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

We cover angina, COPD-asthma overlap, home oxygen, colon cancer screening, cancer survivorship, tobacco cessation, e-cigarettes, step counts for health,  new drugs, the RSV vaccine, addiction medicine, interstitial lung disease, APOL1-mediated kidney disease, testosterone therapy, antimicrobial resistance, office-based allergy testing and more! The Curbsiders review highlights, clinical pearls, and practice-changing updates from the American College of Physician Internal Medicine Meeting #IM2024!  No CME for this episode due to rapid turnaround, but claim CME for most episodes at  curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro ACP Pearls Outro Credits Producers: Matthew Watto MD, FACP; Paul Williams MD, FACP, Molly Heublein MD, Nora Taranto MD, Chris Chiu MD, Rahul Ganatra MD MPH, Beth Garbitelli MD Show Notes: Matthew Watto MD, FACP; Paul Williams MD, FACP, Molly Heublein MD, Nora Taranto MD, Chris Chiu MD, Rahul Ganatra MD MPH, Beth Garbitelli MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer:Matthew Watto MD FACP Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Sponsor: Beginly Health Visit https://beginlyhealth.com/curbsiders for the job matching platform for every Physician and Advanced Practice Clinician, from training to practice 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.

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). Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME 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 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. Sponsor: Locumstory Tune in to The Locumstory Podcast on Spotify, Apple, or Google podcasts. Sponsor: Babbel Curbsiders listeners get 60% off at babbel.com/CURB

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.  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME 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 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. Sponsor: Grammarly Make a bigger impact at work with Grammarly. Sign up and download for FREE at grammarly.com/PODCAST

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 Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME 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 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. Sponsor: Locumstory Tune in to The Locumstory Podcast on Spotify, Apple, or Google podcasts.

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! Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME 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 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. Sponsor: Panacea Financial Download the 2024 Residents & Fellows Survey Report for free at panaceafinancial.com/report.

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). Claim CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! |Mailing List | Contact | CME! 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 Tune in to The Locumstory Podcast on Spotify, Apple, or Google podcasts. 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. 

Show description:  Join us as we review the diagnosis and treatment of pericarditis, myocarditis, peri-myocarditis, myo-pericarditis…and everything in between! We are joined by our esteemed guest, Dr. Vivek Kulkarni (@VivekKulkarniMD), a clinical cardiologist and assistant program director for the Cardiovascular Disease Fellowship at Cooper University Health Care, who helps us get to the heart of the matter!  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro, disclaimer A case of pericarditis Diagnosing pericarditis The difference between pericarditis, myocarditis, myopericarditis, and perimyocarditis Etiologies of pericarditis and initial testing recommendations Treatment of acute uncomplicated pericarditis Using colchicine to prevent recurrent pericarditis Patient counseling after diagnosing pericarditis A case of myocarditis Interpreting elevated troponin levels Distinguishing between myocardial infarction and myocardial injury Diagnostic testing for suspected myocarditis When to pursue cardiac MRI and endomyocardial biopsy The spectrum of myocarditis presentations Fulminant myocarditis Common etiologies of myocarditis Immune checkpoint inhibitor myocarditis Myocarditis from mRNA vaccines and from SARS-CoV-2 infection Management of patients with myocarditis Activity restrictions for patients with myocarditis Outro Credits Hosts: Paul Williams, MD, FACP, Matthew Watto MD, FACP Guest: Vivek Kulkarni, MD, FACC Producer, Script, and Show Notes: Adam Barelski, MD Infographics and Cover Art: Edison Jyang Reviewer: Leah Witt, MD Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP 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. Sponsor: Panacea Financial Download the full  2024 Residents & Fellows Survey Report for free at panaceafinancial.com/report. Sponsor: Factor Head to factormeals.com/curb50 and use code curb50 to get 50% off.

This episode has been Unlocked from patreon.com/curbsiders! Hone your obesity medicine skills in primary care! We discuss overcoming barriers, patient counseling, obesity pathophysiology, motivational interviewing, tools and tips from a weight loss program, and how to discuss medications for weight loss including phentermine/topiramate, bupropion/naltrexone, orlistat, oral superabsorbent hydrogel, and GLP1 agonists. We’re joined by obesity medicine expert, Dr. Kimberly Anne Gudzune of @HopkinsMedicine, recorded @SocietyGIM#SGIM23 in Denver, Colorado This audio episode is only available on Patreon!  Below are links to the original interview & show notes. #405 Obesity Medicine, GLP1 agonists, Weight Loss Management Tools and Tips Picks of the week: Paul recommends: Blue Eye Samurai (Netflix) Matt recommends:  Live, Die, Repeat aka Edge of Tomorrow (film) Show Segments 00:00 Introduction and Happy New Year 02:22 Overview of Obesity Medicine 04:13 Challenges in Weight Maintenance 06:07 Prevention of Obesity 08:04 Barriers to Obesity Care 09:29 Setting Realistic Weight Loss Goals 10:24 Counseling Patients on Weight Loss 11:45 Measuring Waist Circumference 12:44 Telemedicine and Tracking Apps 13:41 Psychological Considerations in Obesity Medicine 15:05 Low-Carb Diets 21:04 Managing Side Effects of GLP-1 Agonists 23:54 New Medication for Obesity 24:52 Prolia and Forteo for Osteoporosis 26:18 Statins and Lab Testing 29:30 Annual Labs and Urine Testing 32:37 Picks of the Week 35:02 Outro Join our Patreon today and save 16% on an annual membership at patreon.com/curbsiders. Kashlak Admitting Privileges comes with ad-free episodes, access to the Kashlak Vault, which contains PDF files and graphics from over 400 Curbsiders shows, access to our private Discord group, plus twice monthly bonus episodes like this one!

Is bicarbonate supplementation for metabolic acidosis in chronic kidney disease (CKD) a thing we do for no reason? We cover the pathophysiology and long-term consequences of metabolic acidosis, the history of bicarbonate use, alternative options for bicarbonate repletion including baking soda, lemon juice, fruits and veggies, whether the renal diet works, counseling patients with CKD, and common mistakes and pitfalls in managing metabolic acidosis in CKD. Our guest is Dr. Timothy Yau (@Maximal_Change, @WUNephrology, @AJKDOnline). It’s NephMadness 2024! Fill out your bracket today and check out the other podcasts participating in the NephMadness pod crawl! Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Time stamps refer to the ad-free version 00:00 Introduction and Guest Bio 07:46 Case Presentation 08:42 Initial Approach to CKD Management 09:10 Metabolic Acidosis in CKD 13:30 Consequences of Metabolic Acidosis 22:28 Administration of Bicarbonate 23:54 Alternative Options for Bicarbonate Repletion 24:47 Citrate and Bicarbonate 26:02 Sodium Bicarbonate for CKD 30:19 Dietary Modifications 33:35 Renal Diet 38:20 Counseling CKD Patients 41:39 Veverimer and Other Treatments 44:36 Mistakes and Pitfalls 46:55 Conclusion 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: Timothy Yau MD Sponsor: Rocket Money  Cancel your unwanted subscriptions by going to RocketMoney.com/CURB Sponsor: Freed You can try Freed for free right now by going to freed.ai And listeners of Curbsiders can use code CURB 50 for $50 off their first month. 

Elevate your primary care management of anxiety. Become confident in counseling patients about a new anxiety diagnosis, 2nd and 3rd line medications, augmentation for anxiety treatment, and options for non-pharmacological anxiety treatment. We are joined by psychiatrist and mental health expert Dr. Jessi Gold, @drjessigold (University of Tennessee System; drjessigold.com).  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Case from Kashlak Diagnosing anxiety Explaining anxiety to patients Non-pharmacological management of anxiety Pharmacological management of anxiety 2nd and 3rd line treatments Cannabis and anxiety Outro Credits Writer, Producer, Show Notes, Infographic, Cover Art: Edison Jyang Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Sai Achi MD, MBA Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Jessi Gold MD Sponsor: Locumstory Tune in to The Locumstory Podcast on Spotify, Apple, or Google podcasts. 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. Sponsor: Allbirds   Visit Allbirds.com and use code CURB for a free pair of socks with a purchase of $48 or more.