Category Archives: Endocrinology

Diabetes management

The alphabet mnemonic is useful for remembering all the things that need to be discussed with patients: Advice – smoking, diet, exercise, weight loss. See about referring to structured educational programmes. Blood pressure Cholesterol Diabetes control Eye checks Foot checks … Continue reading

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Subclinical hypothyroidism

A decent-sized meta-analysis of RCTs on the treatment of subclinical hypothyroidism (raised TSH with normal T4) has been done, and the conclusion is that treatment makes no difference to symptoms, compared to placebo. There are some caveats: Pregnant women weren’t … Continue reading

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Diabetes update

Some key points: DPP-4 inhibitors are now second-line after metformin Aim for HbA1c target of 48 mmol/l at diagnosis, unless clinical reasons why inappropriate (metformin and DPP-4 inhibs don’t risk hypoglycaemia, so this is feasible to do safely). For patients … Continue reading

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Talking to people about their diabetes

Judith Handley, a health policy geek with Type I diabetes, has written an article for the ‘What your patient is thinking’ section of the BMJ, on alternatives to asking people with diabetes whether they’re well-controlled (to which she always feels … Continue reading

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When not to use HbA1c for maintenance

We’re hopefully all familiar with the list of situations in which HbA1c might give a false reading when used to diagnose diabetes (short version; any situation in which the glucose might have undergone rapid recent change), but it’s also important … Continue reading

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Flozins and COPD inhalers

That’s two separate subjects, not one, whose link here is that they were both the topics of useful papers in this week’s BMJ. The first was on possible adverse effects of flozins (sodium-glucose cotransporter-2 inhibitors). The paper was a very … Continue reading

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Thyrotoxicosis – initial treatment

An article from the BMJ, with some useful tips on starting anti-thyroid drugs if necessary. Causes: Medication-related (see below) Thyroiditis (subacute, de Quervain’s, initial phase Hashimoto’s, postpartum) Grave’s Toxic multinodular goitre Solitary toxic adenoma Very rarely, functional thyroid carcinoma Medication-related … Continue reading

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