Endocrine

Spotlight: A case of Metformin Associated Lactic Acidosis

May 11, 2018
Spotlight: A case of Metformin Associated Lactic Acidosis

By  Jasmine Nee and Martin Fried, MD

Peer Reviewed

LEARNING OBJECTIVES

1. What is metformin-associated lactic acidosis?
2. How does severe acidemia lead to acute kidney injury?
3. How do you treat metformin-associated lactic acidosis?

CASE SUMMARY

The patient is a 40-year-old man with alcohol dependence and type II diabetes who presented to the emergency department for alcohol intoxication. After arriving hemodynamically stable with reassuring labs, he become tachypneic, confused, and lethargic a few hours later. At this point, he admitted that he took “a …

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Insulin in a Pill: Barriers to Development of Oral Insulin

May 8, 2018
Insulin in a Pill: Barriers to Development of Oral Insulin

By Nicolas Gillingham

Peer Reviewed

Over 30 million Americans—9.4% of the population—live with diabetes, six million of whom are at least partially dependent on exogenous insulin. Insulin can be self-administered by subcutaneous injection, either classically via a syringe, an insulin pen, or using an insulin pump. However, patients with diabetes report that these daily injections can feel particularly burdensome, not to mention stigmatizing, when compared to oral medications like metformin, which is one reason why insulin carries a lower rate of adherence. What if our …

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A Rare Complication of Diabetes: Diabetic Myonecrosis

March 29, 2018
A Rare Complication of Diabetes: Diabetic Myonecrosis

By Allison Harrington, MD

Peer Reviewed

Learning Objectives:

1) When should diabetic myonecrosis be suspected?

2) What are the diagnostic criteria for diabetic myonecrosis? What is the pathophysiology?

3) What is the management of diabetic myonecrosis? How can it be prevented?

A 41-year-old female with a past medical history of poorly controlled type I diabetes (hemoglobin A1C , 13%), a right lower extremity deep vein thrombosis (DVT) status post inferior vena cava filter placement in March 2017 presents with persistent weakness and left lower extremity …

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How Reliable Is Hemoglobin A1c?

April 6, 2017
How Reliable Is Hemoglobin A1c?

By Alexa Yuen

Peer Reviewed 

According to the CDC, there are 22 million people with an established diagnosis of diabetes mellitus in the United States, but more frightening is that the rate of diabetes continues to rise both nationally and globally, with predictions that 7.7% of the world’s adult population will be afflicted with the disease in 2030., Preventing, monitoring, and managing this disease is of utmost importance in responding to the growing epidemic. The hemoglobin A1c (HbA1c) blood test has become a powerful tool …

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Gamechanger? Can Pioglitazone Reduce Cardiovascular Events After a Stroke? An Analysis of the IRIS Trial

January 19, 2017
Gamechanger?  Can Pioglitazone Reduce Cardiovascular Events After a Stroke?  An Analysis of the IRIS Trial

By Johanna Hase, MD

Peer Reviewed

Welcome to Gamechangers, a series that takes a critical look at the latest in medical literature to answer one important question: would the results of this article change my practice? Featuring thorough evidence-based review as well as expert commentary, our aim is for this series to help you decide if the results of a given study are, in fact, a gamechanger

A 64 year old woman with pre-diabetes, hyperlipidemia, and hypertension on aspirin, losartan and simvastatin, recently was diagnosed …

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Botox: Not Just for Wrinkles Anymore

July 28, 2016
Botox: Not Just for Wrinkles Anymore

Samantha Kass Newman, MD

Peer Reviewed

You can get a Botox injection almost anywhere these days. Internists, dermatologists, and even gynecologists have capitalized on an aging group of baby boomers who aren’t fans of their wrinkles. And it’s true that with an impressive safety profile, few contraindications, rapid effectiveness, and positive cash return for providers, botulinum toxin injections for cosmetic purposes can make everyone happy.

Botulinim toxin is produced by the anaerobic bacterium, Clostridium botulinum. This is the strongest toxin found in nature. When injected …

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Could Metformin be the First Anti-Aging Drug?

February 11, 2016
Could Metformin be the First Anti-Aging Drug?

By Amy Shen Tang, MD

Peer Reviewed

“I would pay you if you took it away from me. I’d try to buy it back,” said Irving Kahn, the late Wall Street investment advisor when asked if he would ever retire from work . Mr. Kahn, who founded Kahn Brothers Group, Inc. with his sons more than 40 years ago, took an active role as chair of his company until his passing last winter at the ripe age of 109 years. Kahn and his siblings all …

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Is It Time to Reconsider Who Should Get Metformin?

December 11, 2015
Is It Time to Reconsider Who Should Get Metformin?

By Lauren Strazzulla

Current FDA guidelines for the use of metformin stipulate that it not be prescribed to those with an elevated creatinine (at or above 1.5 mg/dL for men and 1.4 mg/dL for women). It is also contraindicated in patients with heart failure requiring pharmacologic treatment, and people over age 80, unless their creatinine demonstrates that renal function is not reduced. These guidelines are in place to prevent lactic acidosis, an understandably feared complication of metformin. However, metformin is, by consensus, the initial drug …

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