MOFFITT AM ENDOCRINE REPORT PEARLS 7/18/16: Insulin Resistance!

Thanks to Mark Anderson for bringing a case for our first endocrine report of the year!

 

*Pearl: For patients on high doses of insulin, adjunctive agents are still an option for increased glucose control!

Mark recommends 4 categories in this setting:

Thiazoladinediones (suffix -glitazone):

– Good: Improves lipid profile

– Side effects: heart failure, fractures

GLP-1 agonists (Exenatide/Byetta- injection only):

– Good: Weight loss

– Side effects: GI

DPP-4 inhibitors (suffix -gliptin, e.g. Sitagliptin/Januvia):

– Good: Weight neutral

– Side effects: GI, nasopharyngitis

SGLT2 inhibitors (suffix -gliflozin):

– Good: Weight loss, BP reduction

– Side effects: UTI, yeast infection

 

Causes of insulin resistance:

Type 2 DM

Obesity/Inactivity/Metabolic syndrome

Excess counterregulatory hormones

– Glucocorticoids (Cushing syndrome)

– Catecholamines (Stress/infection or Pheo)

– Growth hormone (Acromegaly)

Pregnancy

PCOS

Immune-mediated (anti-insulin or insulin receptor antibodies)

Primary insulin-receptor mutations

 

Workup for Cushing syndrome (dx established if two of these tests are abnormal):

– Late night salivary cortisol

– 24 hour free urine cortisol

– Overnight dexamethasone suppression test

 

Evernote: https://www.evernote.com/shard/s272/sh/3439aff7-b66a-4617-8270-0618197febf4/d46e77b2eb3e5ce3d7c9a734c6ed2b13

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