Aust Fam Physician
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Many patients with type 2 diabetes need to progress to insulin use when oral glucose lowering therapies fail to maintain adequate glycaemic control. ⋯ In general, initiation of insulin should be considered in individuals on maximal tolerated doses of metformin and sulfonylureas with HbA1c levels >7.0% over a 3-6 month period. Current Australian guidelines recommend initiating insulin therapy as once daily basal therapy or as premixed insulins.
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Addiction to opioids, or opioid dependence, encompasses the biopsychosocial dysfunction seen in illicit heroin injectors, as well as aberrant behaviours in patients prescribed opioids for chronic nonmalignant pain. ⋯ The same principles and skills general practitioners employ in chronic illness management underpin the care of patients with opioid dependence. Opioid pharmacotherapy, with the substitution medications methadone and buprenorphine, is an effective management of opioid dependence. Training and regulatory requirements for prescribing opioid pharmacotherapies vary between jurisdictions, but this treatment should be within the scope of most Australian GPs.
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Prescribed career paths are not for everyone and there are other, less obvious options that can lead to an interesting and varied career. Below are some reflections on my own career aimed at helping doctors of tomorrow find their way - especially if they are prepared to work in remote or developing world settings and possibly follow a path toward working in public health.