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#fell into a rabbithole of Netflix cult content. and yeah

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I have a question about this image of Xanathar's Thieves Guild.

Why does he have sexily lounging elf boys?

I ask because I cannot imagine a beholder being attracted to anything other than itself. Does he just understand Sexily Lounging Elf Boys to be a status symbol, and he wants anyone who visits to know he can afford Sexily Lounging Elf Boys?

Maybe I'm the asshole here for assuming. Maybe these boyfriends are master tacticians here to advise Xanathar, they happen to like wearing leather pants and no shirts and I should be less quick to reduce them to sex objects.

I don't care, I love it, this is all I can think of every time I see it:

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Elizabeth Kirkman Fitzhugh, Militant Mary

November 13, 1914

#I feel u Mary

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If I ask nicely will people reblog this and tell me what their most common breakfast is? Not your favorite necessarily, just what you have for breakfast most frequently? 🙏🏽

#bagel w/ cream cheese #or English muffin w/ butter and jam #if I have time I’ll do eggs but I have to #leave the house at 6:15am now #so my breakfast routine got compressed

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Audio: I have a prisoner. Ruth chased it into our room and I don’t know what the hell to do with it. It’s very cute. I’m worried that might be a cat bite wound on its abdomen. Ah! No. I know, you’re a smarty. So if it’s a brown rat, like a Norway rat it’s a juvenile, because it’s way too small. And it’s slightly bigger than the mice I’m familiar with. I don’t know what this is. What is this thing?

#lifeblogging #rodents #Ruth the kitten #my cat doesn’t go outside #we have a 100 year old house with a rat problem #a pest control company is…failing. lol #I’m going to make them deal with this situation #because I don’t feel like getting lepto or hantavirus today #it just sucks ass because I do like rats a lot

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watch my favorite BDG video

#i can't wear hats #Youtube

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Bothering the beast

#sometimes I do this to Ruth #more frequently Ruth does this to me

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i'm conducting an experiment. everyone who's from an english speaking country state your country, regional area and what you call the following images. i need to see something

#USA (Oregon) #fries chips biscuits #cookies soda candy #cigarettes beanie cotton candy #candy floss is an option but it makes you sound insane

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A glass of kanar Commission for the lovely @samcentral! Yes, I'm open for commissions :D.

#I like the red highlights #have they graduated from lunch to after-dinner drinks? #good for them etc #star trek #star trek: ds9

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if you see the vision you see it all ill say

#I See It OP #star trek #star trek: ds9

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Realized I have a naked rat and a small piano

Here's Harry banging out the tunes, April 13th 2023

#is this cosplay?

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Everyone knows that ‘Meridian’ is a bad episode, but I have a specific argument for why it’s out of character for Jadzia: all of her other impulsive, risk-taking behavior is about preserving her existing relationships! She places an extremely high value on loyalty. Jadzia Dax was willing to suffer total alienation from Trill society and the eventual death of her symbiont to maintain a relationship with Lenara Kahn that Torias Dax started. Jadzia Dax was willing to risk her Starfleet career and commit murder to uphold an oath of vengeance that Curzon Dax made. Yes, she’s gregarious and flirty, yes she’s the kind of person who could meet a guy on a day trip down to his planet and immediately start a relationship with him, but she is not the kind of person who would prioritize that new relationship over her career, her symbiont, her friends, and her family.

#star trek #star trek: ds9 #Jadzia dax #ds9 #top posts

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I've been trying to figure out what the deal is with prediabetes so I can write a meaningful response to an ask I got about it, and I just keep going wait--okay--here's one paper--but here's another one--here's a Cochrane review--but here's a different meta-analysis--and here's newer data from an RCT...

It's nuts! It's bananas. And anybody who says we have good, crisp, clear guidelines around what prediabetes even IS, much less what to do about it, is FULL OF SHIT.

What I really need to know in order to feel more confident about my handle on whether to medicate pre-diabetes is the population incidence. Not prevalence. Because if I take the most optimistic studies about medication as an intervention, specifically, I could be looking at about a 30-40% reduction in risk of progression to diabetes. But! How many people is that, actually? Because medication is not without its harms! We need to compare number needed to treat with number needed to harm, we need to have high-quality evidence that says yes, if we give this medication to everyone who meets X level of criteria for pre-diabetes (it's different in different sources AND it's changed repeatedly over our lifetime!), we will see a level of benefit sufficient to justify making these other people who would not have progressed to diabetes without it endure the hassle and side effects of taking a medication for the rest of their lives.

AND HERE'S THE REAL FUN PART: we don't really know where tissue damage begins! We thought we did! 6.5-7ish A1c. But it turns out there is a marked risk of retinopathy beginning at 5.5! Which is considered normal. AND ALSO we should probably be thinking of it as at least three separate disease based on our current ability to measure--A1c is a broad marker that collapses multiple forms of dysregulated blood sugar, and when we use more fine-grained tests, we see meaningful distinctions that probably affect preferred treatments between people who have impaired fasting glucose, people who have abnormal values on an oral glucose tolerance test, and people who have both. We should treat these groups differently because they reflect different underlying pathways: elevated fasting glucose means your liver is breaking down too much glycogen while you sleep, which is one issue, while elevated post-prandial glucose means your skeletal muscles (OR SOMETHING ELSE they're not totally sure) are behaving abnormally in response to insulin. IT'S NOT THE SAME THING and people with both impaired fasting glucose and abnormal post-prandial glucose are at higher risk of progression to diabetes/tissue damage than people with just one of those. AND WHILE WE'RE AT IT, what is diabetes? What's the best cutoff? What's the best measure? How many underlying pathophysiologies are getting collapsed into the same group????

THE MORE I LEARN ABOUT THIS THE MORE QUESTIONS I HAVE and experts are all being serenely confident while contradicting each other so I have to actually dig in the data a lot harder than I usually do. I've been meaning to do this for months, but one of the presenters this morning made a comment about the benefits of putting prediabetics on metformin that made me go "hm, do I need to start doing that?" and I've gone from my kneejerk answer being "no, we studied this and it doesn't help" to "I don't fucking know and neither does anyone else."

...as always, Cochrane is probably right.

#ok. good to know its mystifying for everyone #I'm gonna try to drink less fruit juice/soda #and eat more actual fruit because it comes with fiber. *nods*

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On the weight loss thing - how much does A1C matter, and what are you supposed to do about it, if not 'aggressive weight loss'? I've dug through some studies but ... there's so much fatphobia, and honestly, it's poking my own eating disordered history in the nose. My partner's terrified of becoming diabetic and I don't know how to support them on that.

A1c matters, but the thing is, the medical community dropped standards so “pre-diabetes” is now defined as an A1c of 5.7 or up in most settings I’ve worked in. (Hemoglobin A1c is a way to measure an estimated 3-month rolling average blood sugar based on glycosylation, which Autocorrect turned to “glucose Latinos,” which, no.) Diabetes is defined as an A1c at or above 6.5.

But like… the goal we’re told to set for diabetics is under 7.0.

So does tissue damage from high sugars start happening at 5.7? No. And I would argue that if we don’t say that medication is required until 7.0, then the DISEASE starts at 7.0.

There’s been attempts to medicate people with “prediabetes” to prevent the development of diabetes. It’s not effective. Lots of people in the “prediabetic” category never go on to develop diabetes. I just think it’s a bit of a garbage categorization scheme.

And you’re never gonna believe what I’m going to tell you about preventing diabetes… it’s eating right and exercise. Doesn’t matter whether you lose weight. Eating right and exercising will help even if you don’t lose a pound. Even if you gain weight. Stay active and eat lots of fresh fruits and vegetables and whole grains, and your odds of developing complications from diabetes are quite low. Plus, if you DO get diabetes, we have highly effective medication options. Yes, insulin is still a mainstay, but the last 30 years have seen incredible advances in diabetes care.

Diabetes is neither a moral judgment nor a death sentence. Genetics has a whole lot to do with it, and it is highly manageable. Proper care of your body will help it live its longest and best life.

Eat well, move around, do things you love. Sleep right—that’s a huge component of blood sugar. Minimize stress. You do not have to hate your body to keep it in line. It’s part of your team.

#found it

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i could've sworn you answered an ask about prediabetes and now i can't find it. did i imagine that ask?

No, but god knows I can’t find anything either. TLDR is that “prediabetes” is a crock. Like a third of people with prediabetes will go on to develop diabetes. They arbitrarily lowered the A1c (three month rolling average of blood sugars) to create a “disease” before there’s tissue damage and when most of the people with it will never DEVELOP that tissue damage. It’s a crock.

#oh no someone asked the same question only 3 months ago #well. we'll find it with a little more digging I expect.

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I've heard some people say that prediabetes isn't real because mildly elevated A1C levels don't reliably predict a future diabetes diagnosis. They call it a marketing term to sell weight loss drugs, which sounds at least plausible, based on my experience with the industry. Is there any truth to this claim, or is it from a corner of the body-positive internet that's started veering into medical conspiracy theories?

Yeah, no, they’re right. I did post about this a while back but god help us with tumblr search options.

#context: scientia-rex is an MD #and for 2 years now I've had an A1C of like...5.8 or 5.9 #which I have a hard time seeing as a real problem