Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is there any role for bisphosphonate or alternative bone-modifying agents use in SMM in the absence of other indications for its use?
The short answer is no, unless the patient has an indication like osteoporosis. Bisphosphonates have been evaluated in smoldering multiple myeloma in studies performed over 10 years ago. Treatment with pamidronate (D’Arena et al., 2011) or zoledronic acid (Musto et al., 2008) did not affect the time...
For patients on weekly insulin (AWIQLI), do you recommend reducing their dose prior to major surgery?
Thanks for the question. AWIQLI (insulin icodec) has a half-life of 8 days. Insulin efsitora, which has a half-life of 19 days, was just approved. Both are approved only for people with type 2 diabetes. These weekly basal insulins have the potential to improve compliance and reduce the burden of inj...
What are the main differences between TRYNGOLZA and Redemplo?
TRYNGOLZA (olesarsen) and Redemplo (plozasiran) both work to reduce apoC-III production, a known inhibitor of LPL activity, thus leading to significant triglyceride lowering. Olezarsen is an antisense oligonucleotide, and plozasirin is an siRNA. Both lower triglycerides by 40-60% and both are FDA-ap...
How do you approach the choice of basal-bolus insulin vs correctional insulin alone to manage hyperglycemia in a hospitalized older adult with type 2 diabetes and significant frailty?
Frail older adults with type 2 diabetes, compared to their less-frail counterparts, may have less predictable oral intake, and you may have more difficulty obtaining an accurate medication reconciliation. You may need to review facility records or speak to multiple collateral historians to find out ...
What is the correct dose of Lugol's iodine solution and duration of therapy for preparing a thyrotoxic patient for surgery and minimizing the risk of thyroid storm?
KI can be given 3 times per day in a full glass of water or juice (bitter) for 10 days before Graves' hyperthyroidism surgery as Lugol's solution (8 mg iodide/drop) 5-7 drops SSKI (50 mg iodide/drop) 1-2 drops Minor calculated differences in dose described for these 2 types of KI are insignificant s...
Do you manage mild-to-moderate diabetic ketoacidosis with a subcutaneous rapid-acting insulin protocol rather than an IV insulin infusion?
Yes, SC rapid-acting insulin can be used in the mild cases of DKA, provided that dehydration is not severe enough to affect insulin absorption. Small, frequent doses every hour may replace the IV insulin in mild cases. A good tip is to start correcting fluid loss in the first or two hours before sta...
Would you favor the use of denosumab over bisphosphonate therapy for treatment of osteoporosis in patients who are at high risk for osteoarthritis given recent data suggesting reduced risk of developing knee OA?
Although the overall data to date concerning the impact of denosumab to reduce incident knee OA or lessen established disease remain limited, there are sufficient signals that warrant further investigation and support the need for an appropriately powered RCT with endpoints that include both patient...
Will you give a trial of tirzepatide in patients with PsA and obesity who have a partial response to bDMARD rather than switching their immunosuppressive regimen?
I don't believe the data on the magnitude of the benefit of GLP-1 agonists in arthritis symptoms is sufficient to suggest that adding one of these agents would be preferable to changing DMARDs in a patient with inadequate response.
Is the rise in LDL and liver fat after starting tryngolza a concern?
A modest increase in LDL-C after olezarsen (Tryngolza) and plozasiran (Redemplo) have been been reported, particularly in patients with severe hypertriglyceridemia. It probably reflects the conversion of TG-rich LPs and TG-remnants to smaller lipid particles, including IDL and LDL. Notably, the non-...
What therapies do you offer patients who have osteoporosis and CKD and have had adverse reactions to several oral bisphosphonate therapies and denosumab?
Without further details as to the severity of CKD, the severity of the osteoporosis, and the specific intolerance issues with denosumab (and/or BPs), this is a very difficult question to provide specific advice. Some general comments can be offered: CKD stage 4-5 is essentially without fracture data...