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1a) Welcome to a 🆕#accredited #tweetorial on the importance of time in range #TIR in #diabetes . . . with additional emphases on #primarycare and on practice in 🇨🇦.
#FOAMed #endotwitter #MedEd @MedTweetorials #nephtwitter #cardiotwitter
#FOAMed #endotwitter #MedEd @MedTweetorials #nephtwitter #cardiotwitter
1b) Hence we welcome2⃣ expert faculty from Canada: Ilana Halperin @ilanajhalperin, academic endocrinologist at @Sunnybrook and @uoftmedicine, and Noah Ivers @NoahIvers, #familydoc & researcher at Women's College Hospital @UofT 
2) Earn 0.75hr 🆓CE/#CME by following this🧵! This program is supported by an unrestricted educational grant from Sanofi Canada and is intended for #HCPs. Statement of accreditation & faculty disclosures at cardiometabolic-ce.com/disclosures/.
And so we begin . . .
And so we begin . . .
27 yrs old patient, detected to be pregnant when she missed her periods one day back. She has Graves disease on Rx for past 3 years, presently on Carbimazole 5mg daily and not on propranolol. She was euthyroid with Rx for past 1 year. Best strategy ?
Present reports 👇
Present reports 👇
A. Stop carbimazole and monitor by weekly/fortnightly TSH, FT4 levels and follow up.
B. Switch to PTU 50mg bd and do FT4, TSH after 2 weeks and review
C. Switch to PTU 50 mg bd + LT4 50mcg OD. TSH, FT4- 4wkly
D. PTU 50mg BD and Propranolol XL 20mg , Monthly TSH,FT4-followup
B. Switch to PTU 50mg bd and do FT4, TSH after 2 weeks and review
C. Switch to PTU 50 mg bd + LT4 50mcg OD. TSH, FT4- 4wkly
D. PTU 50mg BD and Propranolol XL 20mg , Monthly TSH,FT4-followup
Good morning everyone,
Happy to share that we have received research funding from the RSSDI for our Precision Medicine project called Diabetology.co.in.
#MedTwitter #EndoTwitter #Technocrinology
Happy to share that we have received research funding from the RSSDI for our Precision Medicine project called Diabetology.co.in.
#MedTwitter #EndoTwitter #Technocrinology
Diabetology.co.in is India's first and only evidenced based precision medicine & personalized medicine platform for diabetes made for the doctors and by the doctors.
The project is mentored by Dr. Arvind Gupta, a legend in this field from Jaipur.
We thank the RSSDI Research team, especially Dr. @banshisaboo and @dramitaol for giving us this opportunity.
We thank the RSSDI Research team, especially Dr. @banshisaboo and @dramitaol for giving us this opportunity.
Young woman with progressive muscle weakness was suspected to have muscular dystrophy, but a clinical finding pointed to another diagnosis
1. 22-year old Mini had weakness of legs and arms for two years. Weakness began in legs and after a year involved the arms too.
#MedTwitter
1. 22-year old Mini had weakness of legs and arms for two years. Weakness began in legs and after a year involved the arms too.
#MedTwitter
2. Mini had difficulty in getting up from squatting position, climbing stairs, combing hair & reaching for top shelves in kitchen.
She also had myalgia, muscle cramps and fatigue.
She had no numbness and had normal bladder & bowel control.
No one else in family was affected.
She also had myalgia, muscle cramps and fatigue.
She had no numbness and had normal bladder & bowel control.
No one else in family was affected.
3. Mini consulted a local physician, who ordered a few investigations. Serum CPK was high (2600 U/L, normal<190 U/L). EMG showed low/small amplitude potentials suggestive of myopathy. He suspected a diagnosis of Becker's muscular dystrophy & referred for muscle biopsy to confirm.
Case of a woman whose shoe size increased from 5 to 7 over two years
1. It was an usual OPD, when I was counselling one of my patients with back pain about exercise, diet and correct posture. Incidentally, I noticed his wife's face who was sitting beside the patient.
#MedTwitter
1. It was an usual OPD, when I was counselling one of my patients with back pain about exercise, diet and correct posture. Incidentally, I noticed his wife's face who was sitting beside the patient.
#MedTwitter
2. Her nose & lips appeared a bit larger than usual. When she smiled, her teeth were little spaced out and tongue was also little larger than normal. She spoke with a little heavy voice.
Being a #neurologist, I was imagining the possibility of a brain #disease.
#neurotwitter
Being a #neurologist, I was imagining the possibility of a brain #disease.
#neurotwitter
3. I asked her- "Don't mistake me, but has your shoe size increased?" Her eyes almost popped out. She replied with a shocked expression- "doc, yes! It has increased from 5 to 7 in the past two years. Don't everyone's feet become larger as they grow older?"
She was 37-year-old now
She was 37-year-old now
Examining pulse of a patient with “MOTOR NEURON DISEASE” helped me find a cure
1.Motor neuron disease (MND) or amyotrophic lateral sclerosis (ALS), is a progressive neurological disease causing severe weakness and wasting of muscles. It has no cure and results in death in most.
1.Motor neuron disease (MND) or amyotrophic lateral sclerosis (ALS), is a progressive neurological disease causing severe weakness and wasting of muscles. It has no cure and results in death in most.
2. A 50-year old man consulted me 6 months ago for a second opinion. He had complaints of difficulty in swallowing, slurred speech, weakness and wasting of muscles of arms and legs, which had progressed over previous 9 months.
#MedTwitter #neurotwitter #ALS #MND
#MedTwitter #neurotwitter #ALS #MND
3. He was seen by neurologist and after needle electromyography; diagnosis of ALS was made. In view of grave prognosis, patient wished for second opinion. On examination, he had muscle fasciculation, wasting of tongue, arms and leg muscles. Deep tendon reflexes were exaggerated.
Bart Staels, PhD of Univ of Lille, France gave an outstanding talk on Interplay Between #NAFLD & #CVD at the #WCIRDC. CVD is the leading cause of death not liver disease. Fibrosis severity correlates with higher CVD risk. @WCIRDC @YHandelsmanMD
healio.com/news/endocrino…
healio.com/news/endocrino…
Type 2 #diabetes and #NAFLD have a reciprocally injurious relationship mediated through common pathophysiology magnifying the risk for #CVD events.
pubmed.ncbi.nlm.nih.gov/33015726/ @zilbermint @AlinaAllenMD
pubmed.ncbi.nlm.nih.gov/33015726/ @zilbermint @AlinaAllenMD
#NAFLD is considered the hepatic manifestation of the metabolic syndrome and is closely linked to:
✅#Obesity, especially visceral adiposity
✅Insulin resistance
✅Chronic inflammation
✅#Lipotoxicity
nature.com/articles/s4141…
✅#Obesity, especially visceral adiposity
✅Insulin resistance
✅Chronic inflammation
✅#Lipotoxicity
nature.com/articles/s4141…
I am a big fan of @baxirahul sir and his Tweetorials.
Short, crisp and chockful of useful data --> highly recommended for physicians and patients --> for diabetes is all pervasive.
#MedTwitter
#endotwitter
#diabetes
#prediabetes
Short, crisp and chockful of useful data --> highly recommended for physicians and patients --> for diabetes is all pervasive.
#MedTwitter
#endotwitter
#diabetes
#prediabetes
What is my personal regime?
1. Weekly BP and weight measurements.
2. Brisk walking to cover at least 7k steps/day. I also have my own exercise regimen.
1. Weekly BP and weight measurements.
2. Brisk walking to cover at least 7k steps/day. I also have my own exercise regimen.
3) I follow a diet prescribed by my dietitian.
I am gradually phasing out all junk food and simple carbs.
The Bengali diet is delicious.
But the carb load in the bhaat and NOT THE MISHTI is killing us.
I am gradually phasing out all junk food and simple carbs.
The Bengali diet is delicious.
But the carb load in the bhaat and NOT THE MISHTI is killing us.
How do we diagnose Cushing's? We have 3 screening tests:
1. 24-hour Urinary Free cortisol
2. dexamethasone suppression test
3. Late night salivary cortisol
Late night salivary cortisol is THE BEST first test for Cushing's. Let's explore why the other two have their problems:
1. 24-hour Urinary Free cortisol
2. dexamethasone suppression test
3. Late night salivary cortisol
Late night salivary cortisol is THE BEST first test for Cushing's. Let's explore why the other two have their problems:
When can't we trust the dexamethasone suppression test?
1⃣.changes in Cortisol Binding Globulin (CBG)
⏫ CBG- increased estrogen (pregnancy, oral contraceptives, hormone replacement therapy), SERM
⏬ CBG- cirrhosis, nephrotic syndrome, critical illness
1⃣.changes in Cortisol Binding Globulin (CBG)
⏫ CBG- increased estrogen (pregnancy, oral contraceptives, hormone replacement therapy), SERM
⏬ CBG- cirrhosis, nephrotic syndrome, critical illness
When can't we trust the dex suppression test?
2⃣ changes to dex metabolism
⏫ dex metabolism (CYP3A4 inducer)- anti seizure meds, pioglitazone, alcohol
⏬ dex metabolism- antidepressants (fluoxetine), diltiazem, cimetidine
ALWAYS measure a morning dex level with the cortisol!
2⃣ changes to dex metabolism
⏫ dex metabolism (CYP3A4 inducer)- anti seizure meds, pioglitazone, alcohol
⏬ dex metabolism- antidepressants (fluoxetine), diltiazem, cimetidine
ALWAYS measure a morning dex level with the cortisol!
This is the most important tweet you will read today.
Vit D levels deficiency is a nebulous concept.
@hswapnil sir explains this mystery!
#MedTwitter
#Endotwitter
#NephTwitter
#VitaminD
Vit D levels deficiency is a nebulous concept.
@hswapnil sir explains this mystery!
#MedTwitter
#Endotwitter
#NephTwitter
#VitaminD
@anujtiwari11 @vimlesh62283335 @ashwinrajenesh @DrSarahAlam @thehormoneD0C @Coffeehudigi @DrPyaricetamoI @nihar_nayak2
*vitamin D deficiency
Excited for the second session of Day 2 of #AACECVMET where Ralph A. DeFronzo, BMS, MD, MS, BS (@UTHealthSA) talks about "SGLT2 Inhibitors and GLP-1 RAs: Cardio-Renal Metabolic Drugs for the Ages", moderated by Joseph A. Vassalotti, MD (@Joe_Vassalotti) #EndoTwitter #diabetes
@UTHealthSA @Joe_Vassalotti Ominous Octet for hyperglycemia: increased lipolysis, increased glucose reabsorption (kidney), decreased glucose uptake (muscle), neutrotransmitter dysfunction, increased HGP (liver), increased glucagon secretion, decreased insulin secretion, decreased incretin effect #AACECVMET
@UTHealthSA @Joe_Vassalotti SGLT2 inhibitors: reduce HbA1C, corrects a novel pathophysiologic defect, reversal of glucotoxicity, promotes weight loss, reduces blood pressure, no hypoglycemia, and complements action of other antidiabetic agents = improves glycemic control and CV risk factors #AACECVMET
Day 2 of #AACECVMET starts with "Protecting Our Patients: Implementing Immunization Recommendations Within a Culture of Vaccine Confidence" by Kenneth Izuora, MD, MBA, FACE, moderated by Betul Hatipoglu, MD @TheAACE #AACE #EndoTwitter
@TheAACE During flu seasons, influenza vaccinations reduce all-cause mortality in adult patients with type 2 diabetes by 50% #AACECVMET #MedTwitter #AACE
@TheAACE AACE's Updated Diabetes Guidelines include vaccine recommendations for adults with diabetes mellitus: #AACECVMET #EndoTwitter #MedTwitter
Up next is "Healthcare Disparities in Cardiovascular Disease: Social and Nutrition Deserts" by Joshua J. Joseph, MD, MPH, FAHA (@joshuajosephmd), moderated by S. Sethu K. Reddy, MD (@endocrineguru) at #AACECVMET #AACE #Endotwitter
@joshuajosephmd @endocrineguru There are higher rates of diabetes mortality (2-fold death disparity) in rural areas as compared to urban areas, and a higher mortality in Black patients compared to White patients. #AACECVMET #AACE #HealthDisparities
@joshuajosephmd @endocrineguru Diabetes prevalence & hospital admissions correlate w/ residential security maps. The 1930s Home Owners Loan Corporation redlining score has an impact today: 1 unit-higher HOLC grades assoc w/ 54% higher DM mortality & 67% higher rate of diabetes years of life lost #AACECVMET
The first afternoon session at #AACECVMET is "Endocrine Hypertension and Cardiovascular Effects" by Richard Auchus, MD, PhD, FACE (@EndocrinologyM), moderated by L. Maria Belalcazar, MD, FACE (@utmbhealth)! #EndoTwitter #WeAreAACE
@EndocrinologyM @utmbhealth Pheochromocytoma Cardiovascular & Metabolic complications include commonly tachycardia & HTN, but also MI, ventricular rupture, catecholamine cardiomyopathy, hemorrhagic stroke, aortic dissection, and hyperglycemia+fatty liver+ weight loss together! #AACECVMET #Endotwitter
@EndocrinologyM @utmbhealth Primary Aldosteronism is excess renin-independent aldosterone & the most common cause of secondary HTN! There are low rates of screening & diagnosis (<1% ever screened). It has higher end-organ damage than primary HTN. It is curable or treatable with targeted therapy. #AACECVMET
Session 2 of #AACECVMET that I'm attending is "Nonalcoholic Fatty Liver Disease: The Global Pandemic" by Dr. Scott Isaacs, MD (@EmoryMedicine)! #WeAreAACE
@EmoryMedicine Pathogenic drivers of NAFLD: genetics, epigenetics, dysbiosis, dysfunctional adipose tissue, insulin resistance, and calorie excess #AACECVMET
@EmoryMedicine All stages of NAFLD show increased mortality over a 30yr period, with mortality increasing with fibrosis stage #AACECVMET #NAFLD
Kicking off Day 1 of @TheAACE Cardiometabolic Conference with "AACE Guideline Update: Developing a Diabetes Mellitus Comprehensive Care Plan" by Lawrence Blonde, MD (Ochsner Medical Center), moderated by S. Sethu K. Reddy, MD (CMU College of Medicine) #WeAreAACE #EndoTwitter
@TheAACE Grade B rec: Artificial intelligence systems, authorized by the FDA for detecting greater than mild diabetic retinopathy, can be used as an alternative to traditional screening approaches...facilitate diagnosis of vision-threatening retinopathy #AACE #Diabetes
Grade A: In T2DM and established ASCVD (or high risk) use GLP-1 RAs with proven CV benefits to reduce the risk of myocardial infarction, stroke, or CV death regardless of other glucose-lowering or cardiovascular therapies and independent of A1C #AACE #AACECVMET
1) Interesting case for which I need some help.
20y female presents with darkening of the lips for past several years.
She is a known case of PCOD, dx in 2015 and is on COC for the same duration.
20y female presents with darkening of the lips for past several years.
She is a known case of PCOD, dx in 2015 and is on COC for the same duration.
2) She has never been able to go off COC as her periods become extremely irregular.
No h/o sudden LOC on standing up, tiredness or discolouration in the body.
No hx suggestive of acne, hirsutism, acanthosis nigricans, deepening of voice or any genital abnormalities.
No h/o sudden LOC on standing up, tiredness or discolouration in the body.
No hx suggestive of acne, hirsutism, acanthosis nigricans, deepening of voice or any genital abnormalities.
3) Gen survey
Pt C/A/C
Pulse - 90/min
BP - 130/60, L arm, sitting
RR - 18/min
T° - afebrile
No pallor, cyanosis, clubbing, icterus,edema, LNpathy or JVP
Hair growth on top of lips, side burn area 3+ by FG score in each
Dark lips and mucosal hyperpigmentation +
Pt C/A/C
Pulse - 90/min
BP - 130/60, L arm, sitting
RR - 18/min
T° - afebrile
No pallor, cyanosis, clubbing, icterus,edema, LNpathy or JVP
Hair growth on top of lips, side burn area 3+ by FG score in each
Dark lips and mucosal hyperpigmentation +
Thyroid hormones regulate liver enzymes via thyroid hormone receptors. When the liver is steatotic, hepatic thyroid hormone receptors don’t respond effectively. This results in an intrahepatic hormonal milieu where the liver is essentially hypothyroid. #livertwitter #endotwitter
Thyroid hormone receptor-β plays a key role in hepatic homeostasis including:
✅De novo lipogenesis
✅Fatty acid β-oxidation
✅Mitophagy
✅Mitochondrial biogenesis
✅Cholesterol metabolism
✅Carbohydrate metabolism
#livertwitter #endotwitter
✅De novo lipogenesis
✅Fatty acid β-oxidation
✅Mitophagy
✅Mitochondrial biogenesis
✅Cholesterol metabolism
✅Carbohydrate metabolism
#livertwitter #endotwitter
Thyroid hormone receptor-β agonism has demonstrated clinical benefits on hepatic lipid metabolism.
frontiersin.org/articles/10.33…
frontiersin.org/articles/10.33…
1) Inspired by @AaronGoodman33
Middle aged male gets tired easily, had a hx of TLOC on sudden standing up, low grade fever × past 1 year
Clinical exam --> gradual darkening of skin and oral mucosa.
What is your diagnosis?
#MedTwitter
Middle aged male gets tired easily, had a hx of TLOC on sudden standing up, low grade fever × past 1 year
Clinical exam --> gradual darkening of skin and oral mucosa.
What is your diagnosis?
#MedTwitter
What are your differentials?
What labs +/- imaging would you request?
What labs +/- imaging would you request?
I am surprised nobody thought of hemochromatosis.
Unexplained fatigue and postural hypotension --> hemochromatic cardiomyopathy
Low grade fever --> hemochromatosis renders you susceptible to infection
Hyperpigmentation --> hemoCHROMATOSIS
Unexplained fatigue and postural hypotension --> hemochromatic cardiomyopathy
Low grade fever --> hemochromatosis renders you susceptible to infection
Hyperpigmentation --> hemoCHROMATOSIS
1) Welcome to an #accredited #tweetorial on optimizing the use of #SGLT2i in the management of #T2D. This program is accredited for 0.50 🆓credits for #physicians #nurses #physicianassociates #nursepratcitioners #pharmacists by @academiccme! I am @tmodarressi of @HeartDoctorNJ.
@AndrewJSauer @DrMichaelShapir @MichaelJBlaha @dramitkhera @pnatarajanmd @PamTaubMD @DrMarthaGulati @DrRaniKhatib @AAgarwalaMD @RpratleyMD @drricardocorrea @AliceYYCheng @SantosGallegoMD @SABOURETCardio @hvanspall @DLBHATTMD @cpcannon
2) This program is intended for healthcare professionals and is supported by an educational grant from Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company. See archived programs, all by expert authors, still available for credit at cardiometabolic-ce.com.
Excited to hear this talk about Time-Restricted Diets by Dr. Grajower moderated by @theweightmd I'll try to share what I learned #AACE2022 #endotwitter
What are time restricted diets? We are using intermittent fasting incorrectly -- most are actually doing time restricted eating
Let's hear The Evidence For and Against Combination #Thyroid Hormone therapy by Dr. Bianco #AACE2022 #Endotwitter. This conversation is controversial here are some of the main slides
Patient's on Lt4 reporting a lot of residual symptoms in energy, cognition
Normal physiology the majority of thyroid hormone production is T4 (16:1 T4:T3) and gets converted peripherally to T3 (5mcg made in thyroid, 25mcg made peripherally)
Now to talk about Phosphatonins and #phosphorus metabolism/bone disease by Dr. Kumar moderated by @sfeirjad...I'm ready to learn since admittedly I know little of this #AACE2022 #Endotwitter #bone
Why bother about phosphorus? Well it plays many roles in cellular signaling and maintenance of membrane structure of #bone. Low concentrations associated with rhabdo, decreased cardiac function and bone dysfunction (#osteomalacia, #rickets). low and high phos causes bone disease
High Phos Concentrations are Associated with CV Disease and Excess Mortality in CRF and decreasing levels reduces CV mortality
Starting day 2 #AACE2022 with @ArchanaSadhu talking to us about #diabetes technologies in 2022 #endotwitter
Look how far we have come in #diabetes technology and there is still a lot more to go #AACE2022. #CGM technology has been a game changer and the accuracy continues to improve with each generation
So what's new in the pipeline for #diabetes technology? Let me tell you starting with #dexcom G7. It will be smaller with a better MARD, better warm up and ALL-IN-ONE applicator and transmitter! Just pending FDA review #AACE2022 #endotwitter #medtwitter
