Tuesday, December 31, 2024

PaJR BP monitoring on the Omron app

 

Conversational Transcripts:

[29/12/2024, 08:21] 65M Hypertension diabetes few years: For last one week, I am not using Telmisartan 20mg morning But, Telmisartan-H 40mg at night is continuing


[29/12/2024, 08:30] PaJR moderator: Share 10 readings today at random intervals covering the entire 24 hours


[29/12/2024, 19:41] 65M Hypertension diabetes : This reading is take just now while eating hot & highly salted magi.
This is FYI


[30/12/2024, 08:30] 65M hypertension diabetes : 

128/82 - 84 at 8:15 am on 30th
118/78 - 69 at 5:50 am on 30th
132/62. - 86 at 4:40 am on 30th
138/83 - 78 at 4:30 am on 30th
144/84. - 79 at 4:10 am on 30th
138/78 - 77 at 9:40 pm on 29th
158/90 - 84 at 7:30 pm on 29th
136/76. - 79 at 5:15 pm on 29th
133/66 - 82 at 3:00 pm on 29th
113/57 - 78 at 2:00 pm on 29th
108/61 - 84 at 1:40 pm on 29th
139/81 - 75 at 10:30 am on 29th
139/82 - 75 at 8:15 am on 29th
142/85 - 75 at 8:07 am on 29th

[30/12/2024, 08:34] 65M hypertension diabetes : 

142/85,  after coffee  1 reading 
144/ 84 immediately after waking up
158/90 immediately after high salt Maggi intake




[30/12/2024, 08:45] PaJR moderator: 

Please share the timing of your BP medication

[30/12/2024, 08:53] 65M hypertension diabetic : Only night at 9:00 pm Telmisartan-H 40mg one tablet

[30/12/2024, 08:45] PaJR moderator: What did you use to plot this?

[30/12/2024, 08:54] 65M hypertension diabetes : Omaron app



UDLCO: Aviation and healthcare, flight simulator driven learning and medical education simulation analogies toward a google map of healthcare

 

Summary

The conversation revolves around the analogy between aviation and healthcare, exploring the complexities of healthcare and the potential for creating a "Google Map" of healthcare. The discussants delve into the challenges of mapping individual patient journeys, the role of technology and data, and the differences between engineering and clinical perspectives.

Some featured quotes from the conversational transcripts below:

The engineer sees systems; the clinician sees stories.

Both approaches are complementary: the system an engineer envisions supports the individualized journeys the clinician focuses on. The challenge is bridging the system's abstraction with  patient-specific adaptability.

An illness as mentioned earlier can be likened to a plane ride and there are possibly multiple interventions involved including medications, operations and physiotherapy (each of these interventions are different vehicles involved in that plane ride including the vehicles one uses to reach the departing and arrival airports).

As mentioned earlier the outcome of that travel ending safely and quickly can be predicted to a certain extent by the comorbidities the patient traveller already brings as a baggage. 

Now in this flight analogy while the plane offers a lot of significant contribution in the journey, not all operative interventions may offer the same support in terms of solving the patient's main problem other than guaranteeing a smooth passage into deeper planes of anesthesia with some statistical guarantee of emerging out from it.

The main problem/s of the patient could fester and persist prolonging the journey (most of the times it's between the airport and home) and eventually time emerges as the greatest healer. Inspite of all the hype when it comes to healing efficacy no single intervention has been able to compete with time in terms of healing (which also means it's the internal medicine intelligence of our 30 trillion celled bodies that eventually decides their own outcome).

Human reticence to understand and overcome these challenges through data driven healthcare stems from their reticence to capture and share data in a transparent and accountable manner

Key Words
1. Aviation and Healthcare Analogy
2. Google Map of Healthcare
3. Individual Patient Journeys
4. Technology and Data in Healthcare
5. Engineering and Clinical Perspectives
6. Medical Informatics
7. Robustness and Reliability

Conversational Transcripts:

[25/11, 12:27] Patient Advocate 29M Quantified Self: Various possibility for this rare event, including possible mannual error (but not only that).


[25/11, 12:34 rb: Need more details of the procedure including OT notes to comment

Health IT relevance:

Lots! Transparent and accountable healthcare still sounds like a dream promise of health IT but the above case scenario is the reason we need more health IT driven transparency and accountability in data driven healthcare


[25/11, 12:48] AC: First... I think the doctor is a thorough professional with very high integrity. Lithotripsy is not a "guaranteed" treatment

Second... From medical devices perspective - the brand of the machine could be at fault too and not so sure about the professionalism of the technician. 

Was the device taken through "dummy" test that day? 

Is the planning and targeting correlation demonstrated for the device. Ultrasound penetration is heavily dependent on tissue type. Improper targeting "can" cause pain during lithotripsy. Does it? Will need to check literature

The treatment planning for patients should be maintained for any such claim. 

Personal opinion: Names are best left out


[25/11, 13:28] RKB AIH: When an engineer makes a faulty bridge or financial error with significant losses he literally pays with his job. It becomes his responsibility primarily, not the bull dozer or the computer on which he did his calculations. And yes, if there are inconsistencies those external factors are also punished.


[25/11, 15:10] AC: When a plane crashes without pilot error?


[25/11, 15:34] RKB AIH: The pilot is first suspended & put on probation until pending investigation of Blackbox contents before expert panel & TSA reps


[25/11, 16:01] Patient Advocate 29M Quantified Self: Technological limitation. 

Clinical science doesn't have checks and balances for high accuracy, neither funding to brute force diagnostics, nor safety profile to brute force treatment plan. So we keep steering decision (approach) for improving it according to data gathered while discourage overdiagnosis and overtreatment.

So the quality standards are also made accordingly in medicine. 

Airlines and bridges are not operated in uncertain / risky environment beyond a small limit. Thanks to Technological advancements.

Ex. - failure rate of lithotripsy (kidney stone breaking procedure) is 10-30%


[25/11, 16:15] AC: But quite often cleared too. 

The reason I mentioned the pilot example is from the perspective of safety critical systems. 

Medical systems are some of the most common case studies in  safety critical systems engineering


[25/11, 16:35] rb: Yes and the other point is that medicine has been hyped so much over the last few decades by unscrupulous vendors wanting to profit that the public feels it's as good as a plane ride most of the time while the truth is it's much more complex than that!

Perhaps one could have an interesting model interface based on a commercial flight analogy where one may enter the predictive variables of any patient (aka plane traveller) entering the hospital and based on his her comorbidities try to predict the likelihood of his her reaching destination health safely and very importantly the probable time taken to reach there! @⁨AC⁩ @⁨RKB AIH⁩


[25/11, 16:40] RKB AIH: I respectfully disagree…every faculty has risks & guardrails. Aviation risk factors along with flight parameter risks coupled with environmental factors are one of the most dynamic risk factors in the world.

[25/11, 16:43] Patient Advocate 29M Quantified Self: Medical science is lagging far behind in terms of technological advancement and it's access.

[25/11, 16:45] rb: Let's consider this analogy:

In an aeroplane you have a normal person without any illness boarding the plane and getting down at the destination

In an OT you have a person with pre existing illnesses getting operated.

Now his chances of surviving the operation will depend on his pre existing illnesses vs no pre existing illnesses.

Next would come the efficacy of the intervention in solving the problem (here the plane analogy may not hold good unless dragged into a further train or car journey till they reach home)

[25/11, 16:49] Patient Advocate 29M Quantified Self: *Lagging far behind in terms of promising high certainity for individual case.

Surely huge advances for humanity.

[25/11, 16:50] RKB AIH: In case of a flight there are thunderstorms, mechanical failures/bugs (remember boeing 737 rudder issues on fly by wire) etc etc, shortage & overworked personnel, wars & diversions to unknown terrains…yet the casualties r minuscule


[25/11, 17:00] Patient Advocate 29M Quantified Self: Atul gawande pioneered checklist use 20+ years ago, still same example is repeated in these papers..they are useful. Even 1% error correction is good and it did more..but still very very tiny thing if we consider over all clinical practice.

[25/11, 17:02] Patient Advocate 29M Quantified Self: There are many more strategies Implemented and practiced and then the current quality standards are met which is still too low compared to airlines accuracy.

[25/11, 17:02] RKB AIH: So nothing changed to correct course in 20 years ? Maybe its the reticence that need to be addressed first

[25/11, 18:21] AC: Aviation is not "safe" in that sense. 

Because everything is controlled factors like random pockets of turbulence are avoided. Passenger have died owing to turbulence in the past few weeks

25/11, 18:50] rb: This would be analogous to  anesthesia related deaths and are fortunately rare

[25/11, 18:23] AC: This video will most likely change the perception people have of flight safety. 

Wear your seatbelts when the pilot asks you to


[25/11, 18:46] rb: Let's try this analogy again:

Healthcare is a journey and has a certain course and every illness as well as patient journey is different because of the greater amount of known and unknown variables

An illness as mentioned earlier can be likened to a plane ride and there are possibly multiple interventions involved including medications, operations and physiotherapy (each of these interventions are different vehicles involved in that plane ride including the vehicles one uses to reach the departing and arrival airports).

As mentioned earlier the outcome of that travel ending safely and quickly can be predicted to a certain extent by the comorbidities the patient traveller already brings as a baggage. 

Now in this flight analogy while the plane offers a lot of significant contribution in the journey, not all operative interventions may offer the same support in terms of solving the patient's main problem other than guaranteeing a smooth passage into deeper planes of anesthesia with some statistical guarantee of emerging out from it.

The main problem/s of the patient could fester and persist prolonging the journey (most of the times it's between the airport and home) and eventually time emerges as the greatest healer. Inspite of all the hype when it comes to healing efficacy no single intervention has been able to compete with time in terms of healing (which also means it's the internal medicine intelligence of our 30 trillion celled bodies that eventually decides their own outcome).

Human reticence to understand and overcome these challenges through data driven healthcare stems from their reticence to capture and share data in a transparent and accountable manner



[25/11, 19:18] AC: Nice points. One major difference - airlines usually begin the process with healthy people and healthy machines. 

In healthcare, again usually - maybe hopefully, the machines are healthy, but invariably 50% of the equation are not. They are called patients!

25/11, 19:28] rb: Yes also mentioned in the pubmed article linked above

[25/11, 19:20] AC: Think of a pilot flying with even one seriously ill patient. 

Or, flying a sick plane.


[25/11, 19:35] S Ed: You know the structure and mechanics of the plane because humans designed it. With humans, the "normal" is also not fixed. Your heart may not be in the place you expect and you may be fine.

[25/11, 19:43] RKB AIH: What stops us from perfecting the understanding ? This is why  rb’s last paragraph is  very important

[25/11, 19:45] RKB AIH: We do have sick planes !! Pilots deftly maneuver around those drawbacks…u will dread flying and I will guarantee u will have heart attack 😀

[25/11, 19:48] RKB AIH: Believe me I pray to thousand gods before setting foot on a plane…ignorance is truly bliss in this regard

[25/11, 19:48] AC: So we need people designed by humans.

[25/11, 19:50] RKB AIH: Yay ! Digital twin makes a comeback 😃

[25/11, 20:02] rb: Problem is treating digital twins will not cure their physical brethren!

[25/11, 20:03] rb: Robots yes but most of them will likely have their own healing systems embedded in their design very much similar to how evolution created our trillion celled collaboration over ages

[25/11, 20:04] AC: I meant designer babies... 

Built to spec

[25/11, 20:04 rb: Hmm you meant biological!

[25/11, 20:06] AC: Yes. Synthetic diseased beings get recycled without a thought. 

Biological ones get recycled too... But the emotional loading is high. 

.... 

From a disease loading perspective, make designer babies with all attributes one likes.


[27/11, 10:08] JG: Phone safety versus road sign safety. https://www.instagram.com/p/DC2-Nmes21m/


[27/11, 10:18] rb: "3 men were killed after their car drove off an incomplete bridge and plunged onto a riverbed while they were navigating with Google Maps in Uttar Pradesh, India.

A local police officer reportedly said the front portion of the bridge collapsed into the river during floods earlier in 2024, but this change was not reflected on the navigation app.

He added that there were no safety barriers or warning signs on the bridge.

A Google spokesperson said: “Our deepest sympathies go out to the families. We’re working closely with the authorities and providing our support to investigate the issue.”


[27/11, 10:21] RKB AIH: So is Google liable for their deaths ?


[27/11, 10:22] rb: Very interesting question!


[27/11, 10:23] JG: No, read terms of service disclaimer. Liability is with local authorities for lack of road safety signs.

[27/11, 10:23 rb: Let's reframe the question and answer in the light of aviation and healthcare analogies and let's try to spot the transportation and healthcare analogy here


[27/11, 10:27] rb: We too practice this kind of healthcare in what we have started calling "global learning toward hyperlocal caring" and we often with all our texts to the patient ask them to get our suggestions verified with their local doctors in the same style as Google! But can they? Obviously not and that's the reason they are reaching out to us distantly with their hyperlocal needs! 


So this is a current problem in E healthcare that we have to contend with?

[27/11, 10:28] rb: It's a collaborative endeavour and everyone including the drivers (tech end user) is liable?


[27/11, 10:29] JG : The user has to first accept terms of service then only can use it. So Google most probably won’t be held liable. They can challenge it in courts.

[27/11, 10:31] rb: Yes and accepting it is as simple as clicking on "i agree" at the time of downloading it from Google playstore? What if the app was pre-downloaded by the mobile phone vendor?


[27/11, 10:31] RKB AIH: Exactly!! Google can’t look for you & you can’t put signs everywhere. It’s a collective responsibility, yet when an incident happens Nobody is automatically absolved, hence Google had to reach out and intervene despite its job being accomplished


[27/11, 10:34] RKB AIH: I dont know how it works in medical field..can someone extend this to a medical world…what happens when it goes south with a patient?

[27/11, 10:34] JG: If ordinary folk get large compensation from negligence of administrators, we would have a different scenario. Holding tech companies liable is an easy way out.

[27/11, 10:35] JG: Same for using AI in medical field. No liability

[27/11, 10:35] rb: We don't have a Google map of healthcare!

[27/11, 10:37] RKB AIH: Isn’t that what medical education is supposed to do ? Ur doctors are ur gps to maneuver ur health in right path ?

[27/11, 10:39] rb: Yes but our map is not as great as the current google map!

Healthcare is still largely 99.999% uncharted territory! Although the percentage perspective will vary with your years in healthcare. For the first year medical student its 99.99% charted territory


[27/11, 10:43] RKB AIH: That’s what boggles mind. Pardon my medical ignorance. If one company could map every single road in the world in a span of 2 decades, why can’t a conglomerate of medical professionals across the entire globe map a human body correctly with it’s characteristics


[27/11, 10:44] rb: The human body is analogous to the universe and the mapped surface of thd Earth is just one of it's trillion cells!


[27/11, 10:48] RKB AIH: Agreed. But most treatments are at bone/muscle/nerve level wouldn’t that make it easier to  atleast partially cover major ailments?


[27/11, 10:50] rb: Yes that's covered but currently that is way inadequate to match up to the travellers requirements and expectations


[27/11, 10:54] rb: I think i shall offer that as a hook to the audience tomorrow to break the ice! Can we engineers and doctors think of building a google map of healthcare together to help navigate billions of healthcare journeys!

That will be our ask!



[27/11, 11:23] AC: It needs to be formed like a crypto


[27/11, 11:27] AC: Because google maps is crowd sourced

It has been done on humans

1. HeLa
2. The subjects of visible human project
3. Human genome project
4. Human Brain project (on going) 

Just like physicians are the only "doctors" folks encounter, gmaps is the only mapping folks encounter. 

For instance, not many here would be aware of open cell id project

[27/11, 11:53] AC: This was sunset last year


[27/11, 11:55] rb: Yes but here the analogy is to gmaps and individual journey navigation.

The projects you have listed may not compare?

We need to compare it with individual patient journeys!

Let's say for example an 80 year old man has a fall and other than a black eye also notices left upper limb weakness and visits a neurosurgeon who advices an operative intervention to decompress what appears to be a spinal cord compression on MRI in the hope that this will give him better mobility and then the journey begins with the current google map of healthcare!


[27/11, 11:59] AC: Think again! 

The map is one, how it's used presented is unique

The same happens with genomic medicine

Should begin to happen with neuro

..... 

The challenge lies in not being able to crowd source the map of each individual. 

Even gmaps fails outside cities. 

.... 

The only crowd sourcing individuals can  do is my the crowd of themselves... Their longitudinal EHR

.... 

Don't disagree with your view on personal patient journeys, but maybe the analysis you applied needs a refactoring


[27/11, 12:02] RKB AIH: Map is only the guideline, how you use it for individual patient care should be ascertained

I draw analogy as map is like foundational model & you transfer learn for downstream tasks


[27/11, 12:02] AC: While you type let me try chatPakoda... Whether it gets the nuances


[27/11, 12:03] RKB AIH: Like Dr. Hinton eluded trying g to make sense of entire brain in one shot may be too much…localized understanding may be the key


[27/11, 12:06] AC: Your and Dr. rb's approaches differ in focus and perspective, stemming from your professional backgrounds:

1. Approach to the Problem

Engineer, Reductionist perspective:

Focuses on the system-level architecture and foundational principles (e.g., maps as a unified dataset, EHR as the data backbone).

Reductionist in that you break the problem into components (data, crowdsourcing, maps) and analyze scalability, reliability, and use cases.

Emphasizes individual data aggregation (longitudinal EHR) as the key to personalizing the map.

You view the map as a system shared by all, where the uniqueness arises in interpretation and application.


Clinician, Patient-Centric perspective:

Views healthcare from the lens of individual patient journeys.

Focuses on the experiential aspects of the journey, such as decisions, interventions, and their outcomes.

Analogizes the map to the navigation of individual clinical situations, where personalized deviations from the norm are key.

Highlights real-time problem-solving, especially in complex, patient-specific contexts.



2. Underlying Differences in Professional Backgrounds

Engineer:

Deals with complex systems, requiring abstraction, scalability, and process optimization.

Prioritizes systems integration, repeatability, and leveraging data infrastructure for consistency and personalization.

Often reductionist to analyze individual components of a system, but capable of understanding emergent behaviors in complex systems.


Clinician:

Focuses on human-centric, real-time decision-making, rooted in individual variability and holistic outcomes.

Experience-driven, often anecdotal, yet attuned to system-wide limitations impacting patient care.

Less focused on systems engineering but deeply invested in navigating complex biological systems.



3. How This Shapes the Analysis

Engineer:

Emphasize creating a reliable, universal framework (the map) where personal journeys derive from individual data integration.

Advocate for longitudinal health data to serve as the patient's own "crowdsource" resource.

View variability as a result of system limitations in data aggregation or infrastructure, solvable via better tools (EHRs, genomic databases).


Clinician:

Focuses on the individual's immediate experience, prioritizing the journey itself over the infrastructure.

Sees variability as intrinsic to patient care, emphasizing adaptive decision-making over universal frameworks.



Conclusion

Your differences likely stem from your distinct professional paradigms:

The engineer sees systems; the clinician sees stories.

Both approaches are complementary: the system you envision supports the individualized journeys he focuses on. The challenge is bridging your system's abstraction with his patient-specific adaptability.

[27/11, 12:07] AC: I would say this is an "artistic" reply from the AI


[27/11, 12:07] SA: Very very nicely put


[27/11, 12:10] RKB AIH: Well summarized. I agree, this is why medical AI help as they r complementary

[27/11, 12:14] AC: I liked the part where it says "engineers see systems, doctors see stories"

[27/11, 12:21] rb : There is a story inside every system!

[27/11, 12:22] rb: Can no longer call it chat pakoda! It's proving to be anandamide!


[27/11, 14:16] JG: All the best. If you can map all the trillions of neural pathways in the brain of a single individual, that alone will be similar to mapping the universe.


[27/11, 15:55] AC: I guess I know why... We can't even lend a simple pen to someone without worrying that it's not coming back to us! 

What a population! Our lack of integrity is the biggest proof that modern humans originated here. 

Originated here and conned all the other hominid species out of existence.


[27/11, 23:32] SN: The road department got away with the death of the  Tata executive where 3 lanes suddenly became two with a walk in front. Regular people are immaterial for our killer roads.


[27/11, 23:35] SN: They could have had the same accident even without Google.   Fault lies with whoever is responsible for maintaining the road. They should put barriers and signs to close the road.


[28/11, 00:41] AC: The robots are not the challenge, the network latency is.

One off demo can be done, but deployment at scale is not feasible


[28/11, 00:43] AC: Ref CNS for the planet

It should now be obvious why a global round trip for packets needs to happen faster than our NCV to the digits


[28/11, 01:57] RNG HIT: And that is under major threat from uncontrolled growth of AI 🤔. End of Kalyug?


[28/11, 06:20] AC: Rather beginning of its patal phase...

Patal is true singularity... Before that there will be the various other layers.


[28/11, 06:24] AC: Anyway, pataal, rakshasas etc are not what mass media of the oceanic type (read in English) have made it out to be.

I tried to use AI to generate images of Pataal which is an utopian abode with Rakshasas who are the most attractive beings. Will share if I find it.


[28/11, 06:35] AC: Found this. Most of the description I remember were captured by AI.

1. No sunlight, lots of "mani"
2. Even nights are glittering bright 
3. Lots of magnificent contraptions
4. People who live there use artificial means to look very attractive 
5. Diseases are almost non existent 
6. Abode of other life forms like Nagas who are super intelligent 
7. Buildings touch the sky


[28/11, 06:38] AC: Anyway, this deserves a little explanation of how it's digital health related.

Patal lok has a model of UHC. Universal Health Coverage 

Those were the thought experiments of our Rishis on how health for all could be achieved 

Patanjali was claimed to be a Naga.


[28/11, 06:42] AC: This article touches upon how the purported Pataal entry remained covid free.

(Though I disagree with it literal interpretation)



[28/11, 07:06] rb: Sounds like internal medicine as in getting into our internal universe of trillion cells and their interstitial SPACE!


[28/11, 07:17] AC: Ayurveda and Yoga Sutra do link these to the body


[28/11, 07:18] AC: Matches our maps of healthcare and geo maps discussion yesterday 

The anecdotal stories have survived... Which is good

However, most of the anecdotal interpretation have been lost

[28/11, 07:21] rb: Yes so in this collaborative Google map of healthcare that we hope to collaborate on here, there's an external road map of external patient life events and there's a parallel road map for internal medicine life events that happen inside the patient's body and these maps are connected but we still need to make the connection explicit


[28/11, 07:22] rb: Essentially external and internal data points surrounding an individual's car journey through birth and death

[28/11, 08:59] AC: Medical informatics needs robustness like financial informatics

The amount of modelling that exists for Fintech is exponentially higher than medtech (for the clinical encounter, not high end devices)


Here's a summary, key words, and thematic analysis of the conversational transcripts:

Summary
The conversation revolves around the analogy between aviation and healthcare, exploring the complexities of healthcare and the potential for creating a "Google Map" of healthcare. The discussants delve into the challenges of mapping individual patient journeys, the role of technology and data, and the differences between engineering and clinical perspectives.

Key Words
1. Aviation and Healthcare Analogy
2. Google Map of Healthcare
3. Individual Patient Journeys
4. Technology and Data in Healthcare
5. Engineering and Clinical Perspectives
6. Medical Informatics
7. Robustness and Reliability

Thematic Analysis
_Codes_
1. Aviation and Healthcare Analogy
2. Complexity of Healthcare
3. Technology and Data
4. Individual Patient Journeys
5. Engineering and Clinical Perspectives
6. Medical Informatics
7. Robustness and Reliability

_Themes_
1. _Aviation and Healthcare Analogy_: The conversation starts with the analogy between aviation and healthcare, highlighting the complexities of healthcare and the potential for creating a "Google Map" of healthcare.
2. _Complexity of Healthcare_: The discussants emphasize the complexity of healthcare, with multiple variables and uncertainties, making it challenging to create a comprehensive map.
3. _Technology and Data_: The conversation explores the role of technology and data in healthcare, including the potential for AI, machine learning, and data analytics to improve patient outcomes.
4. _Individual Patient Journeys_: The discussants highlight the importance of individual patient journeys, emphasizing the need for personalized care and the challenges of mapping these journeys.
5. _Engineering and Clinical Perspectives_: The conversation reveals the differences between engineering and clinical perspectives, with engineers focusing on systems and clinicians focusing on individual patient stories.
6. _Medical Informatics_: The discussants touch on the importance of medical informatics, highlighting the need for robust and reliable systems to support clinical decision-making.
7. _Robustness and Reliability_: The conversation emphasizes the importance of robustness and reliability in healthcare systems, drawing parallels with financial informatics.

Learning Insights
1. _Interdisciplinary Collaboration_: The conversation highlights the need for interdisciplinary collaboration between engineers, clinicians, and other stakeholders to create a comprehensive map of healthcare.
2. _Personalized Care_: The discussants emphasize the importance of personalized care, highlighting the need for individual patient journeys to be mapped and understood.
3. _Technology and Data_: The conversation reveals the potential for technology and data to improve patient outcomes, but also highlights the challenges of implementing these solutions in complex healthcare systems.
4. _Medical Informatics_: The discussants highlight the importance of medical informatics, emphasizing the need for robust and reliable systems to support clinical decision-making.
5. _Complexity of Healthcare_: The conversation emphasizes the complexity of healthcare, highlighting the need for nuanced and multifaceted solutions to improve patient outcomes.





CC licence for the above image: https://commons.m.wikimedia.org/wiki/File:980310-N-7355H-003_Simulator_Training.jpg#mw-jump-to-license

UDLCO: The beta AI generation and artificially distributed natural intelligence

Featured Summary:


AI is nothing but artificially distributed natural intelligence and while evolution designed this cognitive instrument called "intelligence" rather well, it didn't manage to distribute it well enough equally amidst all beings it allowed an embodiment of cognition!

Artificially distributed natural intelligence comes to compensate for this evolutionary folley?

Key Words
1. Generation Beta
2. AI
3. Natural Intelligence
4. Artificially Distributed Natural Intelligence
5. Societal Divide
6. Equalizer
7. Super Intelligence


Conversational Transcripts:

[30/12, 20:02] rb: In two more days the world will get ready to welcome gen beta!

Generation Beta follows Generation Alpha, whose members were born between 2010 and 2024. Before Generation Alpha came Generation Z (1996-2010) and millennials (1981-1996). The naming convention, starting with Generation Alpha, uses the Greek alphabet to mark the beginning of a new generational era.

While gen z and alpha were shaped by internet and google, gen beta will be shaped by AI!

[30/12, 20:04] DRNR: Totally devoid of own faculties? 

No natural intelligence?


[31/12, 11:29]rb: AI is nothing but artificially distributed natural intelligence and while evolution designed this cognitive instrument called "intelligence" rather well, it didn't manage to distribute it well enough equally amidst all beings it allowed an embodiment of cognition!

Artificially distributed natural intelligence comes to compensate for this evolutionary folley?

[31/12, 12:14] DRNR: Yes, it will certainly be a _bigger_ folly - those who have access to and those who do not  - AI


[31/12, 13:00] PS : Good logic . So AI can be a great equalizer perhaps , one can buy intelligence and productivity . 

Earlier religion and ethical groups used to be the one against rapid scientific growth . In case of AI - scientists and inner circle of people including father of AI are warning against its dangers and want it to slow down


[31/12, 13:01]DRNR: AI will be the new weapon for societal divide - haves and have nots!


[31/12, 13:04]PS: Internet equalized people and made business possible for poor too . AI I don't know 

But it is predicted to become super intelligent  more than any human . And then .... ?????


[31/12, 13:05] PS: It is certainly going to reduce manpower need in immediate future . 

Even one man alone can run a small company it seems - using AI assistants .

Here's a meta AI generated summary, key words, and thematic analysis of the conversational transcripts:

Summary

The conversation revolves around the upcoming Generation Beta, who will grow up with AI shaping their lives. The discussants explore the implications of AI on society, including its potential to equalize access to intelligence and productivity, but also to exacerbate societal divides.

Key Words
1. Generation Beta
2. AI
3. Natural Intelligence
4. Artificially Distributed Natural Intelligence
5. Societal Divide
6. Equalizer
7. Super Intelligence

Thematic Analysis
*Codes*

1. Generation Beta
2. AI Impact
3. Natural Intelligence
4. Artificially Distributed Natural Intelligence
5. Societal Divide
6. Equalizer
7. Super Intelligence

*Themes*
1. *Generation Beta and AI*: The conversation starts with the introduction of Generation Beta, who will grow up with AI shaping their lives.
2. *AI Impact on Society*: The discussants explore the implications of AI on society, including its potential to equalize access to intelligence and productivity.
3. *Natural Intelligence vs. Artificial Intelligence*: The conversation touches on the concept of natural intelligence and how AI can be seen as artificially distributed natural intelligence.
4. *Societal Divide*: The discussants express concerns that AI may exacerbate societal divides, creating a new class of "haves" and "have nots".
5. *Equalizer or Divider*: The conversation raises questions about whether AI will act as an equalizer, providing access to intelligence and productivity for all, or a divider, widening the gap between those who have access to AI and those who do not.

Learning Insights
1. *AI's Double-Edged Sword*: AI has the potential to both equalize access to intelligence and productivity and exacerbate societal divides.
2. *Need for Responsible AI Development*: The conversation highlights the need for responsible AI development, ensuring that AI is designed and deployed in ways that benefit society as a whole.
3. *Importance of Digital Literacy*: As AI becomes increasingly prevalent, digital literacy will become essential for individuals to navigate and benefit from AI-driven technologies.
4. *Potential for Job Displacement*: The conversation touches on the potential for AI to displace jobs, highlighting the need for workers to develop skills that complement AI-driven technologies.



Monday, December 9, 2024

Playbook sample chapter: Participatory medical cognition 2.0-3.0 and beyond, a PaJR UDLCO with Meta AI and later perplexity: Hypoglycemia hyperawareness

Summary:


The conversation revolves around a patient's daily blood sugar levels, medication, and food intake. The patient is being monitored and advised by a healthcare provider. The conversation also touches on the topic of hypoglycemia hyperawareness, a phenomenon where individuals with diabetes become overly sensitive to bodily sensations that may be misinterpreted as hypoglycemia.

_Key words:_

1. Diabetes management
2. Blood sugar levels
3. Medication adherence
4. Hypoglycemia hyperawareness
5. Patient education
6. Healthcare provider-patient communication

The entire PaJR of the patient is archived open access here: https://2patienthealthreport.blogspot.com/2024/06/patienthealthreport.html




Conversational learning transcripts:

[04/12, 23:49] Patient DM1 MP Advocate 2: 7:15 am Drink 1 cup black tea without sugar 

9:10 am before breakfast sugar 136

9:15 am

1 Paratha with potato fry 

11:50 am after breakfast sugar 200

12:20 pm eat apple 

2:05 pm before lunch sugar 158

2:10 pm 

2 roti with potato fry 

4:20 pm after lunch sugar 168

5 pm eat 1 guava 

7:50 pm drink 1 cup black tea without sugar and ate 2 piece fruit cake

8 pm insulin lantus 8.5 unit 

9:40 pm before dinner sugar 176

9:45 pm 

2 roti with Ganth gobhi fry

11:45 pm after dinner sugar 178


[05/12, 06:23] Patient DM1 MP Advocate 2: Good morning sir 
5/12/24
6:25 am fasting sugar 137


[05/12, 08:47] PaJR moderator: 👍

[05/12, 23:10] Patient DM1 MP Advocate 2: 7:05 am drink black tea without sugar
9:10 am before breakfast sugar 131
9:15 am 
2 roti with long beans fry                                                                          
11:50 am after breakfast sugar 196
12:20 pm eat 1 apple
1:25 pm before lunch sugar 176
1:30 pm 
2 Paratha with long beans fry
4:00 pm after lunch sugar 219
4:30 pm eat 1 guava
7:45 pm eat banana chips
7:50 pm drink black tea without sugar
8 pm Insulin Lantus 8.5 unit
9:40 pm before dinner sugar 208
9:45 pm 
2 roti with long beans fry ,ganth gobhi curry and chalkumra fry             
11:15 pm after dinner sugar221


[06/12, 06:27] Patient DM1 MP Advocate 2: Good morning sir 
6/12/24

6:30 am fasting sugar 171

[06/12, 11:14] PaJR moderator: 👍can make it 9 today

[06/12, 11:26] Patient DM1 MP Advocate 2: Ok sir

[06/12, 23:00] Patient DM1 MP Advocate 2: 6:45 am drink 1 cup black tea without sugar 

9:15 am before breakfast sugar 131

9:20 am 

1 roti with pointed gourd fry 

11:30 am after breakfast sugar 210

12:30 pm eat papaya 

1:25 pm before lunch sugar 215

1:30 pm 

2 roti with pointed gourd fry 

4 pm after lunch sugar 241

5 pm drink 1 cup black tea without sugar 

5:30 pm eat 1 apple 

6:30 pm eat some banana chips 

8 pm insulin lantus 9 unit 

9:15 pm before dinner sugar 126

2 roti with pointed gourd fry, brinjal fry and kochuri loti 

11 pm after dinner sugar 265


[07/12, 06:13] Patient DM1 MP Advocate 2: Good morning sir 
7/12/24
6:15 am fasting sugar 141


[07/12, 08:43]pm: 👍

[07/12, 23:11] Patient DM1 MP Advocate 2: 6:45 am drink 1 cup black tea without sugar 

9:15 am before breakfast sugar 143

9:20 am 

1 roti with bottle gourd fry 

11:30 am after breakfast sugar 155

12 pm eat papaya 

1:25 pm before lunch sugar 202

1:30 pm 

2 roti with bottle gourd fry 

4 pm after lunch sugar 235

4:30 pm eat 1 apple 

7:50 pm drink 1 cup black tea 

8 pm  insulin Lantus 9 unit 

9:20 pm sugar 92 trembling and sweating 

Eat 2 chochlate and then rice and arum curry 

11 :15 pm after dinner sugar 199


[08/12, 07:39]pm: Fasting today?

[08/12, 08:55] Patient DM1 MP Advocate 2: Good morning sir 
8/12/24
9 am fasting sugar 134


[08/12, 17:39] Patient DM1 MP Advocate 2: 10 am Drink 1 cup black tea without sugar 

10:25 am before breakfast sugar 147

10:30 am 

Porridge 

12:30 pm after breakfast sugar 106

body trembling problem

Then eat 1 chocolate,guava,and Oreo biscuit 

3:25 pm before lunch sugar 136

3:30 pm 

Rice with lentil, boiled pumpkin, long beans chutney and sem phali fry 

5:30 pm after lunch sugar 182


[08/12, 23:34] Patient DM1 MP Advocate 2: 5:30 pm eat some seeds 

6 pm drink 1 cup black tea without sugar 

8 pm insulin lantus 8 unit 

9:40 pm before dinner sugar 158

9:45 pm 

Rice with boiled pumpkin, long beans chutney and lentil 

11:40 pm after dinner sugar 221


[09/12, 06:20] Patient DM1 MP Advocate 2: Good morning sir 
9/12/24
6:25 am fasting sugar 179


[09/12, 08:29] pm: 👍


[09/12, 08:30]pm: Why was her lantus reduced again by 1?

[09/12, 09:18] Patient DM1 MP Advocate 2: Sir, Patient feeling very weak in the body and due to low sugar, insulin has reduced, today I will increase the insulin.


[09/12, 09:21] PaJR moderator: None of the sugar values shared by the patient above while on 9U don't appear to be low? I guess the patient was having subjective sensations of hypoglycemia?

@⁨Metacognitist Mover and Shaker1⁩@⁨Inner Strength Engineer1⁩  can we review the literature with @⁨Meta AI⁩ to see if there's an entity called hypoglycemia hyperawarenes similar to hypoglycemia unawareness?


[09/12, 09:21] Meta AI: Yes, there is a phenomenon known as "hypoglycemia hyperawareness" or "hypoglycemia anxiety," although it is not as widely discussed or researched as hypoglycemia unawareness.

Hypoglycemia hyperawareness refers to an increased sensitivity and awareness of bodily sensations that may be misinterpreted as hypoglycemia, even when blood glucose levels are within a normal range. This can lead to anxiety, fear, and stress related to hypoglycemia.

Studies suggest that hypoglycemia hyperawareness can be more common in individuals with diabetes who have experienced previous episodes of hypoglycemia, particularly if they were severe or traumatic. It can also be seen in individuals with anxiety disorders or those who are prone to catastrophic thinking.

The literature suggests that hypoglycemia hyperawareness can be addressed through education, cognitive-behavioral therapy (CBT), and relaxation techniques. It's essential to work with a healthcare provider to develop strategies to manage hypoglycemia anxiety and improve overall quality of life.

References:

- Cryer, P. E. (2013). Hypoglycemia in Diabetes. Diabetes, 62(12), 4083–4089.
- McAulay, V., & Frier, B. M. (2001). Hypoglycemia: A Clinical Approach. Journal of Clinical Endocrinology and Metabolism, 86(10), 4739–4746.
- Wild, D., & von Maltzahn, R. (2008). Hypoglycemia and Anxiety in People with Diabetes. Journal of Diabetes and its Complications, 22(3), 175–184.

CBBLE collective cognition nodal processing:

Summary: at least two of the above references were real albeit with wrong citations!

On Mon, 9 Dec 2024, 09:36 CM @gmail.com> wrote:
Excellent

From: PaJR moderator >
Date: Mon, 9 Dec 2024, 09:45
Subject: Re: PaJR UDLCO with Meta AI : Hypoglycemia hyperawareness
To: CM <@gmail.com>
Cc: <caregiver7careseeker@gmail.com>

Thanks. While we are learning things about the human body with AI sometimes it's difficult to keep checking if the references AI cites is real or confabulated. Can you help me to check if the references cited below by meta AI are correct?

From: PaJR moderator@gmail.com>
Date: Mon, 9 Dec 2024, 20:28
To: CM @gmail.com>
Cc: <caregiver7careseeker@gmail.com>


Thanks for these useful references.

Nice to see that the first reference (at least one of the listed ones by the LLM) was real!

On Mon, 9 Dec 2024, 11:52 CM, @gmail.com> wrote:
I did a quick search for you. The references were pretty old, the most appropriate one was Wild D, von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L. A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Patient Educ Couns. 2007;68(1):10-15. doi:10.1016/j.pec.2007.05.003
 which had the wrong citation.


I attach the us diabetes association pdf with a lot of information and more relevant references.
c

_Thematic Analysis:_

The conversation can be grouped into several themes:

1. _Diabetes Management_: The patient's daily blood sugar levels, medication, and food intake are discussed.
2. _Hypoglycemia Hyperawareness_: The phenomenon of hypoglycemia hyperawareness is discussed, including its definition, causes, and management.
3. _Patient Education_: The importance of patient education in managing diabetes and hypoglycemia hyperawareness is emphasized.
4. _Healthcare Provider-Patient Communication_: The conversation highlights the importance of effective communication between healthcare providers and patients in managing diabetes.

_Codes:_

1. Blood sugar levels
2. Medication adherence
3. Hypoglycemia hyperawareness
4. Patient education
5. Healthcare provider-patient communication
6. Diabetes management
7. Food intake
8. Insulin dosage

_Insights:_

1. Effective diabetes management requires regular monitoring of blood sugar levels, medication adherence, and healthy food choices.
2. Hypoglycemia hyperawareness is a real phenomenon that can have a significant impact on patients' quality of life.
3. Patient education is crucial in managing diabetes and hypoglycemia hyperawareness.
4. Effective communication between healthcare providers and patients is essential in managing diabetes.

_Learning Points:_

1. Healthcare providers should be aware of hypoglycemia hyperawareness and its impact on patients' quality of life.
2. Patients with diabetes should be educated on effective diabetes management, including regular monitoring of blood sugar levels, medication adherence, and healthy food choices.
3. Effective communication between healthcare providers and patients is essential in managing diabetes.
4. Further research is needed to better understand hypoglycemia hyperawareness and its management.

Update in the patient's PaJR around this issue today July 25, 2025:


[24/07, 19:37] pajr.in CEO, NHS Endocrinologist: This is a very interesting case of Autonomic Hyper responsiveness from chronic diabetes


[24/07, 19:38] pajr.in CEO, NHS Endocrinologist: Anyone interested in publishing this as a short case report /abstract?


[24/07, 19:39] pajr.in CEO, NHS Endocrinologist: Ideally, aligning with PaJR principles, @⁨Patient DM1 MP Advocate 2⁩ should be the lead author for this as that would make it completely patient led.


[24/07, 20:04] hu1: Any evidence of Heart rate variability or autonomic events noted..? 

Autonomic hyper-responsiveness in chronic diabetes is an alteration of the autonomic nervous system (ANS), commonly involving both overactivity and dysfunction, particularly in the sympathetic arm. However, in chronic diabetes, the more typical issue is autonomic dysfunction or neuropathy—but increased sympathetic activity (hyper-responsiveness) can occur, especially in early or preclinical stages.
Key Points
Autonomic dysfunction (especially Cardiac Autonomic Neuropathy—CAN) is a well-known, frequent, and serious complication of both type 1 and type 2 diabetes. It affects control of heart rate, blood pressure, and vascular tone, leading to clinical manifestations such as resting tachycardia, arrhythmias, and cardiovascular instability.
Hyper-responsiveness refers to increased activity or reactivity within the ANS. Research shows that in early diabetes (and in prediabetic metabolic syndrome), there can be signs of sympathetic overactivity (increased response) before the development of clear autonomic neuropathy or overt loss of function.
Mechanisms: This overactivity has been linked to:
Insulin resistance and hyperinsulinemia, which are associated with increased sympathetic tone.
Early metabolic dysfunction, even before full-blown diabetes, can cause altered autonomic responses, possibly preceding clinical neuropathy and contributing to risk for metabolic syndrome.
Over time, persistent hyperglycemia (high blood sugar) leads to oxidative stress, formation of advanced glycation end-products, and damage to autonomic nerves—eventually causing loss of normal responsiveness (hyporesponsiveness), reduced heart rate variability, and impaired cardiovascular reflexes.
Clinical presentation typically progresses from hyper-responsiveness (overactive sympathetic drive) in early disease toward hyporesponsiveness or failure (neuropathy) as the condition becomes chronic.
Assessment: Heart rate variability (HRV) and heart rate recovery (HRR) after exercise are commonly used to detect altered autonomic responses, including early hyperactivity.
https://www.perplexity.ai/search/9bb6244d-4b1a-4832-aa8a-af490a454124


[25/07, 00:07] Patient DM1 MP Advocate 2: 24 July fasting sugar 124

6:30 am drink 1 cup black tea without sugar 

9:25 am 

1 Omeprazole tablet 

2 roti with green beans fry 

1 Metformin Tablet 

11:25 am after breakfast sugar 235

11:40 am eat papaya 

1:30 pm before lunch sugar 154

3 roti with green beans fry 

3:30 pm after lunch sugar 155

4 pm eat some roasted makhana 

9 pm 

0.25 mg Glimepiride Tablet 

1 Omeprazole tablet 

Rice with green beans fry and panner curry 

1 Metformin Tablet 

11:30 after breakfast sugar 128

11:45 pm drink 1 cup milk with pinch of termeric powder


[25/07, 07:30]hu2: I would like to help too, sir!


[25/07, 08:36] pajr.in CEO, NHS Endocrinologist: You can start right away by preparing a draft.


[25/07, 10:06] hu3: I'll join too!


[25/07, 10:11]cm: Thanks.

Any perplexity style reference links to this perplexity paper on the topic? 

@⁨Dr.Abdulsalam Med Ed Leads⁩ may be able to get his LLMs to trace them.

Unless they are visible on clicking the link which I am yet to click
[25/07, 10:19] Rakesh Biswas: Just checked the link. Yes all references are linked there along with exttacts (i have pasted from the site below)!

Amazing! Who would really need to publish a separate paper in the coming years? 

Title: Autonomic hyper responsiveness in chronic diabetes


Autonomic hyper-responsiveness in chronic diabetes is an alteration of the autonomic nervous system (ANS), commonly involving both overactivity and dysfunction, particularly in the sympathetic arm. However, in chronic diabetes, the more typical issue is autonomic dysfunction or neuropathy—but increased sympathetic activity (hyper-responsiveness) can occur, especially in early or preclinical stages.

Key Points

Autonomic dysfunction (especially Cardiac Autonomic Neuropathy—CAN) is a well-known, frequent, and serious complication of both type 1 and type 2 diabetes. It affects control of heart rate, blood pressure, and vascular tone, leading to clinical manifestations such as resting tachycardia, arrhythmias, and cardiovascular instability.

Hyper-responsiveness refers to increased activity or reactivity within the ANS. Research shows that in early diabetes (and in prediabetic metabolic syndrome), there can be signs of sympathetic overactivity (increased response) before the development of clear autonomic neuropathy or overt loss of function.

Mechanisms: This overactivity has been linked to:

Insulin resistance and hyperinsulinemia, which are associated with increased sympathetic tone.

Early metabolic dysfunction, even before full-blown diabetes, can cause altered autonomic responses, possibly preceding clinical neuropathy and contributing to risk for metabolic syndrome.

Over time, persistent hyperglycemia (high blood sugar) leads to oxidative stress, formation of advanced glycation end-products, and damage to autonomic nerves—eventually causing loss of normal responsiveness (hyporesponsiveness), reduced heart rate variability, and impaired cardiovascular reflexes.

Clinical presentation typically progresses from hyper-responsiveness (overactive sympathetic drive) in early disease toward hyporesponsiveness or failure (neuropathy) as the condition becomes chronic.

Assessment: Heart rate variability (HRV) and heart rate recovery (HRR) after exercise are commonly used to detect altered autonomic responses, including early hyperactivity.

Supporting Details
Studies indicate that delayed heart rate recovery and reduced HRV signal autonomic dysfunction in diabetes and that sympathetic hyperactivity is likely in early metabolic syndrome and prediabetic states.

Clinical features of autonomic hyper-responsiveness may include increased resting heart rate, exaggerated blood pressure swings, or increased vasoreactivity, but true overt clinical manifestations often develop later, after the onset of neuropathy.

The physiological progression in diabetes is: early sympathetic overactivity (hyper-responsiveness) → chronic exposure to metabolic/toxic damage → autonomic failure/neuropathy.

Limitations
The evidence for sustained autonomic hyper-responsiveness in chronic (long-standing) diabetes is limited, because the trend is usually toward progressive nerve damage and loss of autonomic function over time. Most references describe earlier sympathetic predominance, which gives way to global autonomic failure in chronic diabetes. The pattern and timing may vary between individuals.

In summary: Autonomic hyper-responsiveness—primarily sympathetic overactivity—can be seen in early or preclinical diabetes, often driven by insulin resistance and metabolic dysfunction. However, chronic diabetes more commonly leads to autonomic neuropathy and loss of function rather than persistent hyper-responsiveness.

References:

Autonomic hyper responsiveness in chronic diabetes

1. Journal of Diabetes Investigation
pmc.ncbi.nlm.nih.gov/articles/PMC86…

Autonomic dysfunction, diabetes and metabolic syndrome - PMC
Relationships among autonomic nervous system, diabetes and metabolic syndrome.


2. World Journal of Diabetes
pmc.ncbi.nlm.nih.gov/articles/PMC43…

Diabetes and cardiac autonomic neuropathy: Clinical manifestations ...
Cardiac autonomic neuropathy (CAN) is a frequent chronic complication of diabetes mellitus with potentially life-threatening outcomes. CAN is caused by the impairment of the autonomic nerve fibers regulating heart rate, cardiac output, myocardial ...

3. Diabetes & Metabolism Journal
e-dmj.org/journal/view.p…
Diabetes & Metabolism Journal
Schroeder et al. (2005) ARIC study; USA5,410 NFG, 3,561 IFGShort-term HRVNot provided↓RR interval and rMSSD at baseline. No differences in the rate of change in HRVFasting glucose (weak association at baseline) Perciaccante et al. (2006) Hospital diabetes clinic; Italy20 control, 20 IFG, 20 IGT24 hr HRVNot provided↓SDNN, low TP, and ↑LFnu in IFG and IGTHOMA-I

4. Wjgnet
wjgnet.com/1948-9358/full…
Cardiac autonomic neuropathy in patients with diabetes mellitus
Cardiac autonomic neuropathy in patients with diabetes mellitus
journals.plos.org favicon

5. PLOS ONE
journals.plos.org/plosone/articl…
The cardiac autonomic response to acute psychological stress in ...
Background Impaired cardiac autonomic control is common among people with type 2 diabetes. The autonomic nervous system and its regulatory influence on the cardiovascular system also play a key role in the physiological response to psychosocial stressors. It is unclear whether the disease-related impairment of cardiac autonomic control in people with type 2 diabetes affects the stress response. The aim of this study was therefore to examine the cardiac autonomic and the psychological stress response of people with type 2 diabetes compared to healthy control participants. Methods We used the trier social stress test to induce stress in n = 51 participants with type 2 diabetes and n = 47 healthy controls. We assessed heart rate (HR) and heart rate variability (HRV) using six ECG samples before, during and after the stress test. We measured participants’ psychological stress response using visual analogue scales. Results Longitudinal multilevel models showed an attenuated HR increase in response to the stress test combined with a slower HR recovery after the stress test, in people with type 2 diabetes. This pattern was accompanied by significantly lower low frequency HRV but no differences in high frequency HRV between the groups. Additionally, people with type 2 diabetes showed an increased level of self-reported psychological tension 45 minutes after the stress test. Conclusions The impairment of the autonomic nervous system found in people with type 2 diabetes is reflected in the HR response to stress—but not in the HRV response—and partially mirrored in the psychological stress response. Our results underline the importance of considering the interplay of psychosocial stress and disease-related changes in the physiological stress response system in research and treatment of type 2 diabetes.
diabetesjournals.org favicon

6. American Diabetes Association
diabetesjournals.org/care/article/2…
Influence of Autonomic Nervous System Dysfunction on the ...
OBJECTIVE—We investigated whether autonomic nervous system dysfunction, estimated by slow heart rate recovery (HRR) following cessation of an exercise trea

7. Circulation
ahajournals.org/doi/10.1161/ci…
Diabetic Cardiovascular Autonomic Neuropathy | Circulation
To investigate the effect of ACE inhibition or angiotensin receptor blockade and their combination on both DAN and LVDD in asymptomatic patients with diabetes, Didangelos et al 106aexamined 62 patients (34 women) with long-term diabetes mellitus (24 with type 1 diabetes mellitus and DAN). The patients, who were aged 51.7±13.9 years and were free of coronary artery disease and arterial hypertension at baseline, were studied for a 12-month period. Early ACE inhibition or angiotensin receptor...
journals.lww.com favicon
8. journals.lww
journals.lww.com/jfmpc/fulltext…
Comparative study of autonomic function in diabetics and yoga ...
9. ahajournals
ahajournals.org/doi/10.1161/01…
Hyperreactivity to Nitrovasodilators in Forearm Vasculature Is ...
sciencedirect.com favicon

10. sciencedirect
sciencedirect.com/science/articl…



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How does sympathetic overactivity contribute to autonomic hyper responsiveness in diabetes

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Could early ACE inhibition prevent autonomic hyper responsiveness in diabetes progression

How can I monitor and manage autonomic symptoms to reduce complications from diabetes




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