Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you change your pre-operative insulin dosing when patients are NPO for surgery, but also just recovering from newly resolved DKA?
I agree. As long as the patient does not need the surgery emergently, the cause of the DKA should be determined. The patient should also be monitored to ensure that the DKA does not return once it has resolved. The basal insulin should be reduced by 25%. I usually reduce the dose of basal insulin be...
How do you determine the appropriateness of starting a CGM in patients aged 75 and older with type 2 diabetes on multiple daily insulin injections?
In general, the profile of T2D on MDI is a compelling indication for CGM. The wrinkle here is "age 75 and older". Though our gut instinct is that if the base case is compelling, the case should be stronger for those aged 75 and older. Specifically, avoiding hypoglycemia is critical to keep elders we...
How do you approach persistent fatigue in a patient after thyroidectomy whose TSH is within the target range, given that fatigue affects the majority of thyroidectomy patients yet its underlying mechanisms remain poorly understood?
I tend to assess fatigue in the 6-12 months post-thyroidectomy, as the initial 4-8 weeks post-op visit can skew results, especially after larger surgeries or not always optimal TSH levels. If the TSH is in the normal range, I also look at other causes of fatigue, like iron deficiency, OSA, etc. If t...
How do you distinguish between andropause versus pathological hypogonadism in older male patients?
The American Urological Association (AUA) guidelines state: "Men with sustained elevated prolactin levels, very low total testosterone (T) levels (<150 ng/dL) and unexplained failure to produce luteinizing hormone (LH)/follicle-stimulating hormone (FSH) warrant a pituitary magnetic resonance imaging...
How do you counsel patients with diabetes regarding the risks of cannabis use?
Cannabis use is becoming increasingly more common among patients with diabetes, with 10% recording use in the past month in a survey from 2022 (Han et al., PMID 39037352). Severe medical problems have been associated with cannabis use, including addiction(CUD), increased cardiovascular events, and a...
Will TRYNGOLZA (olezarsen), recently approved for familial chylomicronemia syndrome, also lower triglycerides due to other genetic causes of hypertriglyceridemia?
Yes, olezarsen does lower triglycerides due to other causes of hypertriglyceridemia. It is currently in trials in patients with severe hypertriglyceridemia without Familial Chylomicronemia Syndrome (FCS).
Would you use a parathyroid hormone analog for treatment of osteoporosis in a patient with mildly elevated AlkPhos of unclear etiology?
I would be hesitant to administer an anabolic in this setting without first delineating the reason for an elevated AlkPase. I would suggest starting with sorting out the source of the AlkPase (i.e., bone, liver, or gut with measuring bone-specific AlkPase, G-GGT levels, and possibly a liver ultrasou...
In patients with T1DM, when would you consider the use of amylin analogues for control of post prandial hyperglycemia?
Pramlintide was FDA-approved in 2005 after demonstrating modest A1C reduction, improvement in post-prandial hyperglycemia, no increase in hypoglycemia, and some weight loss. I prescribed it to several of my patients with type 1 diabetes. Unfortunately, many of them had challenges such as GI side eff...
How should clinicians balance the use of finerenone with other heart failure treatments like SGLT2 inhibitors, considering their glycemic benefits?
Finerenone could replace spironolactone or eplerenone since the likelihood of adverse effects are less. Unfortunately, RCTs of finerenone have compared it placebo. Until superiority to spironolactone (a cheap and very effective drug for heart failure) is shown we cannot justify the cost.
In patients using a tandem insulin pump on auto-mode/Control-IQ, would decreasing the basal settings on the profile actually reduce the delivered hourly insulin dose or is that only relevant if they switch to manual mode?
In the control IQ, the basal adjustment IS relevant in Auto-mode. The algorithm uses predicted CGM reading in 30 minutes (in the future) and responds to keep the glucose by CGM in the targeted range. See below: Above 160 mg/dL, basal insulin rate increases Above 180 mg/dL, a correction bolus is giv...