Master the management of hyperglycemia, DKA, and learn to avoid common pitfalls. This episode is packed with clinical pearls from repeat guest, Endocrinologist, Dr. Jeffrey Colburn. Get the original show notes here!



Prior diabetes episodes: 
#330 & #331 Inpatient Diabetes with Dr. Dave Lieb
#309 USPSTF Quick Update: Prediabetes & Type 2 Diabetes Screening
#296 Diabetes FAQ with Dr. Jeff Colburn
#243 Diabetes Triple Distilled
#168 Diabetes Update with Jeff Colburn MD
#96: Diabetes: A1C targets & ACP guidelines controversy
#51: Diabetes treatment in 2017: New meds, insulin, and cardiac risk reduction



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Show Segments






Intro
Rapid fire questions
Definitions and classification of diabetes
DKA in type 2 diabetes?
Pathophysiology of DKA
Severe hyperglycemia mislabeled as DKA
Which type 2 diabetics get DKA?
The cardinal issue is dehydration
Starvation ketosis vs DKA vs other
How to handle severe hyperglycemia in outpatients
Sick day management in type 1 diabetes
Initial testing for diagnosis of DKA
Subcutaneous or IV insulin for DKA
Initial evaluation and management in ER
Fluids and electrolyte management
SGLT2 inhibitors and euglycemic DKA




Credits






Writer, Producer: Matthew Watto MD, FACP
Show Notes: Matthew Watto MD, FACP
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Stuart Brigham MD
Showrunner: Matthew Watto MD, FACP
Technical Production: PodPaste
Guest: Jeffrey Colburn MD, FACP, FACE




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REBOOT #25 Master Hyperglycemia and DKA

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview the experts to bring you clinical pearls, practice-changing knowledge, and bad puns. Doctors Matthew Watto, Paul Williams, and friends (a national network of students, residents, and clinician-educators) deliver a little knowledge food for your brain hole. Yummy! No boring lectures here, just high-value content and a healthy dose of humor. Fantastic for Internal Medicine, Family Medicine, Primary Care, and Hospital Medicine.

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Science

Health & Fitness

Energize your education on endometriosis! Learn common clinical presentations, optimal diagnostic imaging tests, and how to counsel patient on treatment options. We are joined by Dr. Adela Cope (Mayo Clinic) and Dr. Isabel Green @isabelgreenMD (Mayo Clinic).



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Show Segments






00:00 Intro 
03:00 Guest Introduction
06:45 Topic
07:30 Endo Definition & Symptoms
14:40 Endo phenotypes
21:30 Differential Diagnoses to Consider
25:47 Making a Diagnosis 
31:00 Imaging to consider
37:40 Endo Hormonal Treatment Optiosn
48:30 Monitoring Treatment
52:20 When to Refer
57:30 Surgical Treatment
1:09:20 Pain Management
1:13:30 Take Homes
1:19:00 Outro




Credits






Producer, Show notes, Infographics: Carolyn Chan, MD, MHS
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
Reviewer: Sai S Achi, MD, MBA
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Dr. Adela Cope and Dr. Isabel Green




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#436 Endometriosis for the Internist with Dr. Cope & Dr. Green

A real pain in the neck (Get it?! We have fun.)



Protect your neck!  Learn how to evaluate a patient with neck pain, and differentiate between mechanical neck pain, radiculopathy, and myelopathy. You’ll learn who should be reassured, who should see a surgeon, and what nonoperative options are available.  We’re joined by Dr. Anthony Mikula @anthony_mikula from Mayo Clinic. 



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Show Segments






00:00 Introduction 
06:14 Anatomy and Pain Generators
09:58 Approach to Neck Pain
22:57 Differentiating Radiculopathy from Non-Specific Neck Pain
24:05 Management of Mechanical Neck Pain
27:36 Indications for Imaging
29:21 Terminology and Explanation of Spondylosis, Spondylolisthesis, and Spondylolysis
30:48 Diffuse Idiopathic Skeletal Hyperostosis (DISH)
32:23 Imaging Terminology and Plain Films
36:19 Pathophysiology of Cervical Radiculopathy
38:34 Physical Examination for Cervical Radiculopathy
44:54 Diagnostic Work-up for Radiculopathy
51:53 Interventions for Cervical Radiculopathy
53:53 Considerations for Surgery
57:49 Recognizing Cervical Myelopathy
01:00:17 Natural History of Myelopathy
01:02:25 Referral and Treatment for Myelopathy
01:09:28 Summary and Takeaways




Credits






Written and Produced by: Paul Williams, MD, FACP
Show Notes: Paul Williams, MD, FACP
Infographic and Cover Art: Paul Williams, MD, FACP
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
Reviewer: Leah Witt, MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Anthony Mikula, MD




Sponsor: Freed



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#435 Neck Pain with Dr. Anthony Mikula

It’s NOT Always a UTI!



Sounds like another UTI but it could be more than that! Time to explore the entire pelvic floor and see what more you can treat. School’s in session with the Bladder Teacher,  Kellen Choi, DO from the University of Louisville @KellenChoi



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Show Segments






Intro
Rapid fire questions/Picks of the Week
Case #1 and Definitions
Bowel habits
Water intake 
Case #2
Vaginal Estrogen
Non-antibiotic prophylaxis
Antibiotic in prophylaxis
Pelvic Floor Physical Therapy
Take-home points
Outro




Credits






Producer, Writer & Show Notes: Isabel Valdez, PA
Infographic & Covert Art: Edison Jyang
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
Reviewer: Fatima Syed, MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Kellen Choi DO, FAOCS




Sponsor: Freed



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#434: Ur-INe for Recurrent UTI?!  with Dr. Kellen Choi, DO  AKA The Bladder Teacher

Step up your diabetes game! Learn the ins and outs of continuous glucose monitors (CGM) including key features, what and how to order, interpreting CGM data (time in range, time above range, etc.), and how to make adjustments to a patient’s insulin regimen, aka “insulin pattern matching”. We discuss common scenarios including overnight hypoglycemia, exercise-induced hypoglycemia, post-prandial hyperglycemia, what to do when the patient runs high all the time, and how to incorporate GLP1 agonists and SGLT2 inhibitors into a patient's regimen. Returning guest and Paul’s favorite frenemy, Dr. Jeff Colburn (VCU Health) returns!



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Show Segments






00:00 Introduction and Diabetes Puns
01:00 Introduction of Guest and Topic
09:12 Qualifications and Eligibility for CGMs
11:32 Types of CGMs and Sensor Placement
24:47 Interpreting CGM Data and Alarms
34:30 Troubleshooting Patterns and Adjustments
35:23 Understanding Hypoglycemia and Counter Regulatory Hormone Responses
36:15 The Rule of 15 and Addressing Hypoglycemia
37:10 Reducing Basal Insulin to Address Nocturnal Hypoglycemia
38:29 Addressing Postprandial Highs with GLP-1, SGLT-2 Inhibitors, or Prandial Insulin
39:51 Managing Exercise-Induced Hypoglycemia
41:43 Preventing Exercise-Induced Hypoglycemia with Snacks
43:42 Managing Nocturnal Hypoglycemia with Sulfonylureas
45:31 Addressing Postprandial Hyperglycemia with GLP-1, SGLT-2 Inhibitors, or Prandial Insulin
46:54 Adjusting Basal Insulin to Address Morning Hyperglycemia
51:18 Troubleshooting High Blood Sugars with Basal Insulin and Mealtime Insulin
56:49 Managing High Blood Sugars with Basal Insulin and Mealtime Insulin
57:44 Addressing Adherence and Medication Barriers
59:39 Using Continuous Glucose Monitors (CGMs) for Diabetes Management
01:02:30 Using Sulfonylureas and Basal Insulin Combination as a Stopgap
01:05:49 Considering Patient Adherence and Barriers to Treatment




Credits






Writer and Producer: Matthew Watto MD, FACP
Show Notes: Matthew Watto MD, FACP
Cover Art and Infographic: Matthew Watto MD, FACP
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
Reviewer: Emi Okamoto MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Jeff Colburn MD




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#433 CGMs, Insulin, and How to Adjust Diabetes Meds to Glucose Patterns

Join us as we review recent practice-changing articles on E-cigarettes for smoking cessation, Gabapentin and COPD exacerbations, lidocaine patches for mechanical neck pain, Cdiff risk by antibiotic type, and “dosing by clicks” for GLP1 agonists. Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), and Matt Watto (@doctorwatto).



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Credits






Written and Hosted by: Rahul Ganatra MD, MPH; Paul Williams, MD, FACP, Matthew Watto MD, FACP
Cover Art: Matthew Watto MD, FACP
Reviewer: Rahul Ganatra MD, MPH
Technical Production: Pod Paste
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP






Show Segments






Introduction and disclaimer
E-cigarettes for smoking cessation
Gabapentinoids and COPD exacerbations
Topical lidocaine for neck pain
Association between specific antibiotics and C. diff infection
Shortage of GLP-1 agonists and “dosing by clicks”




Sponsor: Locumstory



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Sponsor: Freed 



You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. 

#432 Hotcakes: E-cigarettes for smoking cessation, Gabapentin and COPD exacerbations, Lidocaine for neck pain, C diff risk by antibiotic type, and “dosing by clicks” for GLP1’s

REBOOT #25 Master Hyperglycemia and DKA

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