Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Are recurrent UTIs a contraindication to SGLT2i use?
I don't view UTIs as a contraindication to SGLT2i use, but I make a risk and benefit analysis with each patient. Bacterial UTI as well as mycotic vaginal infections may be a sign that the patient has excessive glycosuria from hyperglycemia. In general, treating hyperglycemia should lessen the freque...
What dietary modifications do you recommend for the management of type 2 diabetes, considering the benefits of Mediterranean, plant-based, low-carbohydrate, and ketogenic diets?
In general, the most important consideration for diet modifications for patients with type 2 diabetes is an individualized diet plan to which the patient can adhere and which will help the patient lose weight. Lower carb/keto diets might be associated with better weight loss in the short term, but t...
Do you favor Sotagliflozin over SGLT2i alone for cardiovascular risk reduction in patients with Type 2 diabetes and chronic kidney disease?
The use of Sotagliflozin rather than SGLT2i alone is reasonable based on the results of the SCORED trial (Aggarwal et al., PMID 39961315). Although this trial compared sotagliflozin to placebo, rather than to SGLT2i, it did show a reduction in both MI and stroke in patients who have type 2 diabetes ...
For patients with low risk, differentiated thyroid cancer, how do you navigate the decision between less aggressive treatments, such as lobectomy alone without radioactive iodine, and more aggressive strategies?
This question is the basis of the entirety of the thyroid cancer teaching for our fellowship. I will try to answer here: Lobectomy: Generally if the tumor is low risk that is entirely within the thyroid (no extrathyroidal extension, no metastatic nodes, no aggressive history such as tall cell varia...
How does contralateral suppression of more than 50% with cosyntropin during adrenal venous sampling influence your decision to recommend adrenalectomy in patients with primary aldosteronism?
Most but not all studies support it as a secondary criterion, and ratios <1 and 0.5 compared to the periphery have been suggested. There have been rare cases where I have used it as the sole criterion where the contralateral adrenal vein could not be successfully catheterized (usually in conjunction...
What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?
Treatment of hyponatremia due to adrenal insufficiency with glucocorticoid therapy may result in overcorrection of serum sodium due to suppression of ADH and resultant water diuresis. Therefore, serum sodium, urinary osmolality and urinary output should be closely monitored. A brisk water diuresis w...
How do you adjust your management strategy to address the unique needs of anuric end-stage kidney disease patients when treating diabetic ketoacidosis?
There is no osmotic diuresis, and they do not need IVFluid, the opposite is true they may appear intravascularly overloaded, and will respond to insulin alone, they do not need HD for this. They will not be K deficient, do not give K. Their potassium will likely respond to insulin alone, and should...
What is the upper limit of blood glucose target in hyperglycemic critically ill patients?
I don't think there's much data that argues that setting the upper limit between 180 and 200 will make much of a mortality difference. The SCCM guidelines center around initiation of insulin infusions, and doesn't seem to say that we should start insulin infusions for BG>180, but tolerate it up to 2...
Would the diagnostic yield for ABIs or peripheral arterial duplex doppler in a patient with metal rods in both legs be similar or acceptable in comparison to those tests in a patient without metal rods?
Ankle-brachial index(ABI) relies on the compression of upper and lower extremity arteries with blood pressure cuffs and measuring the ratio of blood pressure between them. While I am not aware of specific studies in those with metallic rod fixation, ABI measurements should have similar utility as lo...
Does oral semaglutide provide similar cardiovascular risk reduction benefits as injectable semaglutide?
Novo Nordisk, the manufacturer of oral and injectable semaglutide, just released positive topline results in its SOUL cardiovascular outcomes trial (n=9,650) for its oral semaglutide in people with T2D and established CVD and/or CKD. The trial met the primary endpoint demonstrating a statistically s...