Endocrinology Feature Archive

Case Study: Hyperglycemia, concern for diabetic ketoacidosis, and type 1 diabetes

Case Study: Hyperglycemia, concern for diabetic ketoacidosis, and type 1 diabetes

A 36-year-old man with type 1 diabetes presents to the emergency room with hyperglycemia and possible diabetic ketoacidosis after not taking his insulin for 3 days.

Using information technology to tailor diabetes care

Using information technology to tailor diabetes care

A study of one tracking system's effect finds improvement in the management of diabetes.

Case Study in Diabetes: Use of DPP-4 inhibitors with GLP-1 agonists

Case Study in Diabetes: Use of DPP-4 inhibitors with GLP-1 agonists

A 63-year-old man with type 2 diabetes was admitted to the hospital to undergo right robotic partial nephrectomy.

The 2017 Standards of Medical Care in Diabetes: an update from the ADA

The 2017 Standards of Medical Care in Diabetes: an update from the ADA

The document addresses important new issues in diabetes management, including metabolic surgery and a more specific definition of hypoglycemia.

Vision changes after bariatric surgery

Vision changes after bariatric surgery

A patient notes concerns with vision difficulty 4 years after undergoing a laparoscopic biliopancreatic diversion with a duodenal switch.

Diabetic peripheral neuropathy: an overview

Diabetic peripheral neuropathy: an overview

Often underreported and undertreated, outcomes can be improved in this condition with appropriate screening and diagnosis.

Interventions in childhood obesity

Interventions in childhood obesity

Effective use of research-based interventions and recommendations for overweight and obese children begin with initiating a conversation with the family.

Weak and dizzy spells in a patient after gastric bypass surgery

Weak and dizzy spells in a patient after gastric bypass surgery

A patient came to the clinic to discuss her dizzy spells 4 years after her Roux-en-Y gastric bypass surgery.

A tip for encouraging exercise

A tip for encouraging exercise

Patients should be encouraged to incorporate daily exercise into their treatment regimen.

Thyroid antibodies

Thyroid antibodies

When symptoms of thyroid disease are present, clinicians should check thyroid antibodies even if thyroid function is normal.

Cultural considerations in diabetes: controlling HbA1c in a patient observing Ramadan

Cultural considerations in diabetes: controlling HbA1c in a patient observing Ramadan

A patient with type 2 diabetes is undergoing dialysis and needs to control his HbA1c levels while fasting during Ramadan.

Odorous stools, laboratory abnormalities after gastric bypass surgery

Odorous stools, laboratory abnormalities after gastric bypass surgery

A patient comes to her yearly nutrition check-up 11 years after undergoing gastric bypass surgery with reports of loose stools with significant odor several times per day.

Medical nutrition
 therapy in diabetes

Medical nutrition
 therapy in diabetes

Developing personalized nutrition goals with a registered dietitian
can be effective in managing non-insulin-dependent diabetes.

Managing nephropathy in a patient with type 2 diabetes

Managing nephropathy in a patient with type 2 diabetes

A patient with type 2 diabetes presents with elevated microalbumin levels and a recent history of elevated glucose due to bedtime snacking.

Vitamin D supplementation does not improve functional outcomes in postmenopausal women

Vitamin D supplementation does not improve functional outcomes in postmenopausal women

Vitamin D deficiency is especially prevalent in postmenopausal women, and recommendations from current guidelines are inconsistent regarding vitamin D use.

Avoiding hypoglycemia in a hospitalized patient with diabetes and increased physical activity

Avoiding hypoglycemia in a hospitalized patient with diabetes and increased physical activity

While undergoing physical therapy after a stroke, a patient with type 1 diabetes has a hypoglycemia-related stroke.

Achieving sustained weight loss in an obese patient

Achieving sustained weight loss in an obese patient

After steadily gaining weight for 10 years, an obese patient seeks help in achieving sustained, long-term weight loss.

Severe insulin resistance in a patient with type 2 diabetes

Severe insulin resistance in a patient with type 2 diabetes

Patients with type 2 diabetes and severe insulin resistance may require large doses of insulin to achieve glycemic control.

Metformin XR for diabetes care

Metformin XR for diabetes care

Patients who forget to take Metformin SR twice daily can be switched to Metformin XR with once daily dosing.

Diabetes management in the younger adult population

Diabetes management in the younger adult population

Patients aged 20 to 44 years who have diabetes have unique health concerns compared with older and younger patients with diabetes.

Management of the healthy, post Roux-en-Y gastric bypass patient

Management of the healthy, post Roux-en-Y gastric bypass patient

A patient visits her primary care physician for a two-year follow-up after a Roux-en-Y gastric bypass surgery to check for complications.

SGLT2 receptor blockers 
for diabetes

SGLT2 receptor blockers 
for diabetes


SGLT2 receptor blockers are only approved for type 2 diabetes.

Management and treatment of peripheral neuropathy

Management and treatment of peripheral neuropathy

An older patient with type 2 diabetes expresses concern about potential peripheral neuropathy.

Slipped capital femoral epiphysis
 in obese adolescents

Slipped capital femoral epiphysis
 in obese adolescents

Obese adolescents have an increased risk of slipped capital femoral epiphysis
 (SCFE).

Getting hemoglobin A1c under control after a relapse

Getting hemoglobin A1c under control after a relapse

A patient with diabetes questions the necessity of starting a statin.

When type 1 diabetes complicates surgery

When type 1 diabetes complicates surgery

The patient, aged 69 years, had a 43-year history of type 1 diabetes and was scheduled to undergo a chest wall resection.

Renal failure in a patient with maturity onset diabetes of the young

Renal failure in a patient with maturity onset diabetes of the young

A patient presented to the office with a 45-year history of maturity onset diabetes of the young after renal failure.

Nonprescription approaches to metabolic syndrome

Nonprescription approaches to metabolic syndrome

Metabolic syndrome can be managed using changes in diet and exercise.

Dietary fiber: The prebiotic connection

Dietary fiber: The prebiotic connection

Adequate fiber intake is critical for maintaining good health, but only 5% of Americans consume the recommended daily amount.

Transitioning a patient with a complex insulin regimen from hospital to home

Transitioning a patient with a complex insulin regimen from hospital to home

When creating outpatient diabetes management plan, the patient's inpatient medication regimen should be considered but not necessarily replicated.

Updated recommendations for managing hyperglycemia in type 2 diabetes

Updated recommendations for managing hyperglycemia in type 2 diabetes

In 2012, the ADA and the EASD published a position statement on the management of hyperglycemia in patients with T2DM. In January, 2015, the ADA and EASD issued an update to the original 2012 statement.

Preventing and treating periodontitis

Preventing and treating periodontitis

NPs and PAs must work in collaboration with oral health clinicians to effectively educate patients in the prevention of periodontal disease.

Antidepressant for neuropathy pain leads to hyponatremia

Antidepressant for neuropathy pain leads to hyponatremia

An older male patient started antidepressants for neuropathy pain but developed hyponatremia as a result.

Consider glucomannan for obesity treatment

Consider glucomannan for obesity treatment

Glucomannan can help treat obesity and comorbid conditions of type 2 diabetes, heart disease, and early mortality.

Type 2 diabetes management in a post-bariatric surgery patient

Type 2 diabetes management in a post-bariatric surgery patient

A patient, aged 57 years, was admitted to the hospital to undergo gastric bypass surgery. He had a history of type 2 diabetes for ten years.

Diabetes control in a patient with multiple hospitalizations

Diabetes control in a patient with multiple hospitalizations

A patient with type 2 diabetes for ten years experienced three recent hospitalizations and a COPD exacerbation that required an increase in maintenance steroids.

Inflamed foot in a patient with diabetes

Inflamed foot in a patient with diabetes

A patient diagnosed with type 2 diabetes, hypertension, hyperlipidemia presents to the foot clinic after one month of swelling, redness, and warmth in the left foot.

Think broadly to diagnose the cause of chronic abdominal pain

Think broadly to diagnose the cause of chronic abdominal pain

When diagnosing the cause of chronic abdominal pain, a more specific history and a broad consideration of causes can help with diagnosis.

Elevated blood glucose, weight loss in patient with type 1 diabetes

Elevated blood glucose, weight loss in patient with type 1 diabetes

A patient, Ms. B., was diagnosed with type 1 diabetes three years ago.

Diabetes program helped beat cancer

Diabetes program helped beat cancer


Encouraging a patient to get an overdue Pap exam resulted in an early discovery of uterine cancer that could have gone undetected.

Hypoglycemia in an ambulatory-care setting

Hypoglycemia in an ambulatory-care setting

A type 1 diabetes patient presents to an outpatient facility agitated and slurring his words. Emergency medical help was called to assist the patient.

Pain in a person with hepatitis C and a fatty pancreas

Pain in a person with hepatitis C and a fatty pancreas


An obese patient with chronic hepatitis C, diabetes, advanced cirrhosis, and fatty pancreas presents with chronic right-to-middle upper-abdomen pain.

Statins cut microvascular risk in diabetes

Statins cut microvascular risk in diabetes

Compared with patients who had not taken statins, those who had were less likely to develop diabetic neuropathy by 34%, diabetic retinopathy by 40%, and gangrene by 12%.

Preoperative management in a patient with type 2 diabetes

Preoperative management in a patient with type 2 diabetes

After a patient's elective surgery was postponed due to glucose readings, an assessment of his medical profile and history were evaluated to manage his type 2 diabetes mellitus complications.

Acute or chronic pancreatitis?

Acute or chronic pancreatitis?

How can a clinician distinguish chronic pancreatitis from acute pancreatitis in a patient with alcohol-abuse history?

Debunking diabetes nutrition, carbohydrate myths

Debunking diabetes nutrition, carbohydrate myths

The Grain Foods Foundation explores popular carbohydrate-related myths and assumptions patients with diabetes have likely encountered.

Easy formula for identifying normal glomerular filtration rate

Easy formula for identifying normal glomerular filtration rate

Each patient loses 0.8% kidney function/year after the age of 30. If you round this to a loss of 1% per year (for simplicity), you can calculate if a GFR is normal for a patient's age.

Be cautious of metformin
 use in chronic kidney disease patients

Be cautious of metformin
 use in chronic kidney disease patients

In specific situations, clinicians should monitor a patient's metformin use in order to prevent dialysis and higher risk of kidney failure.

Dizziness, decreased mobility in an elderly diabetes patient

Dizziness, decreased mobility in an elderly diabetes patient

Lack of confidence when mobilizing and hypoglycemia in an elderly lady with type 2 diabetes.

Cardiovascular risk factors may dictate psoriatic arthritis severity

Cardiovascular risk factors may dictate psoriatic arthritis severity

Half of the patients in the study were newly diagnosed with four or more symptoms of metabolic syndrome.

Identifying obstructive sleep apnea

Identifying obstructive sleep apnea


Airflow disturbances during sleep need to be recognized and evaluated before harm comes to the patients themselves or those around them.

Nuts may lower heart, diabetes risks

Nuts may lower heart, diabetes risks

Patients who ate nuts regularly had reduced diabetes, fatal and nonfatal ischemic heart disease.

An obese woman ­presents with polyuria and blurred vision

An obese woman ­presents with polyuria and blurred vision

A patient recently diagnosed with diabetes complains of worsening malaise and fatigue as well as bilateral extremity cramps.

The case for vegetarianism in the fight against heart disease

The case for vegetarianism in the fight against heart disease

Multiple studies show that just about any low-meat or no-meat diet reduces almost all controllable risk factors for cardiovascular disease.

High cholesterol may spell low fertility

High cholesterol may spell low fertility

The longest time to achieve pregnancy occurred in couples in which both partners had high cholesterol levels.

Dyspnea and cough in an elderly woman with diabetes and CHF

Dyspnea and cough in an elderly woman with diabetes and CHF

Our patient had an extensive medical history, but were her new-onset symptoms the result of poor compliance?

CT assesses plaque in diabetes

CT assesses plaque in diabetes

Only about one-third of the coronary plaque detected showed calcification.

Environmental exposures worsen untreated diabetes

Environmental exposures worsen untreated diabetes

Heavy metal exposure from a patient's well water accelerated multisystem damage associated with diabetes.

BMI as a vital sign

BMI as a vital sign

Assessing BMI regularly can help prevent long-term obesity problems.

A spreading shin rash signifies systemic disease

A spreading shin rash signifies systemic disease

A "bruise" from a minor injury continues to linger for weeks.

Hair loss in a post-menopausal woman with diabetes

Hair loss in a post-menopausal woman with diabetes

Are hormonal changes to blame, or something else?

Cardiac workup for patients 
with diabetes

Cardiac workup for patients 
with diabetes


Are more aggressive approaches to cardiac work up warranted in patients with diabetes?

Blood glucose test reliability

Blood glucose test reliability

In which disease states or at what stages of chronic kidney disease is the HbA1c test no longer reliable?

Treatment options for women with facial hair

Treatment options for women with facial hair

What is the best, safest and most cost-effective treatment for women with excess body hair?

A schizophrenic patient with poorly controlled diabetes

A schizophrenic patient with poorly controlled diabetes

Dietary supervision may have driven the patient out of his facility.

Antibiotic failure and weight in obese patients

Antibiotic failure and weight in obese patients

Frequent infections in obese patients lead to more frequent use of antibacterial medications in this population than in those who are not obese.

The challenges of identifying 
Prader-Willi syndrome

The challenges of identifying 
Prader-Willi syndrome

Children with this condition develop an insatiable appetite that leads to obesity, diabetes, hypertension, and behavioral problems when not treated.

Bisphosphonate treatment for a fragility fracture

Bisphosphonate treatment for a fragility fracture


A fragility fracture is defined as a fracture resulting from a fall from a standing height or less.

Misdiagnosed with type 2 diabetes

Misdiagnosed with type 2 diabetes

Despite adhering to lifestyle modifications, a woman's glycemic control remains inadequate.

Is estrogen plus progesterone necessary for vaginal atrophy?

Is estrogen plus progesterone necessary for vaginal atrophy?

Should oral progesterone be prescribed in combination with vaginal estrogen?

Garcinia cambogia: An answer to obesity?

Garcinia cambogia: An answer to obesity?

Garcinia cambogia has potential as a weight-loss aid, but has significant associated risks.

Frozen shoulder susceptibility 
in diabetic patients

Frozen shoulder susceptibility 
in diabetic patients

Why are individuals with diabetes especially prone to developing frozen shoulder?

Green coffee extract: A weight-loss aid?

Green coffee extract: A weight-loss aid?

Green coffee extract appears to be safe and somewhat effective in increasing the efficacy of regular weight-loss methods.

Are testosterone and belly fat linked?

Are testosterone and belly fat linked?

A patient requests her testosterone level be checked because she had heard that belly fat is related to low testosterone levels. Is there any truth to this?

Depression complicates wound treatment in a diabetes patient

Depression complicates wound treatment in a diabetes patient

An off-label treatment gives a patient in pain a second chance.

Techniques for blood glucose monitoring

Techniques for blood glucose monitoring

Many patients with diabetes develop poor blood-glucose monitoring habits over time. Reviewing technique helps assure the process is painless.

Hypertension and ­substance abuse mask an underlying condition

Hypertension and ­substance abuse mask an underlying condition

A middle-aged man presents with 
palpitations, tachycardia, tremors, 
and extreme anxiety.

Restrict fruit juice in a diabetic diet?

Restrict fruit juice in a diabetic diet?

Does fruit juice carry the same diabetes risk as other sugar-sweetened beverages?

Recognizing and treating low testosterone in men

Recognizing and treating low testosterone in men

There is a direct correlation between testosterone and metabolic syndrome, mental function, libido, erectile dysfunction, bone density, and overall energy.

Bariatric surgery may reduce type 2 diabetes in obese patients

Bariatric surgery may reduce type 2 diabetes in obese patients

Bariatric surgery may induce type 2 diabetes remission in obese patients, but more direct evidence is needed.

No CV, mortality benefit with omega-3 fatty acids in diabetes patients

No CV, mortality benefit with omega-3 fatty acids in diabetes patients

Omega-3 fatty acid supplementation does not reduce mortality or cardiovascular events in patients with or at high risk for diabetes.

Dietary adjustments to control Hashimoto disease

Dietary adjustments to control Hashimoto disease

Are there any studies that support eliminating foods like sugar, milk and wheat to improve Hashimoto disease symptoms?

Ease constipation caused by calcium supplements

Ease constipation caused by calcium supplements

Omega-3 supplements can help constipation in postmenopausal women taking calcium and vitamin D supplements.

Fenugreek aids weight-loss, and promotes lactation, healthy glucose and lipids

Fenugreek aids weight-loss, and promotes lactation, healthy glucose and lipids

The seeds of the fenugreek plant, which are used for medicinal purposes, contain saponins, alkaloids and other antioxidants.

What is BPA and how harmful is it to kids?

What is BPA and how harmful is it to kids?

Primarily used in food and drink packaging, ingestion of bisphenol A has recently been linked to obesity, diabetes, and reproductive disorders.

Are climate change and obesity linked?

Are climate change and obesity linked?

Mounting evidence suggests current food production, transport and land use may negatively impact both climate and obesity outcomes.

Use distilled water when taking thyroid medication

Use distilled water when taking thyroid medication

Minerals in tap and bottled water can deactivate some of the hormones in thyroid medication.

Osteoporosis in a patient taking anti-seizure medication

Osteoporosis in a patient taking anti-seizure medication


Are dual-energy x ray absorptiometry scans safe for patients taking anti-seizure medication?

Thyroid hormone and bone density

Thyroid hormone and bone density

Can thyroid hormone replacement therapy affect bone density?

What's causing elevated creatine levels?

What's causing elevated creatine levels?

A patient has elevated creatine and fasciculations. Could an electrolyte imbalance be the cause?

Examining the prostate of an obese man

Examining the prostate of an obese man

Excess fat around the gluteal region can make performing digital rectal exams in obese patients difficult. How can this challenge be overcome?

Interventions for prediabetes

Interventions for prediabetes

Two clinicians disagree on a diagnosis after reviewing two-hour oral glucose tolerance test results. Who is correct?

Vitamin D deficiency: Beyond bone health

Vitamin D deficiency: Beyond bone health

Vitamin D promotes absorption of calcium in the intestine and maintains adequate serum phosphate and calcium concentrations.

How much insulin does it take to lower blood sugar?

How much insulin does it take to lower blood sugar?

A patient with newly diagnosed diabetes has a hemoglobin (Hb) A1c of 12.2% and glucose 350 mg/dL, despite increasing insulin (glargine [Lantus]) to 25 units. What else can be done to lower blood sugar?

Show—don't tell—when it comes to weight loss

Show—don't tell—when it comes to weight loss

Conversations about weight loss can contribute tremendously to behavioral changes, but tangible examples may be even more effective.

Causes of thinning hair in a postmenopausal woman

Causes of thinning hair in a postmenopausal woman

Could a vegetarian diet be contributing to an older woman's alopecia?

Reversing childhood obesity

Reversing childhood obesity

How should a primary care clinician follow-up after performing a lipid profile on an obese pediatric patient?

Breastfeeding with a positive thyroid peroxidase

Breastfeeding with a positive thyroid peroxidase

Could positive thyroid peroxidase adversely affect a mother's milk supply?

Pancreatitis leads to foot amputation

Pancreatitis leads to foot amputation

Was a clinician negligent in the administration of a standard drug used for treating pancreatitis?

Asymptomatic red lesions

Asymptomatic red lesions

Two patients present with asymptomatic red lesions -- a 60-year-old man, whose lesion was present for five years before beginning to bleed, and a 27-year-old man whose lesion doubled in size during a two year period. Can you differentiate between the two?

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