Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is there a role for the use of SGLT2 inhibitors for the treatment of reactive hypoglycemia not responsive to dietary modifications or acarbose?
I would be concerned and very cautious about using SGLT2 inhibitors for "Reactive hypoglycemia." This type of hypoglycemia is a form of hyperinsulinemic hypoglycemia, sometimes associated with late dumping syndrome in those who have had gastric bypass or fundoplication surgery or those who have pred...
What is the recommended approach to treating severe constipation in patients on GLP1 R agonist therapy?
About half of the people taking these drugs will experience some of these GI side effects (diarrhea or constipation), at least transiently. When I prescribe these meds, I also “prescribe” daily fiber and adequate fluid intake. They should have smaller, frequent meals rather than large meals in one s...
What is the recommended frequency and duration of exercise sessions in order to sustain the beneficial effects of exercise on insulin sensitivity?
The beneficial effects of exercise on insulin sensitivity usually last 24-72 hours, depending on the duration and intensity of the exercise. Combination of resistance and aerobic exercise is better than either alone, alternating the two. The ADA recommends at least 150 minutes of exercise per week. ...
When would you consider switching a patient with insulin-requiring Type 2 DM to an automated insulin delivery system?
I would recommend switching to AID System to patients having high insulin requirements, Persistently poor control, Difficulties with compliance with meal time insulin, Tendency to Hypoglycemia Including overnight and patients who are having a variable schedule/Swing shifts or traveling. Importantly,...
Do you recommend the use of bempedoic acid (Nexletol) for treatment of hyperlipidemia in patients with elevated baseline uric acid levels?
I would still use bempedoic acid in patients with asymptomatic hyperuricemia if they have no previous history of gout, and will clearly benefit from lipid lowering (high risk ASCVD and statin intolerance). Would monitor uric acid levels in such individuals. However if they have had recurrent gout, I...
Do you use the homeostatic model assessment (HOMA) to assess for insulin resistance and change your clinical management of patients?
No. As insulin assays are not standardized nationally, glucose measurements are surprisingly variable across methods and institutions, single measurements of fasting glucose and insulin are somewhat quixotic, and as there is a loose relationship of HOMA measures in individuals and gold-standard meas...
Is there any benefit of using aspirin to mitigate VTE risk in testosterone-induced polycythemia?
Erythrocytosis is a common adverse effect of testosterone therapy, and results from several studies suggest an association between elevated hematocrit (Hct) and risk of VTE (Braekkan et al., PMID 19833630; Ory et al., PMID 35050717). There is currently no data to support the routine use of aspirin o...
How do you counsel patients on semaglutide or tirzepatide in light of potential cancer risks?
Use of GLP 1 RAs has sky-rocketed in recent years due to what seems to be a positive class effect on T2DM, weight loss, renal outcomes, cardiac outcomes and hepatic outcomes. I am not aware of any signals of increased malignancy risk. A brief literature review found meta-analyses showing possible be...
How does your hospital approach the use of insulin pumps for admitted patients?
Patients using insulin pumps are only on rapid-acting insulin, so that any interruption in the use of the pump requires them to switch to a combination of basal insulin and rapid-acting insulin. This is hard to do in a controlled outpatient setting (for example, technical failure of the pump), but v...
When would you treat mild anemia from low testosterone in an older male?
The primary indication for testosterone treatment is symptomatic hypogonadism and not anemia. Given the risk for adverse events in terms of erythrocytosis, cardiovascular events, and potential prostate diseases, the risk of providing testosterone for asymptomatic, mild anemia outweighs its benefits,...