Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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 ...
For patients with Hashimoto's thyroiditis, is there a commercially available blood test for detecting abnormalities in the type 1 deiodinase enzyme in order to identify patients who would potentially benefit from T4 and T3 combination therapy?
Most clinicians decide to use combination therapy based on a weak response to levothyroxine, with patients still complaining of symptoms related to hypothyroidism. The TSH should not be low before selecting dual replacement.
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 ...
Do you routinely prescribe vitamin D to reduce the risk of fall-related fractures in elderly patients regardless of their serum levels?
Right now, the evidence would NOT support daily vitamin D in older adults who are not deficient just for the purposes of fall prevention. Kahwati et al., PMID 33847712However, lots get missed on fall prevention - so be sure to review all risk factors and make a personalized plan (STEADI resources ar...
Would you consider adding metformin to the regimen of a diabetic patient with a benign thyroid nodule to decrease its volume?
No. The evidence for this is of fairly low quality. I would, however, add it for their diabetes 100%.
Under what circumstances would you consider a bone biopsy in the workup of renal osteodystrophy?
I am always in favor of doing more diagnostic tests. The problem is that it is often practically hard to get a bone biopsy. I would suggest it anytime there a question of what is happening with the bone disease.