Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What do you recommend to your patients to prevent muscle loss when prescribing a GLP-1 agonist for weight loss?
While there are no clear data supporting the best strategies to preventing muscle loss during weight loss in general or with GLP-1 based therapies, it is generally recommended that patients engage in an exercise program which emphasizes resistance-type exercise as well as ensuring adequate dietary p...
In asymptomatic patients with mild CKD, PTH independent hypercalcemia, and hypercalciuria—after excluding common causes such as hyperparathyroidism, vitamin D abnormalities, multiple myeloma, thyroid disease, vitamin A excess, and antacid use—what is the next best step in evaluation?
It would be helpful to have more information. What is the serum calcium, urinary calcium creatinine ratio, 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D, urine NTX or serum CTX, phosphorus, P1NP or osteocalcin, creatinine clearance?
Which method provides a more accurate assessment of hypercalciuria: 24-hour urinary calcium excretion or the spot urine calcium-to-creatinine ratio?
24-hour urine should be more accurate. F. Singer
Is there any evidence regarding bone density gains/fracture reduction in the setting of treatment with romosozumab after a two year course of teriparatide?
There was a study by Ebina et al., PMID 34020048 titled "To investigate the effects of prior treatment and determine the predictors of a 12-month treatment response of romosozumab (ROMO) in 148 patients with postmenopausal osteoporosis".This study was a prospective, observational, and multicenter st...
What are the potential causes for significant discrepancies between predicted A1c by Dexcom CGM and standard serum A1c by lab draw?
When interpreting A1C and CGM results, it is important to remember that neither measure is perfect. As in all clinical conditions, it is important to evaluate A1C and CGM results in the context of the clinical situation. If there is a disparity between the two measures, one should review the limitat...
What is your approach to managing patients with recurrent nephrolithiasis and nephrocalcinosis in the setting of hypoparathyroidism?
If patients truly have hypoparathyroidism, then the issue is to manage their hypocalemia, which usually requires large doses of oral calcium as well as treatment with VDRAs, which results in marked hypercalciuria, since they do not have PTH to help reabsorb calcium. This even occurs when they have C...
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,...