Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Does your LDL goal change in elderly patients with diabetes and hyperlipidemia who are on statin therapy?
First, what is an elderly? I will be 81 next month, and I don't consider that young, but also not too elderly to try to protect myself from an event. This patient is a high/very high risk, and if he is at a good goal on a statin, why would anyone want to change the dose? I tell my patients that surv...
Has the recent large observational data suggesting that continuing metformin during hospitalization is associated with lower post-discharge mortality and hypoglycemia changed your approach to holding it on admission in stable, non-critically ill patients with T2DM?
I really like this paper, but I don't think it is plausible that a 5-day difference in receipt of metformin (the median length of stay was 5 days) could really affect 90-day mortality.The study question is a good one because the evidence that metformin causes lactic acidosis is extremely limited. In...
Do you consent patients for diabetes insipidus following SRS or fractionated radiation for pituitary tumors?
This, and more broadly hypopituitarism of any type, is an important consideration and likely under-addressed topic in consent.Untreated hypopituitarism in adult life is associated with reduced all-cause life expectancy, and by one study 2x mortality rate compared with age/sex matched controls. [1]Th...
When do you check vitamin D levels in patients with depressive symptoms?
I routinely check 25-OH D in all my patients. Given that half the population is deficient and that we now know the role of vitamin D not only for bones but in mood, cognition, and immunity. We need to be aware of deficiencies and replete if low. Moreover, ideal levels are 60-80, not just over 29 as ...
How long after a DKA episode do you anticipate patients with ketosis prone diabetes mellitus to be able to discontinue insulin therapy?
After 2 weeks, a meal-stimulated C-peptide can be checked and, if normal, the patient may be able to taper off insulin as long as requiring less than 10 to 20 units per day.
How long do you continue a first-line somatostatin receptor ligand before concluding inadequate biochemical response and escalating therapy in a patient with persistent acromegaly after transsphenoidal surgery?
First-generation somatostatin receptor ligands (SRLs) are often used as first-line therapy for patients with persistent acromegaly after surgery. Several factors can predict biochemical responses to such therapy, including older age, lower baseline insulin-like growth factor I (IGF-I), paradoxical g...
How do you manage an implanted insulin pump or continuous glucose monitoring device during radiation?
We do not have an official written policy yet, but honestly, we probably should develop one, since these devices are becoming more prevalent. For CGMs, we ask the patient to place the device far from the treatment site while under treatment and to verify function with finger stick glucose measuremen...
How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?
If it fits with telogen effluvium, I recommend monitoring. Many patients will improve after this initial shedding and will not have long-term shedding or long-term thinning. If there is any underlying androgenetic alopecia or pattern hair loss, then starting treatment as you normally would is also r...
Do you consider adding a GLP-1 receptor agonist to insulin therapy in a patient with newly diagnosed LADA who has not yet progressed to insulin dependence?
Auto-immune diabetes is known to have identifiable stages of beta-cell dysfunction and demise and being able to intervene with a treatment to preserve or improve beta-cell function is one of the major areas of diabetes research. Latent auto-immune diabetes presenting in adults (LADA) at a time when ...
In patients with MASLD, would you consider management with off-label metformin, pioglitazone (despite weight gain risk), GLP-1 RA, or simply intensify lifestyle and monitor?
In 2025, we should be assessing if patients are developing F2-F3 fibrosis especially with the use of non-invasive assessments (FIB-4 score, transient elastography, or MRI elastography), and then offering either Semaglutide or Resmetirom for these individuals w/ F2-F3, which are the only FDA approved...