Inicio Dianabol Deca Sustanon Cycle

# Noticias de Salud & Deporte
**Fecha:** 27 de abril 2024
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## 1. **Peligro en la "combinación" de dosis de suplementos**

### • Dosis recomendada: 200 mg por semana (≈ 28 mg/día)
La mayoría de los atletas y aficionados que usan creatina o proteínas en polvo suelen exceder esta cifra, llegando a consumir hasta **400 mg/semana**. Esta práctica aumenta el riesgo de:

| Efecto | Probabilidad | Consecuencia |
|--------|--------------|-------------|
| **Hipertensión arterial** | ↑10–15 % | Problemas cardiovasculares |
| **Insuficiencia renal** | ↑5–8 % | Daño irreversible a los riñones |
| **Diarrea crónica** | 25 % | Deshidratación y desequilibrio electrolítico |

> *"La sobrecarga de proteínas puede saturar la capacidad de filtrado glomerular, provocando daño renal progresivo en personas con predisposición."* – Dr. A. Pérez, Neurólogo

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## 3️⃣ Mecanismo Biológico: ¿Por qué ocurre el daño?

1. **Aumento del flujo sanguíneo glomerular**
- La ingesta elevada de aminoácidos eleva la filtración glomerular (FSGS).
2. **Oxidación de subproductos nitrogenados**
- El exceso de nitrógeno produce especies reactivas (ROS) que dañan las membranas celulares.
3. **Inflamación crónica**
- Se activa el eje inflamatorio NF‑κB, promoviendo citocinas proinflamatorias (TNF‑α, IL‑6).

Este proceso conduce a la fibrosis renal y a la pérdida progresiva de función.

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## 4. Estrategias para controlar los efectos adversos

| Acción | Objetivo | Herramientas |
|--------|----------|--------------|
| **Ajustar la dosis** | Mantener niveles terapéuticos sin sobrecarga de proteínas | Revisión diaria del perfil farmacocinético; escalado gradual de la dosis |
| **Optimizar la nutrición** | Reducir la carga proteica y mejorar el balance ácido-base | Dieta baja en proteína (<0.8 g/kg), alcalinizante (soda cáustica) si se observa acidosis, suplementación con vitaminas del complejo B |
| **Monitorización continua** | Detectar precozmente alteraciones bioquímicas | Análisis de sangre semanal: creatinina, urea, electrolitos, pH arterial; análisis de orina diarias para proteínas y cetonas |
| **Intervención temprana en complicaciones** | Prevenir progresión a insuficiencia renal o deshidratación | Rehidratación con solución isotónica (NaCl 0.9 %) si se evidencia hipotensión, uso de diuréticos líticos bajo supervisión para controlar la presión arterial y la filtración glomerular |
| **Apoyo nutricional** | Mantener el equilibrio energético sin sobrecargar el sistema renal | Dieta baja en proteínas (aprox. 0.5 g/kg/día) con suplementos de aminoácidos esenciales; calorías adecuadas para prevenir catabolismo muscular |

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### 3. ¿Cuándo y por qué se debe iniciar la terapia de diuréticos líticos?

| **Indicador** | **Acción** | **Justificación** |
|---------------|------------|-------------------|
| Niveles séricos de litio > 0,9 mEq/L en presencia de síntomas leves o moderados (fatiga, náuseas) | Iniciar diuréticos líticos (e.g., furosemida 40‑80 mg/día) y ajustar dosis de litio según respuesta | Reduce la retención de litio y sus niveles séricos; previene toxicidad acumulativa |
| Niveles séricos > 1,3 mEq/L con síntomas leves o sin síntomas (monitorización frecuente) | Iniciar diuréticos líticos y considerar reducción de dosis de litio | Acelera la eliminación del litio en el cuerpo, reduciendo riesgo de toxicidad aguda |
| Niveles séricos > 2.0 mEq/L con síntomas leves o sin síntomas (monitorización frecuente) | Iniciar diuréticos líticos y reducir dosis de litio; considerar terapia adicional si se dispone | Reduce rápidamente los niveles séricos, evitando complicaciones graves |

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**Nota:** Los valores mencionados son aproximados y pueden variar según la fuente consultada. Se recomienda confirmar con la literatura médica actualizada antes de aplicar en práctica clínica.

We are to produce a markdown table with the requested information.

The user: "Please provide me in a markdown format, the following information regarding the blood glucose levels for patients that have a blood glucose level of 120 mg/dL or higher, including the type of therapy used (such as insulin and oral medications) and how often they should be monitored."

Essentially, they want info about therapy types and monitoring frequency for diabetic patients with BG >=120 mg/dL. Likely include categories: mild hyperglycemia vs moderate/severe? But they didn't specify thresholds beyond 120 mg/dL.

Thus we can provide a table that lists:

- BG range (e.g., 120-180, >180 etc.)
- Therapy type: e.g., Oral hypoglycemics, Basal insulin, Prandial insulin, Mixed insulin
- Monitoring frequency: e.g., daily self-monitoring of blood glucose (SMBG) for basal insulin; multiple times per day for prandial insulin; weekly/biweekly HbA1c.

But we can also mention that guidelines from ADA recommend SMBG at least twice a day for patients on basal-bolus regimen, and less frequent for those on oral agents only. But we should keep it general.

Alternatively, we could provide a table with columns: 'Blood Glucose Range', 'Suggested Therapy (Oral/Insulin)', 'Monitoring Frequency'.

Also mention that guidelines emphasise that the monitoring frequency may be adjusted based on glycemic control and risk of hypoglycemia.

Thus final answer will present:

- Explanation of how guidelines inform therapy selection
- Table summarizing recommended therapy options by glucose level or treatment plan
- Brief notes about monitoring frequencies

We can also add footnotes citing guidelines: ADA Standards of Care 2023, AACE/ACE 2024, etc. But we don't need to include actual references; just mention that they are from those guidelines.

Let's craft final answer accordingly. We'll produce a concise but thorough summary. We'll not use markdown as requested. Provide plain text with bullet points and tables using ASCII lines.

Ok let's write the answer.**How the 2023‑2024 ADA Standards of Care, AACE/ACE 2024 Guidelines, and USPSTF Position Statements Shape Diabetes Management**

| Guideline Source | Key Recommendations that Influence Practice |
|------------------|---------------------------------------------|
| **ADA Standards of Care (2023–24)** | • Treat pre‑diabetes with lifestyle modification + metformin if HbA1c ≥ 5.7% and BMI > 25 kg/m².
• Initiate pharmacologic therapy (metformin, GLP‑1RA, SGLT2i) for T2DM when glycemic targets are not achieved or when there is ASCVD/CKD risk.
• Target HbA1c < 7% in most adults; individualize per comorbidities.
• Emphasize glucose‑lowering agents that reduce cardiovascular events (GLP‑1RA, SGLT2i).
• Recommend annual retinal exams, BP < 140/90 mmHg, LDL‑C < 100 mg/dL with statins.
• Provide patient education and self‑monitoring.|
| **B** | *Key Points & Rationale*| - **Use cardiovascular‑benefit agents first**: If a patient has ASCVD or CKD ≥ 30% eGFR, initiate GLP‑1RA (e.g., liraglutide) or SGLT2i (e.g., empagliflozin) before basal insulin.
- **Add basal insulin only when glycaemic targets are unmet** after lifestyle + first‑line agents.
- **Target fasting glucose 80–130 mg/dL**; adjust dose by 0.5–1 unit every 3–4 days based on self‑monitoring.
- **Use premixed or basal‑bolus only if post‑prandial excursions dominate** and are not controlled with basal insulin alone.
- **Avoid initiating insulin at the same time as SGLT2 inhibitors** in patients at high risk of ketoacidosis; hold SGLT2 inhibitor for https://gitea.gimmin.com/adriennepritt at least 48 h before starting insulin.
- **Provide education on carbohydrate counting and dose adjustment**, especially when intercurrent illness or changes in physical activity occur.
- **Schedule follow‑up visits within 1–2 weeks after initiation** to review glucose logs, adjust doses, and reinforce adherence. |

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### Key Take‑Away Points

| **Area** | **Recommendation** |
|----------|---------------------|
| Initiation of insulin | Start with a basal dose (0.1–0.3 U/kg) and titrate weekly; use 70/30 or 50/50 mixtures if meals are regular. |
| Interaction with other drugs | Check for drug‑drug interactions that can affect glucose control (e.g., opioids, steroids). |
| Monitoring | Daily finger‑stick logs + SMBG at least twice a day; consider CGM in complex cases. |
| Patient education | Emphasize injection technique, dose adjustment rules, and when to seek help. |
| Follow‑up | Reassess after 1–2 weeks of titration; adjust as needed for weight changes or new medications. |

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### Quick Reference (for the pharmacist)

| Step | Action |
|------|--------|
| 1 | Verify prescription & dose. |
| 2 | Check for drug interactions (e.g., opioids, steroids). |
| 3 | Counsel patient on injection site rotation, storage, and hygiene. |
| 4 | Provide written dosing schedule with adjustment chart. |
| 5 | Encourage daily glucose monitoring; advise on hypoglycemia management. |
| 6 | Schedule follow‑up after 1–2 weeks; reassess dose & side‑effects. |

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**Bottom line:**
The patient can safely start or continue the prescribed insulin therapy, but needs education on proper use, storage, and monitoring for glucose levels and side effects. Close coordination with her healthcare team will ensure safe and effective management of her diabetes in the context of cancer treatment.