GP Partner North Berwick Health Centre, GPwSI Diabetes/CVRM & Medical Education, Content Advisor
@Medscape
Global & UK, Honorary Clinical Reader
@dundeeuni
#SGLT2is
are therapeutic titans; however no drug is without harm
Here are my
#SGLT2i
resources to help ensure benefits outweigh harms
🎯Patient-facing videos:
🎯
@GinP_Medscape
Primary Care Hacks:
15 years married today! My wife has always told me our marriage is like a pack of cards - it started off all hearts and diamonds but now she just wants a club and a spade...
The primary care management of T2D is increasingly complex; here are my updated
@GPnotebook
Diabetes Shortcuts / clinical aide-memoires to help us help people living with T2D in primary care PDF versions available at
NAFLD is now MASLD: metabolic dysfunction-associated steatotic liver disease It's the liver's manifestation of the metabolic syndrome
My latest
@GinP_Medscape
@Medscape
Primary Care Hack guides the Dx & Mx of MASLD & MASH in primary care
PDF download:
Finally, I have updated my
@GPnotebook
diabetes & renal shortcut to reflect new licenses/indications! Given complexity of the situation I have split original tool into 2 to reflect glycaemic & extra-glycaemic indicationd All feedback welcome! PDF download
As promised-my updated “What next after metformin?” & "Diagnosis & classification of diabetes for Primary Care"
@GPnotebook
Shortcuts / clinical aide-memoires to reflect the rapidly evolving evidence base. PDF versions available here: All feedback welcome!
I've updated my
@GPnotebook
Shortcut on prescribing in T2DM & CKD! It now includes new cana renal indications, incoming oral sema, insulin/GLP1 combinations & other updates PDF download at All feedback & comments welcome!
"Treat the person, not the number"
Here's my latest
@GinP_Medscape
Primary Care Hack covering subclinical hypothyroidism (SCH) in primary care
Also, some tips on hypothyroidism, SCH & pregnancy as well as management of primary hypothyroidism
PDF
I've updated my
@GPnotebook
SGLT2 inhibitors extra-glycaemic indications shortcut to reflect recent changes in SPCs. PDF download All feedback welcome as usual!
Go easy on me but I am now on
@YouTube
&
@tiktok_uk
with patient-facing videos!
The first videos cover all aspects of
#SGLT2is
I have independently funded & created them
Feel free to share with your colleagues & patients
16 years! How it started and how it’s going…I asked Catherine if I was always the only one for her…she gazed emphatically me and said yes…all the others were nines and tens…🤷🏾♂️
I have updated my diabetes renal prescribing tool in light of recent changes to drug SmPCs. Updated version below and also pdf download at Please let me know if any further amendments required
Our most ambitious
@GinP_Medscape
Primary Care hack so far! A CVRM checklist for T2D!
Co-authored with pioneering CVRM GP
@EimearDarcy
we hope it is helpful as an aide memoire & a teaching tool
PDF:
Modern CVRM care is an art so all feedback welcome!
I've updated my
@GPnotebook
renal Shortcut to reflect new dapa HFrEF license This will cause debate as SmPC is a wee bit vague & doesn't follow the evidence IMHO but I feel this approach maintains a positive risk:benefit ratio Let me know what you think! PDF download link below
Really chuffed to be starting a new role as Content Advisor for
@WebMD
@Medscape
Global & UK!
Among many new projects I’ll be launching a global podcast with KOLs from a range of clinical specialties to help translate latest guidelines & evidence into everyday clinical practice
I've also just updated my "What next after metformin?"
@GPnEducation
Shortcut to include recent
@MHRAgovuk
drug safety alerts & other relevant trial data. PDF download at All feedback and comments welcome!
I've updated my
@GLNS_Medscape
Primary Care Hacks "What next after metformin?" & "Managing hyperglycaemia T2D & CKD"
These complement my "Extraglycaemic uses of SGLT2i's" hack
Full PDF downloads here:
14 years married today - Catherine has always said our marriage is like a pack of cards. It started off all hearts and diamonds but now she just wants a club and a spade...
This is my 12 year old daughter Maria’s heartfelt English essay “Being Brown” which made us all cry.
If you have some time please have a read for some insights into the ongoing challenges facing children of mixed race or ethnic origin
A personal post from me Catherine, IYASU’s founder!
My wonderful daughter Maria Fernando wrote a moving personal essay for a school assignment about what it is like being a person of colour and I wanted to share this beautifully written piece with you!
I'm looking forward to tomorrow's
@ADA_DiabetesPro
@EASDnews
consensus report 2022 update.
We're now using SGLT2i's in a much wider range of clinical scenarios in both people living with & without T2D
I've updated my SGLT2i prescribing tool to reflect recent UK license changes
I'm chuffed to announce I have achieved FRCGP & FAcadMEd for my work in diabetes&medical education Bob Proctor said "A mentor is someone who sees more talent & ability within you,than you see in yourself,and helps bring it out of you" Thanks to all my mentors-you know who you are
Reposted for
#WorldHypertensionDay
The first step in healthcare is self-care
We must educate before we medicate
Lifestyle changes & their impact on managing hypertension
PDF download
I did it! My first (and likely only...) half marathon in 1hr 51min 55s! Dedicated to all my patients who have gently been jibing me over the years to practice what I preach!
Here's the latest update for my
@GinP_Medscape
Primary Care Hack on extraglycaemic indications for SGLT2 inhibitors reflecting recent changes to the use of dapagliflozin in chronic heart failure
PDF download here:
All feedback welcome
Useful info for public on testing for COVID-19 False-negatives test can occur for both tests so if you have COVID-19 symptoms then assume you have COVID-19 even if test negative Very important for keyworkers who risk spreading COVID-19 if falsely reassured by a negative test
Our latest IDSC consensus paper has been published!
We've updated our
#SGLT2i
decision tool to reflect current practice It's also now available in interactive pdf format & printable wall poster
PDFs:
2018 NHS Scotland polypharmacy guidance has just been published with new sick day rule cards with space to jot down other meds ie SGLT2i to be temporarily stopped during acute dehydrating illness Stop the DAMN drugs during acute illness D-diuretics A-ACEI/ARB M-metformin N-NSAIDs
I've had a number of questions about my key takeaways from the recently updated & excellent
@ADA_DiabetesPro
@EASDnews
Consensus Report
I've also been experimenting with
@canva
and here's the result!
I'd be interested to hear any other key takeaways from other HCPs
Social media buddies thanks for all your support throughout 2019. It’s been a busy old year and your feedback, retweets and encouragement have been much appreciated! I’m logging off social media until mid-January to recharge and enjoy some family time. See you next year! x
I've updated my
@GinP_Medscape
@Medscape
Primary Care
#Hack
on iron studies to reflect
@bmj_latest
paper encouraging sustainable & effective iron prescribing
PDF
🎯Prescribe iron in a single daily dose or alternate day dosing to optimise iron absorption
Here's my latest
@pcdsociety
Diabetes Distilled piece exploring changes in prediabetes status & the risk of death
Prediabetes appears to be more than just dysglycaemia...
Thanks for all the lovely feedback for my
#T2D
& lifestyle patient-facing videos!
I've also been working with
@Kidney_Research
and have produced a patient-facing video on the importance of the
#uACR
test.
I hope you find it helpful.
Updated
@NICEComms
CKD: managing proteinuria published today suggesting we consider SGLT2 inhibitors in people living with T2D and UACR 3-30mg/mmol in addition to those with UACR ≥30mg/mmol on top of optimised RAAS inhibition What do my renal buddies think of this?!
I've had a few requests to share my renal prescribing in T2DM
@GPnotebook
Shortcut after my Diabetes DIstilled session at the national
@pcdsociety
conference so here it is. PDF download at
@ClareHambling
Morning - here's my latest
@pcdsociety
Diabetes Distilled piece summarising a very holistic & pragmatic consensus statement on diabetes & frailty authored by some of my esteemed colleagues and also
@AmarPut
😉
The diagnosis of diabetes in primary care is increasingly challenging Even the distinction between T1D & T2D can be blurred & often the safest approach is presume T1D until proven otherwise This Shortcut provides pointers to aid diagnosis of some of the commoner forms of diabetes
Our latest Improving Diabetes Steering Committee open-access paper has been published "SGLT2i's: Slowing of CKD Progression in T2D" See below for a peer-reviewed summary slide and also the latest version of our SGLT2 inhibitor prescribing tool
Thanks for my birthday wishes yesterday!
Thanks to my wife Catherine for another fantastic cake inspired by my understated (!) blue tartan suit!
You'll be delighted (horrified?!) to know that as a birthday present to myself, I have 3 new tartan suits arriving later this month!
The first step in healthcare is self-care. We must educate before we medicate
Here's my latest
@GinP_Medscape
Primary Care Hack on lifestyle changes & impact on⬇️BP
Hopefully helpful as a discussion aid when managing people living with hypertension
PDF
5y f/u data from DiRECT!
23% of participants who were in remission from T2D at 2 years remained in remission at 5 years
Those who were still in remission had an average weight loss of 8.9kg at 5 years
Full results
@DiabetesUK
PC 26 April
🔥Let me help you navigate the post-metformin melange!
I have overhauled my
@GinP_Medscape
@Medscape
Primary Care
#Hack
🎯Part 1: metformin, SUs, pioglitazone & gliptins
🎯Part 2: SGLTi's, GLP-1 RAs & tirzepatide
PDF downloads:
We made it! Thanks for all your support & donations - much appreciated!
5895m, -12 degrees celsius & very windy for our summit ascent however a fantastic experience
Now enjoying a few beers in Moshi before flying home 2moro & duty doctor on Monday back at North Berwick 🤦🏾♂️
Delighted to be appointed Educational Director for
@GPnEducation
- a new series of primary care update courses bringing to life the well-loved
@GPnotebook
resource Below is our 1st "Shortcut" tool: prescribing for those with diabetes & CKD. PDF download at
Updated
@NICEComms
CVD risk/guidance published today
QRISK3 & QRISK-Lifetime recommended & updated patient decision aid about statins...
But still using non-HDL targets, which is out of kilter with other lipid guidance
Thanks for feedback for my
@GinP_Medscape
Primary Care Hack covering SCH in primary care
Here are all my abnormal blood test
#Hacks
to date: iron studies, sodium & SCH
More coming soon - LFTs, calcium & high platelet counts and risk of malignancy
PDFs:
Conference season is here so no better time to launch our latest
@GinP_Medscape
Primary Care Hack on identifying people at high risk of T2D or
#prediabetes
!
I have co-authored this with the inimitable
@EimearDarcy
We hope you find it helpful!
PDF:
We're back from our family Antipidoean adventure & ready for 2020! Eventful flight back from NZ as my wife and I had to assess an elderly gentleman with chest pain and SBP of 70 & thready pulse resulting in the plane diverting to Turkey...One for our 2020 appraisal...
There has been significant recent concern about the use ACEi/ARB and risk of COVID19. This is unfounded and there is a very helpful statement from
@escardio
regarding this Of course remember sick day guidance to temporarily stop ACEi/ARB but not longterm
Thanks all who attended last night for our
@GoggleDocs
diabetes charity fundraiser! It was great craic & your energy enthusiasm & support was much appreciated! Same again next year?!
Our latest IDSC paper is published
@Diabetes_Ther
"The place & value of SGLT2is in the evolving treatment paradigm for T2D: a narrative review"
Includes updated SGLT2i prescribing tool & vignettes covering prescribing considerations
Open access paper:
Here are my latest
@GinP_Medscape
Primary Care Hacks covering the investigation of hyponatraemia and hypernatraemia in primary care
PDF downloads:
I hope you find them helpful. All feedback is welcome!
After some helpful feedback from a pharmacist colleague, I have updated my
@GLNS_Medscape
DOAC Primary Care Hack to include additional info on the use of adjusted or actual body weight in CrCl calculations.
PDF download here:
Any further feedback welcome
Thanks, everyone for your constructive feedback, support and encouragement for my various medical education and diabetes endeavours during 2018. Look forward to working with many of you again during 2019. May the best of your past be the worst of your future.
Apologies! Here's an amended version of CVRM checklist correcting a typo
I've also updated my "Lifestyle Changes & Hypertension" Hack to add a reference highlighted by
@drsarahjdavies
regarding the SBP-lowering effect of exercise - similar to drugs!
PDF
I've updated my
@GinP_Medscape
@Medscape
@MedscapeEndo
Primary Care Hack on the extraglycaemic indications of SGLT2 inhibitors to reflect recent changes to licensed indications for empagliflozin & CKD
I hope you find it helpful
PDF download:
I've updated my
@GinP_Medscape
@Medscape
Primary Care Hack on DOAC dosing & renal impairment to reflect a recent
@MHRAgovuk
DSU
I've also signposted some helpful
@NHSGGC
resources to facilitate safe prescribing of DOACs in primary care
PDF download:
Of course, we need to educate before we medicate & the 1st step of healthcare is self-care but if we are prescribing here is my updated What Next After Metformin
@GPnEducation
Shortcut for the generalist. PDF download at All constructive feedback welcome!
I've updated my
@GinP_Medscape
@Medscape
Primary Care Hack Diagnosis & Classification of Diabetes in Primary Care
Due to obesity epidemic often safest strategy is presume T1D until proven otherwise
Here are some diagnostic tips & pitfalls to avoid
PDF
For those of you who missed it last week here are my updated
@GPnotebook
prescribing tools for prescribing in T2D & renal impairment and also extra-glycaemic indications of SGLT2 inhibitors
PDF download at
All feedback welcome!
@nephondemand
My latest
@GLNS_Medscape
Primary Care Hack is live: "The Diagnosis & Classification of Diabetes in Primary Care"
Not all diabetes is T2D - here are some diagnostic pointers & pitfalls to avoid for different types of diabetes
Full version/pdf download:
The end of an era for me: Today was my last
@GPHotTopics
course.I leave NB Medical at the end of June Thanks to all the GPs, nurses & pharmacists I have met over the last 5 yrs for your kind feedback & encouragement (except those who said I look like Carlton from Fresh Prince..!)
Lifestyle modification is pivotal to the management of hypertension Effective lifestyle change can lower BP similar to a single drug This GPnotebook Shortcut outlines systolic BP reductions with a range of interventions to help facilitate change in those living with high BP
GLP1RA usage in T2D in Primary Care for the UK & Beyond: A Narrative Review authored by myself
@drpatrickholmes
@PNewlandJones
@_DipeshPatel
& Steve Bain. Open access article including a benefit/risk tool to aid the prescribing of GLP1RAs in primary care
A new once-weekly GLP1RA (semaglutide) enters the post-metformin melange this month Individualising therapies after metformin is increasingly challenging - many factors to consider e.g. renal function Here's my
#GPnShortcut
for dosing of diabetes therapies in renal impairment
Delighted to announce a new collaboration with my fellow geeks
@dr_amritlamba
@drpatrickholmes
@AmarPut
aka
@GoggleDocs
! We'll be having medically robust yet irreverent chats on a variety of cardiorenal metabolic topics Join us on YouTube & subscribe here
The
@ADA_DiabetesPro
agenda can sometimes be a wee bit overwhelming especially for newcomers. Here are my 3 picks for each day for which I'll attempt to distil key take-home messages (home-schooling permitting...) for those who are interested
My first
@GPnotebook
Podcast for 2021 is live! 25 minutes on the diagnosis & management of vertigo in primary care with an accompanying Shortcut / clinical aide-memoire for use in primary care All feedback welcome!
Here's my latest
@pcdsociety
Diabetes Distilled piece
I discuss an additional clinically meaningful benefit of SGLT2i's: ⬇ use of anti-gout medication
Is this contributing to their cardiorenal benefits & are they future anti-gout treatments?
🔥Hot off the
#ESCCongress
here's my
@pcdsociety
Diabetes Distilled piece on EMPEROR-Preserved
"The EMPEROR really does have new clothes"
All feedback and discussion welcome
Here's my latest
@GLNS_Medscape
Primary Care Hack covering top tips and pitfalls to avoid when requesting and interpreting iron studies in primary care
PDF download here:
I hope you find it helpful.
Very useful
@bmj_latest
"Rational Testing" article on distinguishing between type 1 & type 2 diabetes - very relevant to all in primary care where increasingly the safest strategy is to presume type 1 diabetes until proven otherwise...
Thanks for a great couple of days at DPC 2019 Great education & top banter! Look forward to catching up again at national PCDS conference Birmingham next week As it is the season of diabetes conferences find attached again my diabetes GPnotebook shortcuts for your delectation!
We’re at Barafu (base) camp 4673m!
Summit ascent tonight departing midnight to Uhuru peak 5895m before rapid descent to Millennium camp 3790m
Wish us luck!
@Kidney_Research
DOACs are increasingly prescribed in primary care However they are not "fire and forget" drugs & need careful dosing in renal impairment according to creatinine clearance & not eGFR This
#GPnShortcut
provides guidance on safe dosing of the 4 currently available DOACs in NVAF
Useful reminder from the MHRA last week about using CrCl rather than eGFR for DOACs, nephrotoxic drugs, those >75y, BMI <18 or >40 or drugs with narrow therapeutic index eg digoxin & sotalol Here's my
@GPnEducation
Shortcut on DOAC dosing in renal impairment again to help
My latest
@GLNS_Medscape
Primary Care Hack is live: DOAC dosing for stroke prevention in people with NVAF & renal impairment
I've included some prescribing & monitoring tips as well as pitfalls to avoid within the footnotes
PDF download:
My latest
@GPnEducation
Podcast is live. I am grateful to
@parthaskar
for 10 minutes of his time to discuss the recent data published by
@NHSEngland
on type 1 & type 2 diabetes & COVID-19 related mortality and the implications for us as HCPs and our patients living with diabetes