Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?
In short, no. I think the recent studies tell me two things: We need to better discriminate correction rates based on the risk of osmotic demyelination (ODS). Perhaps, do not worry so much about over-correction. They do not tell me to start rapidly correcting patients, and I guess I will summarize m...
When do you recommend screening patients with T2DM for heart failure?
Screening patients with T2DM for heart failure is recommended at the time of diagnosis. This recommendation is based on the increased risk of HF in this population, even in the absence of symptoms. The American Diabetes Association guidelines recommend that screening for asymptomatic heart failure i...
Do you have any specific recommendations to prevent large fluctuations in sodium levels during a colonoscopy prep in patients with central diabetes insipidus on DDAVP?
Interesting, I have just received a message from a patient in this very same situation. I am not aware of any specific literature on this. In absence of such data, I usually recommend remaining on the same desmopressin dose and obeying to thirst, as I worry about hyponatremia that may be caused by a...
Is azilsartan superior to other angiotension receptor blockers in regard to cardiorenal outcome data?
In short, there are no data. There are very few head-to-head comparisons of ARBs on hard outcomes. Azilsartan was used in SPRINT (alongside losartan and valsartan), though the secondary analyses focused on class effect as opposed to specific med-to-med comparisons within a class (DeCarolis et al., P...
Is the accuracy of continuous glucose monitors (DEXCOM or Libre) lower in patients undergoing dialysis?
The question of the accuracy of CGM in dialysis patients is an important one and has been debated for some time. CGM is a superior method for glucose management over fingersticks in most clinical settings. Patients with ESRD on dialysis in particular, can have very difficult-to-control diabetes. A r...
For patients on peritoneal dialysis with type 2 diabetes mellitus, do you have a preferred long- acting insulin and time of insulin administration?
Insulin management in patients on peritoneal dialysis can be tricky. In my experience, you have to be very cautious with long-acting insulin. Much of the hyperglycemia occurs during the exchanges with the dextrose solution. Therefore, using long-acting insulin can cause hypoglycemia. My suggestion i...
Are there any concerns with live vaccine innoculation and patients who are on denosumab?
This is a complicated question because while denosumab is a biologic therapeutic that has immunomodulatory effects on innate and adaptive immunity its association with serious infections complications appears modest. An increased rate of background infections and some increase in serious infections ...
Do you routinely check vitamin K levels in post-bariatric surgery patients?
Vitamin K levels are not checked routinely in post-bariatric surgery patients. Deficiency of this vitamin is very uncommon in patients who have undergone a sleeve gastrectomy and even with Roux-en-Y gastric bypass. There is more potential for deficiency in patients who have had biliopancreatic diver...
How does a mildly elevated CBG (cortisol binding globulin) level affect the interpretation of the 1mg overnight dexamethasone suppression test results?
We usually do not measure CBG level during the 1-mg DST. If a woman is on oral estrogen, one may wait for the total cortisol level; if abnormal, repeat the test with free cortisol measurement or measure free cortisol proactively to avoid delays in test interpretation. A nice paper from the Mayo Clin...
Is there an available ASCVD risk calculator that does not exclude patients on statin therapy?
The traditional pooled ASCVD risk calculator cannot be used in patients on lipid-lowering therapy. The new PREVENT (Predicting Risk of CVD EVENTs) risk calculator, which was developed by the AHA in 2023, can be used in patients on lipid-lowering therapy. It gives an estimate of 10- and 30-year risk ...