Diabetic Peripheral Neuropathy – Rueppel

Acute reversible neuropathy - associated with hyperglycemia and rapid correction of hyperglycemia.  Ex: DKA.  Improvement is ~50% chance, and can take up to a year to resolve. Pathophysiology:  involves deposition of sorbitol?   Chronic persistent neuropathy: Systemic polyneuropathy:  classic stocking-glove neuropathy; reduced or lost sensation on monofilament testing; burning or tingling. Autonomic neuropathy:  smooth muscle;… Continue reading Diabetic Peripheral Neuropathy – Rueppel


Microalbuminuria – Matelich

Do we continue to follow microalbumin after diagnosing microalbuminuria?   YES - the ADA does recommend yearly checking of the eGFR and microalbumin. At T2DM - start at time of dx At T1DM - start 5 years after dx   Kidney care: Glucose control BP control < 140/90 ACE/ARB   Microalbuminuria = 30-300  Macroalbuminuria >… Continue reading Microalbuminuria – Matelich

Gout – Treatment Guidelines

(BMJ)—A committee of experts w/ experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. The expert group developed 9 treat-to-target recommendations: 1. Serum urate must be measured regularly and urate-lowering tx should be adjusted to attain the therapeutic target. 2. Serum urate level <6 mg/dL should… Continue reading Gout – Treatment Guidelines

Screening for Pre-Diabetes Not Very Accurate

The Brits strike again, undermining what we all think we know!  The article summarized here calls into question the practice of using A1c or fasting glucose to diagnose "pre-diabetes" (a "disease" which I put in "quotations" because it's a "pre-disease.") Screening for pre-diabetes: neither HbA1c nor fasting glucose results are very accurate Clinical Question Are… Continue reading Screening for Pre-Diabetes Not Very Accurate

Yet Another Risk of Testosterone Therapy – Thromboembolism

BMJ 2016 Nov 30;355:i5968 Population-based, case-control study of 19,200 men with confirmed VTE:  8400 with DVT, 10,800 with PE. All were matched by age and risk factors to 910,000 controls.  Mean age 65. Risk for VTE was 25% higher with current testosterone use vs no testosterone use. Current testosterone use for ≤ 6 mos was associated… Continue reading Yet Another Risk of Testosterone Therapy – Thromboembolism

Severe Hyperglycemia Does Not Have to Be Aggressively Managed in Well ED Patients

Ann Emerg Med 2016 Dec; 68:697 Retrospective study of 566 urban ED visits with initial glucose ≥400 mg/dL but not admitted to the hospital.  Hyperglycemia was the "CC" in half of the visits. No patients had DKA or hyperosmolar symptoms. Mean glucose at time of discharge was 334 mg/dL with wide range (48 to 694 mg/dL),… Continue reading Severe Hyperglycemia Does Not Have to Be Aggressively Managed in Well ED Patients

Metformin as Effective as Insulin for GDM

Metformin appears to be at least as effective as insulin for treatment of gestational diabetes mellitusClinical Question:What are the short-term and long-term risks and benefits of metformin therapy compared with insulin therapy for glucose disorders in pregnancy?Bottom Line:The results of this systematic review and meta-analysis show that metformin is at least as effective as insulin… Continue reading Metformin as Effective as Insulin for GDM

Eye Manifestations of Systemic Disease – Czarnecki

Lecture notes from presentation by Dr Scott Czarnecki, 04 January 2017: WHAT IS URGENT? Acute vision loss (<24h) Painful vision loss (<24h) Globe penetration (now) Flashes and floaters (<24h) Semi-urgent:  HSV conjunctivitis, zoster ophthalmicus (24-48h) Ptosis and blown pupil (now) Random ophtho pearls: For bacterial conjunctivitis, use Ocuflox or Polytrim.  Don't use tobra or gentamicin… Continue reading Eye Manifestations of Systemic Disease – Czarnecki