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糖尿病病友最常見的問題之一，就是糖尿病會好嗎？以新陳代謝科醫師的角度來看，回答這個問題要花很多時間。就問題本身，我們不說糖尿病有沒有「好」，而是有沒有「緩解」。
美國糖尿病學會 (ADA) 在幾年前對糖尿病緩解的定義有一份共識報告，今年又與美國的內分泌學會、歐洲的糖尿病研究學會 (EASD)、英國的糖尿病學會 (Diabetes UK) 等專家學者召開共識會議。
新的第二型糖尿病緩解的會議共識如下：
描述第 2 型糖尿病持續的代謝進步到接近正常血糖的專有名詞應該是糖尿病緩解 (remission of diabetes)
緩解的定義是糖化血色素 (HbA1c) 自發性的或經介入後，在沒有用降血糖藥物之下，持續至少 3 個月小於 6.5%。
如果 HbA1c 沒有正確反應血糖，可用空腹血糖小於 126 mg/dL 或 eA1c 小於 6.5% 來替代。
http://hanwenliu.blogspot.com/2021/09/DM-remission.html
Delivered out of Darkness
“It was now about the sixth hour, and darkness came over the whole land until the ninth hour. The sun was darkened, and the veil of the temple was torn in two. Jesus, crying with a loud voice, said, “Father, into your hands I commit my spirit!” Having said this, he breathed his last.” (Luke 23:44-46 WEB)
Jesus was delivered up to the darkness, so that we who were once in darkness could be delivered out of it and be brought near to God, to always walk in the light of His favor.
“giving thanks to the Father, who made us fit to be partakers of the inheritance of the saints in light; who delivered us out of the power of darkness, and translated us into the Kingdom of the Son of his love; in whom we have our redemption, the forgiveness of our sins;” (Colossians 1:12-14 WEB)
The veil in the temple was torn in two because the sins that separated us from God has been justly punished in Jesus’ body. By the tearing of His flesh and the shedding of His blood, we have been reconciled to God.
“For by one offering he has perfected forever those who are being sanctified. The Holy Spirit also testifies to us, for after saying, “This is the covenant that I will make with them: ‘After those days,’ says the Lord, ‘I will put my laws on their heart, I will also write them on their mind;’” then he says, “I will remember their sins and their iniquities no more.” Now where remission of these is, there is no more offering for sin. Having therefore, brothers, boldness to enter into the holy place by the blood of Jesus, by the way which he dedicated for us, a new and living way, through the veil, that is to say, his flesh;” (Hebrews 10:14-20 WEB)
God vowed to never count your sins and iniquities against you, so stand in His presence without self-condemnation. The one-time sacrifice of Jesus’ blood has qualified you to enter the true Holy of Holies in Heaven. The more you enter this place, the more life you receive. Keep coming back through prayer, for it is a new and living way!
Physical health, youth, strength, and beauty can be renewed and increased supernaturally. Get “Younger and Younger” and let’s explore 31 days of God’s youth renewal promises: https://bit.ly/younger-and-younger
Better than the Conscience
“Yahweh God said, “Behold, the man has become like one of us, knowing good and evil. Now, lest he reach out his hand, and also take of the tree of life, and eat, and live forever...”” (Genesis 3:22 WEB)
The ability to discern between good and evil is not a bad thing. God has this ability.
In a person, this ability is called the conscience. Man that has been tainted by sin cannot use the conscience properly because apart from Christ, they seek to build their own way to Heaven.
“They said, “Come, let’s build ourselves a city, and a tower whose top reaches to the sky, and let’s make a name for ourselves, lest we be scattered abroad on the surface of the whole earth.”” (Genesis 11:4 WEB)
Mankind tried to build a high tower that reaches into Heaven, not submitting to the truth that faith in Yahweh is the only way into Heaven.
“For being ignorant of God’s righteousness, and seeking to establish their own righteousness, they didn’t subject themselves to the righteousness of God. For Christ is the fulfillment of the law for righteousness to everyone who believes.” (Romans 10:3-4 WEB)
The conscience causes mankind to invent all sorts of philosophies in fleshly attempts to do good and earn their way into Heaven.
The conscience is the “law for righteousness” (the Ten Commandments) written in every man’s heart ever since Adam ate from the Tree of the Knowledge of Good and Evil.
This law tells us that whoever sins must pay for it with the penalty of death. It is a law that bringing consciousness of sin.
At the cross, Jesus’ allowed His blood to be shed, and He laid down His life, fully satisfying the demands of the Old Covenant of the Law. His divine blood paid for all of the sins of the world, and His death established the New Covenant of Grace.
Whoever places his faith in Jesus is set free from the Ten Commandments, and instead comes under Grace.
Instead of a law that brings consciousness of sin, God has written a new type of law in our hearts and minds.
“Bear one another’s burdens, and so fulfill the law of Christ.” (Galatians 6:2 WEB)
It is called the law of Christ, and it is not the same as the law of Moses.
The law of Moses was the knowledge of sin, whereas the law of Christ is the knowledge of righteousness. The law of Moses is the consciousness of sin which produces the fear of death, whereas the law of Christ is the consciousness of God’s love which produces the desire to obey and follow the Holy Spirit.
““This is the covenant that I will make with them: ‘After those days,’ says the Lord, ‘I will put my laws on their heart, I will also write them on their mind;’” then he says, “I will remember their sins and their iniquities no more.” Now where remission of these is, there is no more offering for sin. Having therefore, brothers, boldness to enter into the holy place by the blood of Jesus, by the way which he dedicated for us, a new and living way, through the veil, that is to say, his flesh; and having a great priest over God’s house, let’s draw near with a true heart in fullness of faith, having our hearts sprinkled from an evil conscience, and having our body washed with pure water, let us hold fast the confession of our hope without wavering; for he who promised is faithful.” (Hebrews 10:16-23 WEB)
Dear believer, God writes a new set of laws in your heart and mind. God said that He would remember your sins and iniquities no more, so the new laws cannot be the consciousness of sin like the Ten Commandments. The Old Covenant is different from the New Covenant.
Under Grace, the Holy Spirit writes in your heart and mind, producing the desire and ability to do good works that please God, not out of fear of punishment, but as a worshipful response to His love.
The law of Christ can be summarized in the apostle John’s words:
“This is his commandment, that we should believe in the name of his Son, Jesus Christ, and love one another, even as he commanded.” (1 John 3:23 WEB)
It is the law of loving God and fellow Christians, as a response to the love that Jesus showed in His life. Nothing about sin. Meditate on the way Jesus loved His disciples and loved the world by dying on the cross, and His love will rise up in you to produce good works of love.
Our hearts must be sprinkled from an evil conscience that is still trying to earn and establish its own righteousness. The conscience in your flesh never got the memo! It still thinks that the sin debt is not paid, and that someone has to pay.
To sprinkle your conscience means to fill your heart with the truth that the blood of Christ is the final payment for sins. We have boldness when we approach God because of the blood of Christ and not because we have paid for the sin debt on our own.
We have something better than the conscience. We have the Holy Spirit inside us and He leads us by the law of Christ. Instead of fear, we are motivated by love. Follow after love!!
Keep studying God’s word and growing in your understanding of His ways. Our Patreon community is currently on a Bible study series called “My Faith Declarations” which looks at the Spirit-inspired utterances of the authors of the Psalms. They wrote about the trials and tribulations they experienced, so the book of Psalms is very relatable.
By turning their faith declarations into our own, we can learn how to overcome similar circumstances in life through faith in the Lord! Become a “God Every Morning” tier or above patron on Patreon to receive this reward, daily devotionals by email, and also all my eBooks. Thanks for being a blessing to this ministry: http://Patreon.com/miltongohblog
益生菌 － 黃世豪腸胃及肝臟科專科醫生＠FindDoc.com
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（一）食物補充益生菌可行嗎？ 00:06
（二）益生菌是什麼？ 00:42
（三）益生菌有什麼功用？ 01:23
（四）醫生如何選擇適合病人的益生菌？ 01:54
(本短片作健康教育之用，並不可取代任何醫療診斷或治療。治療成效因人而異，如有疑問，請向專業醫療人士諮詢。)
參考資料：
1. Lisko, D. J., Johnston, G. P., & Johnston, C. G. (2017). Effects of Dietary Yogurt on the Healthy Human Gastrointestinal (GI) Microbiome. Microorganisms, 5(1), 6. https://doi.org/10.3390/microorganisms5010006
2. Kechagia, M., Basoulis, D., Konstantopoulou, S., Dimitriadi, D., Gyftopoulou, K., Skarmoutsou, N., & Fakiri, E. M. (2013). Health benefits of probiotics: a review. ISRN nutrition, 2013, 481651. https://doi.org/10.5402/2013/481651
3. Hill, D., Sugrue, I., Tobin, C., Hill, C., Stanton, C., & Ross, R. P. (2018). The Lactobacillus casei Group: History and Health Related Applications. Frontiers in microbiology, 9, 2107. https://doi.org/10.3389/fmicb.2018.02107
4. Akatsu H., Iwabuchi N., Xiao J., Matsuyama Z., Kurihara R., Okuda K., et al. (2013). Clinical effects of probiotic Bifidobacterium longum BB536 on immune function and intestinal microbiota in elderly patients receiving enteral tube feeding. J. Parenter Enteral Nutr. 37 631–640. 10.1177/0148607112467819
5. Yang, G., Liu, Z. Q., & Yang, P. C. (2013). Treatment of allergic rhinitis with probiotics: an alternative approach. North American journal of medical sciences, 5(8), 465–468. https://doi.org/10.4103/1947-2714.117299
6. Uronis, J. M., Arthur, J. C., Keku, T., Fodor, A., Carroll, I. M., Cruz, M. L., Appleyard, C. B., & Jobin, C. (2011). Gut microbial diversity is reduced by the probiotic VSL#3 and correlates with decreased TNBS-induced colitis. Inflammatory bowel diseases, 17(1), 289–297. https://doi.org/10.1002/ibd.21366
7. Fedorak R. N. (2010). Probiotics in the management of ulcerative colitis. Gastroenterology & hepatology, 6(11), 688–690.
8. Dale, H. F., Rasmussen, S. H., Asiller, Ö. Ö., & Lied, G. A. (2019). Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review. Nutrients, 11(9), 2048. https://doi.org/10.3390/nu11092048
9. Mimura, T., Rizzello, F., Helwig, U., Poggioli, G., Schreiber, S., Talbot, I. C., Nicholls, R. J., Gionchetti, P., Campieri, M., & Kamm, M. A. (2004). Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut, 53(1), 108–114. https://doi.org/10.1136/gut.53.1.108
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益生菌專題 － 張世華腸胃及肝臟科專科醫生＠FindDoc.com
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（一）什麼時候需要益生菌？ 00:06
（二）益生菌會與藥物相衝嗎？由醫生處方較好？ 01:53
（三）腸道狀況有異樣應怎辦？ 03:20
(本短片作健康教育之用，並不可取代任何醫療診斷或治療。治療成效因人而異，如有疑問，請向專業醫療人士諮詢。)
參考資料：
1. Uronis, J. M., Arthur, J. C., Keku, T., Fodor, A., Carroll, I. M., Cruz, M. L., Appleyard, C. B., & Jobin, C. (2011). Gut microbial diversity is reduced by the probiotic VSL#3 and correlates with decreased TNBS-induced colitis. Inflammatory bowel diseases, 17(1), 289–297. https://doi.org/10.1002/ibd.21366
2. Fedorak R. N. (2010). Probiotics in the management of ulcerative colitis. Gastroenterology & hepatology, 6(11), 688–690.
3. Dale, H. F., Rasmussen, S. H., Asiller, Ö. Ö., & Lied, G. A. (2019). Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review. Nutrients, 11(9), 2048. https://doi.org/10.3390/nu11092048
4. Mimura, T., Rizzello, F., Helwig, U., Poggioli, G., Schreiber, S., Talbot, I. C., Nicholls, R. J., Gionchetti, P., Campieri, M., & Kamm, M. A. (2004). Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut, 53(1), 108–114. https://doi.org/10.1136/gut.53.1.108
5. Toscano M, et al. A consumer’s guide for probiotics: 10 golden rules for a correct use. Dig Liver Dis
(2017), http://dx.doi.org/10.1016/j.dld.2017.07.011
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慢性骨髓性白血病不是絕症？－ 陳敏航血液及血液腫瘤科專科醫生＠FindDoc.com
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（一）慢性骨髓性白血病有什麼治療方法？ 00:06
（二）慢性骨髓性白血病是不是“絕症”？ 00:31
（三）TKI能使慢性骨髓性白血病痊愈嗎？ 01:24
（四）病人是否要一直服藥來控制病情，不能停藥？ 02:10
（五） 醫生對慢性骨髓性白血病有什麼建議？ 03:12
(本短片作健康教育之用，並不可取代任何醫療診斷或治療。治療成效因人而異，如有疑問，請向專業醫療人士諮詢。)
參考資料：
1. Falchi, L., Kantarjian, H. M., Wang, X., Verma, D., Quintás-Cardama, A., O'Brien, S., … Cortes, J. E. (2013). Significance of deeper molecular responses in patients with chronic myeloid leukemia in early chronic phase treated with tyrosine kinase inhibitors. American journal of hematology, 88(12), 1024–1029. doi:10.1002/ajh.23560
2. Cortes JE, Saglio G, Kantarjian HM, et al. Final 5-year study results of DASISION: the dasatinib versus imatainib study in treatment-nviae chronic myeloid leukemia patients trial. J Clin Oncol 2016;34:2333-2340
3. Hochhaus A, Saglio G, Hughes TP, et al. Long-term benefits and risks of Goldberg, S. L., Savona, M., & Mauro, M. J. (2018). Considerations for Successful Treatment-free Remission in Chronic Myeloid Leukemia. Clinical Lymphoma Myeloma and Leukemia, 18(2), 98-105. doi:10.1016/j.clml.2017.11.006 frontline nilotinib vs imatinib for chronic myeloid leukemia in chronic phase: 5 year update of the randomized ENESTnd trial. Leukemia 2016;30:1044-1054
4. Stem Cell Transplant for Chronic Myeloid Leukemia. (n.d.). Retrieved from https://www.cancer.org/cancer/chronic-myeloid-leukemia/treating/bone-marrow-stem-cell.html
5. Talpaz, M., Mercer, J., & Hehlmann, R. (2015). The interferon-alpha revival in CML. Annals of Hematology, 94(Supplement 2), 195-207.
6. Bower, H., Björkholm, M., Dickman, P. W., Höglund, M., Lambert, P. C., & Andersson, T. M. (2016). Life Expectancy of Patients With Chronic Myeloid Leukemia Approaches the Life Expectancy of the General Population. Journal of Clinical Oncology, 34(24), 2851-2857. doi:10.1200/jco.2015.66.2866
7. Timothy P. Hughes, Carla Boquimpani, Naoto Takahashi, et al.(2018). ENESTop 144-Week Update: Long-Term Treatment-Free Remission (TFR) in Patients with Chronic Myeloid Leukemia in Chronic Phase (CML-CP) After Stopping Second-Line Nilotinib, 18, S222. doi:https://doi.org/10.1016/j.clml.2018.07.092
8. Francis J. Giles, Tamas Masszi, María Teresa Gómez Casares, et al. (2019). Treatment-free remission (TFR) following frontline (1L) nilotinib (NIL) in patients (pts) with chronic myeloid leukemia in chronic phase (CML-CP): 192-week data from the ENESTfreedom study. Journal of Clinical Oncology 2019 37:15_suppl, 7013-7013
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