levels could not predict hyperinsulinaemia.  The most reliable diagnostic test for hyperinsulinaemia involves five blood tests over three hours following a glucose drink.   A simpler diagnostic test involves just one blood test, collected two hours  after the glucose drink.   Once diagnosed, hyperinsulinaemia can be managed by lifestyle measures, especially carbohydrate restriction and physical activity.”

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6 comments on “PhD Sucess

  1. Roger
    May 29, 2016

    Catherine,

    Congratulations on your outstanding work! I have long been a fan of Dr. Kraft’s work. Can you direct me to any studies linking hepatic fat (as the primary driver) to dyslipidemia?

    Keep up the great work,

    Roger

    Like

    • pharmacistcatherine
      May 30, 2016

      Thanks Roger. You could try this paper “Fatty liver, insulin resistance, and dyslipidemia”
      http://link.springer.com/article/10.1007/s11892-008-0011-4

      Like

      • Roger
        May 30, 2016

        Thanks! Interesting stuff indeed. I really believe that work similar to yours and Dr. Kraft is key to saving lives.

        I do have a follow up question for you my pharmacist friend.

        Doctors rush to prescribe statins. Statins have been shown to increase risk of IR and DM. If hyperinsulinemia is the true underpinning of the CVD pathogenesis aren’t statins exacerbating the existing pathology? Is the anti-inflammatory property of statins worth the trade off?

        Thank you for your thoughts.

        Roger

        Like

  2. pharmacistcatherine
    May 31, 2016

    Hmmm…..its a bit of a loaded question. It is my personal opinion that at the moment statins have a place in secondary treatment of cardiac events but their use is questionable in primary prevention and also for certain patient groups. I also think that there should be a low threshold for discontinuing the statins given their adverse effects. They are not benign agents. But at the same time, these medications should be assessed on their merits for the individual in question.

    At the same time, we should be going back to why we use a statin. If it is to lower LDL cholesterol, then perhaps we need to move on from that theory and look harder at LDL particle size and triglyceride levels. Statins don’t lower triglycerides. There is also some evidence that perhaps our thresholds for what defines a “too high” cholesterol level should be re-assessed. We need to go back and look harder at the problem and redefine the issue.

    Like

    • Roger
      May 31, 2016

      Thank you for you response.

      I have been in the medical field for a long time. I think statins should be reserved for specific populations (i.e. middle-aged males after their first MI). I have yet to see one physician even ponder about the insulin levels of cardiac patients. I have even gone so far as to point out acanthos nigricans on patients (not diagnosed as diabetic) presenting with chest pain. The general response is something like, “don’t worry about it, their blood sugars are fine”.

      Keep up the good work. Change is coming.

      Roger

      Like

      • pharmacistcatherine
        May 31, 2016

        Thanks Roger.

        I am starting to see change. One physician with whom I work is swift(er) to stop statins and has taken a copy of both Dr Kraft’s book and a copy of my paper on hyperinsulinaemia. The same for some of the other nurse specialists. We have had some good discussions and I can see more coming. Thanks for your support. Catherine.

        Like

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This entry was posted on May 20, 2016 by in Uncategorized.
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