Endocrine

Clinical Question: Pharmacology

December 28, 2007
Clinical Question: Pharmacology

Is there evidence to support the use of Lantus® (human insulin analog glargine) administered Q12h in Type 1 Diabetes?

Commentary by Kathy Lee, Pharmacy Resident 

The goal of diabetes management is to reduce the risk of long-term complications by maintaining near-normal glycemic control, in addition to reducing other risk factors. Patients with type 1 diabetes have an absolute deficiency in insulin and require exogenous insulin replacement. Lantus®, human insulin analog glargine, is the only long-acting insulin that exhibits a “peakless” action profile with duration of …

Read more »

Inpatient Diabetes Management: Case 7

December 20, 2007
Inpatient Diabetes Management: Case 7

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center

Welcome to our final case of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. Over the last few months, we have been presented individual cases followed by some management questions and answers.

Case 7: All our patients go home…
Mr. Smith, Mr. Jones, Mr. Mejia, Mr. Gary, Ms. Samson, and Ms. Longshore are all awaiting discharge. What …

Read more »

Inpatient Diabetes Management: Case 6

November 8, 2007
Inpatient Diabetes Management: Case 6

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center

Welcome to Case 6 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. Over the last several weeks, we have been presenting individual cases followed by some management questions and answers.

Case 6: The Case of Ms. Longshore

Ms. Longshore is a 21 year old female with type 1 diabetes who was admitted to the ICU with …

Read more »

Targeting Triglycerides

October 31, 2007
Targeting Triglycerides

Commentary by Josh Remick MD, PGY-3

Hypertriglyceridemia is defined by the NCEP guidelines for treatment as a fasting triglyceride level greater than 200 mg/dL after the target LDL-C level has been achieved (1). When triglyceride levels are greater than 1000 mg/dL, the risk of pancreatitis increases and treatment with fibrates should be started immediately. Many physicians would also argue for treatment of a triglyceride level greater than 500mg/dL. However, it is the triglyceride level between 200 and 500 mg/dL that is a bit more difficult …

Read more »

Inpatient Diabetes Management: Case 5

October 25, 2007
Inpatient Diabetes Management: Case 5

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center

Welcome to Case 5 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. Over the last several weeks, we have been presenting individual cases followed by some management questions and answers.

Case 5: The Case of Ms. Samson

Ms. Samson is a 55 year-old woman with Lupus who was admitted to the hospital with a Lupus flare. …

Read more »

Clinical Pharmacy Corner: How Do Sulfonylureas Work?

October 17, 2007
Clinical Pharmacy Corner: How Do Sulfonylureas Work?

Commentary by Helen Kourlas, PharmD and John Papadopoulas, PharmD, Pharmacology Section Editors

The sulfonylureas are members of a class of substituted arylsulfonylureas that have been used clinically since the 1950s. These agents are usually divided into two categories or generations. First generation agents include acetohexamide, chlorpropamide, tolazamide, and tolbutamide (the first widely utilized agent). The more potent second-generation agents include glimepiride, glipizide, and glyburide.

Sulfonylureas acutely lower plasma glucose by stimulating the release of insulin. The primary mechanism is through binding to sulfonylurea receptors (SUR-1) …

Read more »

Inpatient Diabetes Management: Case 4

October 11, 2007
Inpatient Diabetes Management: Case 4

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center 

Welcome to Case 4 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. Over the last several weeks, we have been presenting individual cases followed by some management questions and answers.

Case 4: The Case of Mr. Gary

Mr. Gary is a 54 year-old diabetic male admitted with acute renal failure who is being evaluated for long-term …

Read more »

Why Does Hypertriglyceridemia Lead to Pancreatitis?

October 4, 2007
Why Does Hypertriglyceridemia Lead to Pancreatitis?

Commentary by Daniel Frenkel, PGY-2

Case: A 46 year old male with diabetes on oral hypoglycemic medications is admitted to the hospital with one day of constant epigastric pain, nausea, vomiting, and an inability to tolerate oral intake. You are concerned about pancreatitis but laboratory analysis reveals amylase levels that are within the normal reference range. You notice that his glucose level is 410mg/dL and that the specimen is described as lactescent. Should you still be concerned about acute pancreatitis?

Lactescent or lipemic blood samples …

Read more »

Bedside Rounds: How Do You Diagnose and Treat Diabetic Neuropathy

October 3, 2007
Bedside Rounds: How Do You Diagnose and Treat Diabetic Neuropathy

Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

Diabetic neuropathy is one of the most commonly encountered complications of diabetes mellitus. It is seen in up to 20% of diabetics. Patients typically present with neuropathic pain in a “glove and stocking” distribution with the earliest signs in the feet. Night time complaints of “my feet are on fire” are common. Relying on a patient’s complaint of “pain” or “numbness” is inadequate in the diagnosis of peripheral neuropathy since almost half …

Read more »

Inpatient Diabetes Management: Case 3

September 27, 2007
Inpatient Diabetes Management: Case 3

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center 

Welcome to Case 3 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 3: The case of Mr. Mejia

3A. Mr. Mejia is a 30 year old man with Type 1 diabetes who is admitted for shortness of …

Read more »

Inpatient Diabetes Management: Case 2

September 14, 2007
Inpatient Diabetes Management: Case 2

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center 

Welcome to Case 2 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 2: The case of Mr. Jones
Mr. Jones is a man with (insulin requiring) type 2 diabetes who is admitted for pneumonia. He has had …

Read more »

Inpatient Diabetes Management: Case 1

August 28, 2007
Inpatient Diabetes Management: Case 1

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center

Welcome to our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 1: The case of Mr. Smith
Mr. Smith is a 65 year old obese male admitted to the hospital with acute renal failure. He reports a recent history …

Read more »