n**m
发帖数: 7872 | 1 就算糖妈，36周之后很大一部分人的insulin sensitivity也好了，现在测出糖不糖的
意义都不大。其实测两小时血糖还不如测个HbA1C呢，看看前几个月平均血糖是不是高。
蛋糕冰激凌这种高糖高脂的东西确实不宜多吃。我自己的经验证明，连着吃两三天蛋糕
或者cheesecake，早上空腹血糖会长。
放宽心好了。已经吃了的也不能吐出来，已经长了的宝宝也不能缩回去。 |
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w******y
发帖数: 4871 | 2 OB panel我不知道包括哪些
HbA1C是看你过去三个月血糖控制的怎样。
最后一个就是尿培养啊 |
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R*********i
发帖数: 7643 | 3 来自主题: NextGeneration版 - 血糖问题 HbA1C反应好几个月的问题呢。孕前就有高血糖? 不知道？ |
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h*******g
发帖数: 205 | 5 看到这个评论很有趣---有人把ARNA的药和其他的药做比较。
“You are trying to compare a drug that not only help a person lose 5% or
more of their body weight but also reduces secondary medical issues like
heart disease, cancer, diabetes, and others. Belviq significantly improved
glucose control by decreasing HbA1c by almost 1% and decreasing fasting
glucose by 27% which is in line with other diabetic medication. It reduces
systolic and diastolic blood pressured, total cholesterol, LDL-cholesterol,
and tryglyceride levels. ... 阅读全帖 |
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A****t
发帖数: 61 | 6 取决于你吃了什么吧，是refined carb吗？换成低GI的碳水会smooth血糖波动，比如说
用100% whole wheat bread替代white bread，brown rice替代white rice等
此外亚洲人容易受到糖尿病的困扰，你有家族史吗？你的体脂，腰围在健康水平吗？可
以考虑测试HbA1c，也推荐查一个fasting blood sugar。如果症状仍然很明显，还可以
做糖耐量。如果真有糖尿病的倾向的话，亚洲人还容易伴随的问题是高甘油三酯，可以
看你的血脂检查结果。 |
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U**********1
发帖数: 202 | 7 我吃全麦面包，不过大米是普通的白米，不是黄米。我爸妈没有糖尿病，爷爷奶奶辈年
纪大了好像有点高血压高血糖高血脂什么的，不过没听他们说起过糖尿病。
我的体脂应该变动很大，bulk和cut的时候差好远，不知道bulk会不会bulk出糖尿病来
。腰围还好，cut到最小的时候是30inch，bulk到最大的时候大概34.5inch吧。我吃得
挺干净的，估计血脂不高，前两年买保险的时候测是正常范围的最小值，可好久没再测
过，不知道现在咋样了。下次体检让医生给做个Hba1c或是空腹血糖测试看看。我还听
说有人吃完饭会戳破手指测测血糖，不知道有没有用。 |
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A****t
发帖数: 61 | 8 那种家庭血糖计适合糖尿病人追踪用的（横向对比），你不应该使用，本身准确性会有
问题，加上你可能会不熟悉机器，也可能会有使用上的错误。去看医生的时候测HbA1c
是推荐的做法。
bulk跟cut带来的体重波动其实不少医生持负面看法的。我相信某个阶段有个特定的
focus是对的，这样目标明确，比较容易看到结果，get motivated. 但是，我也相信这
种波动对身体有负面作用的。我建议不要把cycle做的太认真了，而且我不太信增肌跟
减脂同步进行是不可能的，我觉得大家不这么做更大程度上是因为不能很快看到明确的
目标。
中国人膳食里面高碳水，尤其吃很多白米其实是个问题。应该在能接受的程度内稍微做
些改变。 |
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U**********1
发帖数: 202 | 9 其实我也想过bulk/cut是否会伤身体，所以在做的时候没有太狠。bulk是吃饱就好，没
吃撑；cut的时候也只是减少食量，可饿了就吃点，没怎么饿着。不过经过一年的bulk/
cut循环，确实进步明显，所以想再来一轮，计划还是悠着点，能长多少就多少，身体
健康才是最重要。
那种家庭血糖计适合糖尿病人追踪用的（横向对比），你不应该使用，本身准确性会有
问题，加上你可能会不熟悉机器，也可能会有使用上的错误。去看医生的时候测HbA1c
是推荐的做法。
bulk跟cut带来的体重波动其实不少医生持负面看法的。我相信某个阶段有个特定的
focus是对的，这样目标明确，比较容易看到结果，get motivated. 但是，我也相信这
种波动对身体有负面作用的。我建议不要把cycle做的太认真了，而且我不太信增肌跟
减脂同步进行是不可能的，我觉得大家不这么做更大程度上是因为不能很快看到明确的
目标。中国人膳食里面高碳水，尤其吃很多白米其实是个问题。应该在能接受的程度内
稍微做些改变。 |
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p****y
发帖数: 23737 | 12 Recently, there has been a renewed interest in vegetarian diets. Today there
are countless books, cookbooks, and magazine articles promoting vegetarian
diets and providing guidance for those who wish to follow a meatless diet. A
Short Historical Perspective on Vegetarian Diets
In the past, many viewed vegetarianism as strange and faddish but
appropriately planned vegetarian diets are now recognized by many, including
the American Dietetic Association, as being nutritionally adequate, and
providi... 阅读全帖 |
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j*b
发帖数: 341 | 13 这个PKM2和肿瘤代谢的关系已经知道很久了，这两篇还不是原创贴。
cantley还可以发nature，能不能解释一下？
Anticancer Res. 2003 Mar-Apr;23(2A):1155-8.
Tumor marker pyruvate kinase type tumor M2 in patients suffering from
diabetic nephropathy.
Oremek GM, Rutner F, Sapoutzis N, Sauer-Eppel H.
Source
Central Laboratory, Hospital of the Johann Wolfgang Goethe-University,
Frankfurt/Main, Germany.
Abstract
INTRODUCTION:
Compared to normal tissues all tumors investigated so far and especially
those with a metastatic potential overexpress an isoenzy... 阅读全帖 |
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j*b
发帖数: 341 | 14 这个PKM2和肿瘤代谢的关系已经知道很久了，这两篇还不是原创贴。
cantley还可以发nature，能不能解释一下？
Anticancer Res. 2003 Mar-Apr;23(2A):1155-8.
Tumor marker pyruvate kinase type tumor M2 in patients suffering from
diabetic nephropathy.
Oremek GM, Rutner F, Sapoutzis N, Sauer-Eppel H.
Source
Central Laboratory, Hospital of the Johann Wolfgang Goethe-University,
Frankfurt/Main, Germany.
Abstract
INTRODUCTION:
Compared to normal tissues all tumors investigated so far and especially
those with a metastatic potential overexpress an isoenzy... 阅读全帖 |
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f******k
发帖数: 5329 | 15 如果你BMI<25，年龄小于46的话，没有症状和其他risk factor，一般不筛查糖尿病的。
你不跑步的时候出汗多么？
你自己把体检报告翻出来看看，有没有A1C这项或者叫HBA1C。小于5.7都算正常。 |
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s********o
发帖数: 3319 | 16 In step 2 CS exam, how to ask about the HbA1c in diabetes follow up?
thanks. |
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m****8
发帖数: 419 | 17 ☆─────────────────────────────────────☆
harrywfu (天南海北山东人) 于 (Fri Apr 3 09:12:07 2009) 提到:
What/how is your hemoglobin A one C level?
or
What is your glycosylated hemoglobin level?
or
What is your hemoglobin level that is measured every 3 month?
☆─────────────────────────────────────☆
JDJ (Step2 CS) 于 (Fri Apr 3 12:35:19 2009) 提到:
When was your last check up? Did the doctor mention any abnormal lab results
to you?
Do you check your blood sugar level at home? How often? Can you tell m |
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a*****2
发帖数: 200 | 18 来自主题: MedicalCareer版 - 关于OB 嗯，我借口OB需要给自己买了个iPod
有很多好玩的软件可以用。 我主要用的就是eporate免费试用版挺好的，后来我嫌贵到
期了就没买了。另外skyscape有的免费的东西，计算什么的。比如有一次病人问我他的
HbA1C相当于血糖的多少，我就拿这个算的。
我见习的地方没有无线网，有些需要连线的就不行了。所以iPod还是不如iPhone方便。 |
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f**********c
发帖数: 127 | 19 来自主题: MedicalCareer版 - ob点滴 作为一个全职主妇，没有老板或者home school connection，能找到一个free clinic
做volunteer，我觉得很幸运。我待的时间并不久，但常常在点点滴滴互动中感受到温
暖和震动。谨记之，作为纪念和学习的脚印。
Free clinic是这个区的大夫、护士和药剂师一起参与建立的，所有人自愿义诊。诊所
面向没有医疗保险的穷人，目前病人总数约2500，尤其以Guyanese（就是以前被英国人
带到西印度群岛的印度裔，现在又移民来了美国 ）居多。诊所里的医生主要是一些白
发苍苍，戴或者不戴助听器的退休老医生，来自内外儿科精神科甚至放射科LOL。基本
上都开业三十几年以上，有一位的白大褂上还绣着，给xx医生，感谢你在xx医院服务五
十年！
不要看他们发须花白，经验丰富，并没有人倚老卖老。他们待人接物彬彬有礼，就连载
我这个nobody回家的时候，都为我打开副驾驶门让我先上车。他们坚持阅读最新文献，
跟踪诊断治疗进展，每个月还自己举办2次noon conference互相讲课，交流经验（和八
卦^^）。例一：有一次说到颈动脉狭窄，N医生就说，你去搜搜看，去年12月份
cl... 阅读全帖 |
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s**********t
发帖数: 217 | 20 Just came back from the NYC CMG seminar, seeing a lot of old friends and
meeting a lot of new friends. Still feel very excited. Many thanks to KDs
organized this wonderful meeting, letting CMGs having this platform to share
information.
As a guy happened started my clinic career couple years earlier, I would
like to share some experience with my young friends. I hope this is going to
help you go through your transition period smoothly.
When an intern reports to me A NEW ADMISSION, what do I wan... 阅读全帖 |
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F********1
发帖数: 151 | 21 今天和skype上两位学友谈到CS准备，我翻出自己以前写的CS总结，在这里贴一下仅供
参考。Hope it helps. 另外，我觉得面对面练习非常重要。希望大家一定要找同城考
友面对面练习。
1) Encounter may begin.
开始阅读doorway信息。last name, 性别，主诉，快速瞄一眼要不要求体检。然后快速
写下OCDFPPAAAGUWASFT PFHAMOSS, 女性把o改为OB/GYN。在AAA旁边写上2-3个鉴别诊断
名词，同时写上体检项目（心、肺、腹、神、头、甲）。同时，这些也是需要询问的大
系统。这一步40-50秒，争取不要超过1分钟。
2) 走到病人面前，微笑，建立眼神接触之后再说话，伸出手准备握手。Hi, Mr. Smith
, I am Dr. X, I am a physician in this hospital. I will be taking care of
you today. Very nice to meet you!
SP: Nice to meet you too.
Before we start, let me cove... 阅读全帖 |
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j*****o
发帖数: 137 | 22 65yo woman comes to the office for a follow-up examination. She has an 18y
history of Dm and 2y history of diabetic nephropathy. She had laser
treatments 1 y ago for proliferative retinitis with some loss of vision. She
currently takes intermediate and short-acting insulin before breakfast and
dinner. She also takes enalapril for HTN. She does home glucose monitoring
three times daily. her blood glucose concentrations usally range bw 70-130
mg/dl, but several readings every week are < 60m/dl at ... 阅读全帖 |
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s********4
发帖数: 64 | 23 CC: Axillofemoral bypass surgery for an occluded right limb
HPI: 62 yo male with antiphospholipid syndrome presents to VAMC for
scheduled axillofemoral bypass surgery on 10/22. Patient was instructed to
hold warfarin and start enoxaparin for bridging prior to surgery. Patient
was admitted pre-op on 10/21 and switched to a heparin drip for
anticoagulation. Surgery was completed successfully with no complications
on 10/22. Post operatively patient feels much better with minimal pain in
his fo... 阅读全帖 |
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l**x
发帖数: 54 | 24 谢谢大家上次回复 。最近病人查出血液尿素偏高（8.9，正常应低于7.5），和葡
萄糖升高（6.2， 正常应低于6.1), 是否与长期服用Torasemide有关呢？ 病人的HbA1c
也升高6.6。是否已是二型糖尿病，需要服用降血糖的药吗？兼顾病人有房颤，和左房
输出障碍导致的水肿，应服用那种糖尿病的药呢? 谢谢！！ |
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l**x
发帖数: 54 | 25 谢谢大家上次回复 。最近病人查出血液尿素偏高（8.9，正常应低于7.5），和葡
萄糖升高（6.2， 正常应低于6.1), 是否与长期服用Torasemide有关呢？ 病人的HbA1c
也升高6.6。是否已是二型糖尿病，需要服用降血糖的药吗？兼顾病人有房颤，和左房
输出障碍导致的水肿，应服用那种糖尿病的药呢? 谢谢！！ |
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s******t
发帖数: 579 | 26 (The patient was admitted because of MDD secondary to her debilitating LLE weakness, numbness and tightness. I'd like to focus on her neurological symptoms.)
CC:
A 72 y/o white F complains of LLE weakness, numbness and tightness.
HPI:
Pt was diagnosed lumbar spondylosis, lumbar spinal stenosis, low back pain and lumbar radiculopathy 2 yrs ago. Had a lumbar fusion 1 yr ago. Started to recover at the beginning, but had worsening of weakness and eventually required a hardware removal 6 months ago. ... 阅读全帖 |
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n*******c
发帖数: 501 | 27 My question is if this patient is diagnosed of DM, what would be the goal of
her blood glucose control, given that she has already developed neuropathy
on HbA1C of 5.1 |
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n*******c
发帖数: 501 | 28 I think early diabetes can have postprandial hypos. Is that true?
The patient is having both hyper and hypoglycemia and we don't know which
one is the reactive one. Is she having hypers secondary to hypos or reactive
hypos? Would be interesting to know when does hypo occur? Postprandial or
not?
If this patient has both hypos and hypers documented and current blood
glucose is normal, as well as HbA1C. Would you start with glucose tolerance
test or 72hr fasting test to investigate? |
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b******a
发帖数: 704 | 29 1. most likely, yes. Her glucose tolerance test after glucose intake: 1 hour
295, how about 2hr??? if two hours after a 75 g oral glucose>200mg/dl,
supporting this diagnosis if I am not wrong. this may explain her BW lose.
However, I am not sure such a short term of DM could lead to complications
such as neuropathy.
2. In exam, I would prefer to get the opinion from an expert to avoid losing
any point, lol. I am not sure what cause her neurological symptoms. her TSH looks normal. HbA1c is... 阅读全帖 |
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d**o
发帖数: 618 | 30 Moral of this story:
1) Technical point: Glucose tolerance test may be artificially high if pt self-starves too much and becomes hyper-sensitive to a glucose stimulus. The first PCP missed this point, and my teacher said he might miss it too. HbA1c could be artificially low if pt has hemolytic anemia, but her anemia has not been classified to be that.
2) Be aware that family history is a double-edged sword. It could guide or misguide diagnosis. In this case, pt likely had a limited diet from ver... 阅读全帖 |
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n*******c
发帖数: 501 | 31 Thanks for the very educational case.
1. Glucose tolerance test should be done properly before we can rely on its
result. It is very important to make sure for days or even weeks before the
test, the patient has not been restricting carbohydrate. Secondly the
patient should be fasted properly (8hrs rule). You would be surprised how
people understand fasting.lol I have had a patient (back in china) who
thought fasting means no meals but fruits doesn't count so she had some
grape before bed...
2.I... 阅读全帖 |
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b******a
发帖数: 704 | 32 咦，蝎子男生也八卦？
-------------------------------------------------------------------------
Much ado about nothing… or eventually something
我的第一个Senior 小K还是和我一个组。 在每天的下午普通门诊里，还有另外一个
Senior M 和intern 小M. 掌管这主要是面向低收入人群的门诊的是两位attending,
慈眉善目的开始向老顽童转变的attending A，和中年精干的印度裔的女attending C。
Attending A 每天都叫我Dr. China， 怕顶着那么大的帽子，我一看见他就跑，只要
有可能，就向Attending C汇报病情。
Attending C有着大而深邃的眼睛，像是经历了无数冰霜和风雨，有着犀利和无奈。 短
短两周，面对机械和笨拙的我的时候，眼睛里就是无言的各种程度的惊疑，无奈，戏谑
，鼓励和宽容。 第一天，第一个病例， 高血压糖尿病病人随访，她是卡车司机（其实
退休了），最近左腿后部被撞了一下，疼痛几日。报告病... 阅读全帖 |
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d**o
发帖数: 618 | 33 美国顶级专家号的奥妙就是不是区区几千块钱就能收买到的。PPO当然不是神器，你光
拿着去约顶级医生十个有九个会说不收新病人。如上面所说，只要病情需要，别说
Medicaid，就是流浪汉都能当天见到最好的neurosurgeon。
那除了病情需要之外的专家号呢，当然也有大把。我见过州长级的病人来约endo chief
看轻微糖尿病，HbA1c甚至都没过七。医生图啥？本院的长远发展贝。我也见过扫厕所
的病人到free clinic看拉稀，正好碰上出诊医生是gastro的vice chief，虽然没有紧
急症状，医生说你明天早上直接到我上班医院来做scope不用挂号。医生图啥？social
justice，是种美国左派思想，通过给最穷的病人最好的医疗来纠正社会的不公。
作为不是大富大贵又不是一穷到底的老中，如果病情不对口一般引不起顶级专家的兴趣
，要想找专家，不二法门是跟PCP搞好关系。The worst you can do is 流露出看不起
PCP的情绪，觉得他们不是专家尽在浪费时间。一般只要你尊重PCP，是他的老病号，碰
上可转可不转的小病PCP会主动提出说我觉得问题不大但是我也可以r... 阅读全帖 |
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l**x
发帖数: 54 | 34 谢谢garland的上次回复，最近病人查出血液尿素偏高（8.9，正常应低于7.5），和葡
萄糖升高（6.2， 正常应低于6.1), 是否与长期服用Torasemide有关呢？ 病人的HbA1c
也升高6.6。是否已是二型糖尿病，需要服用降血糖的药吗？兼顾病人有房颤，和左房
输出障碍导致的水肿，应服用那种糖尿病的药呢? 谢谢！！ |
|
g*****d
发帖数: 991 | 35 尿素偏高，可以考虑与利尿剂有关。我还是前面的建议，病人是不是需要利尿剂。
A1C偏高了，达到了糖尿病的诊断标准了，需要看医生。
这里是网络咨询，没有看到病人和具体资料。希望遵循病人主治医生的诊疗。
HbA1c |
|
l**x
发帖数: 54 | 36 谢谢garland的上次回复，最近病人查出血液尿素偏高（8.9，正常应低于7.5），和葡
萄糖升高（6.2， 正常应低于6.1), 是否与长期服用Torasemide有关呢？ 病人的HbA1c
也升高6.6。是否已是二型糖尿病，需要服用降血糖的药吗？兼顾病人有房颤，和左房
输出障碍导致的水肿，应服用那种糖尿病的药呢? 谢谢！！ |
|
g*****d
发帖数: 991 | 37 尿素偏高，可以考虑与利尿剂有关。我还是前面的建议，病人是不是需要利尿剂。
A1C偏高了，达到了糖尿病的诊断标准了，需要看医生。
这里是网络咨询，没有看到病人和具体资料。希望遵循病人主治医生的诊疗。
HbA1c |
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z*****n
发帖数: 444 | 38 FDA approves Eli Lilly's Trulicity to treat type 2 diabetes.
For Immediate Release
September 18, 2014
Release
The U.S. Food and Drug Administration today approved Trulicity (dulaglutide)
, a once-weekly subcutaneous injection to improve glycemic control (blood
sugar levels), along with diet and exercise, in adults with type 2 diabetes.
Type 2 diabetes affects about 26 million people and accounts for more than
90 percent of diabetes cases diagnosed in the United States. Over time, high
blood suga... 阅读全帖 |
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p****y
发帖数: 23737 | 39 http://www.vegetarian-nutrition.info/updates/vegetarian_diets_health_benefits.php
Recently, there has been a renewed interest in vegetarian diets. Today there
are countless books, cookbooks, and magazine articles promoting vegetarian
diets and providing guidance for those who wish to follow a meatless diet. A
Short Historical Perspective on Vegetarian Diets
In the past, many viewed vegetarianism as strange and faddish but
appropriately planned vegetarian diets are now recognized by many, includi... 阅读全帖 |
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s********1
发帖数: 211 | 40 From Google translator, 将英语译成中文, 若有疑义，请参查原文。
最近，出现了新的兴趣在素食。今天有
无数的书籍，食谱，推广素食和杂志文章
饮食以及对那些谁愿意遵循素食饮食指导。一
简短的历史透视素食
在过去，许多人认为是奇怪的和赶时髦，但素食
计划不当素食已成为公认的，许多人，包括
美国饮食协会作为被营养充足，
提供健康福利的预防和治疗慢性乙型肝炎
疾病（1）。
选择nonvegetarian生活方式具有显着的保健和医疗费用
。总在美国的直接医疗费用占肉类
用量估计为30-60亿美元，经基础
发病率较高的高血压，心脏病，癌症，糖尿病，
胆结石，肥胖和杂食动物之间的食源性疾病与
素食者（2）。
一个科学的大量文献表明，对消费
饮食全谷物，豆类，蔬菜，坚果和水果，与
避免肉类和高脂肪的动物产品，以及定期
锻炼计划是始终与降低血液中的胆固醇
水平，降低血压，减少肥胖，因此少心
病，中风，糖尿病，癌症，死亡率（1,3，4）。在非洲，
美国人来说，坚果，水果和蔬菜沙拉频繁消费
与降低百分之35-44的总死亡率（5）的风险。
特色
素食是区别于杂食其内容
干豆和小扁豆。这... 阅读全帖 |
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S***a
发帖数: 1072 | 42 September's BioPharma Catalyst Calendar
By Lisa LaMotta Sep 01, 2010 2:40 pm
This month could be full of opportunities for biotech and pharmaceutical
investors who know where to look.
•More by Lisa LaMotta
•Forest Faces a Positive-Leaning PanelOrexigen Fattens Its Coffers
With Takeda CashSeptember's BioPharma Catalyst CalendarWhat's the Buzz?
30 top traders on these stocks and more
VVUS 6.33 +0.61 (+10.75%)
FRX 29.20 +1.55 (+5.61%)
CBST 22.52 -0.09 (-0.40%)
... 阅读全帖 |
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R*****n
发帖数: 8658 | 43 i did the test twice. can not remember exact number now, but all within
normal range. so the doc was pretty relaxed |
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R*****n
发帖数: 8658 | 44 from what I learned, this is more related to average glucouse level in your
body.
我觉得还是不要纠结于某些数据， 平时做好饮食控制多监控就好 |
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R*****n
发帖数: 8658 | 45 我好像第一次测是在28周左右， 大概是5.4的样子，或者4.5? (我只记得有个4， 有个
5)
然后大概一个月以后测乐一次也是同样的值
我觉得是我不喜欢甜食， 所以tolerence test一下子来一堆甜的， 身体受不了
但是平均下来还是可以承受的。
不过葱葱够大， haha...
当年niu说她有一次吃乐饭血糖特别高， 着急的都哭， 我看的时候不理解
后来我自己很晚乐， 和dd先去吃乐拉面， 然后看电影又吃冰淇淋， 头都晕乐
回家一测都还超过120
我就很担心伤到乐宝宝
所以不是我听话， 只是孕妇的时候还关系到另外一个生命， 不敢不小心， 越到后面
越明显
tolerance |
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n**m
发帖数: 7872 | 46 我上回在北京面馆，听见有个人在我背后说：“你还吃面条？！”吓了我一跳，呵呵。
一看是dd。
所以觉得你肯定一直很听话，不乱吃东西 :)
我前一阵子也有点担心。做了B超看到宝宝长得很好就不怎么担心了 :)不过总体来说我
都不是特担心
的，估计以后也会比较后妈吧，呵呵。 |
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