As Cushing Disease patient, with bilateral adrenalectomy so now living with affects of Addisons Disease hoping more physicians will have a better understanding of the endocrin system. Thank you
I do not remember where I read that but it is says that if you sugar high up to up to 400 you should use 1.6 formula for every 100, but if your sugar above 400 you should use 2.4 formula.Thank you so much for your lectures
SGLT2, an oral agent in diabetes treatment is a game changer in the management of HF, reducing death and rehospitalization by 25% in diabetic and non-diabetic patients. I believe that should be included in your lecture.
yes but that is not as much important in the EM. What could be important in more acute setting is the possibility of severe urogenital infections , even Fourniers gangrene when using SGLT 2 inh.
I beg to differ, ketone bodies can provide a sustainable energy source for the brain as well. The written statement on slide one should be adjusted to a “primary source” in persons who eat a SAD diet, or a diet other than Keto/carnivore.
Just hit the link will listen.... hope you address adrenal insufficiency. My brother has secondary to acromegaly.. fascinating and complicated; at least in my opinion! Thanks EM doctors for all you do! My brother's orthopod diagnosed his acromegaly... he went undiagnosed for 30 years.
@@RealMonoid The brain uses glucose primarily. Yes can use ketones too but faaaar less efficient and quick. They are not his cup of tea. Also it takes time for the body to create ketones ,they are not readily available. They are not meant to be used that way. Hypoglycemia happens pretty fast and no keto body can't replace it in a sufficient way that brain won't suffer. And most importantly ketones are produced usually in chronic hyperglycaemia, not hypoglycemia, due to diabetes where there is sulprus glucose but body just can't use it because of the lack of insulin and it's inefficacy. So in this prolonged period of energy insufficiency due to impaired glucose usage, the body slowly changes its metabolism towards burning fats instead of carbohydrates. Side effect of this are the ketones. Brain can use them poorly and they cause acidosis. So you can't compare healthy metabolism with a sick one ,like we get in diabetes. The rules of play changes.
@@RealMonoid I really can't see how that is applicable to managing hypoglycemia in the ED. Yes you are right. But that doesn't matter in the emergency room. Are you talking about healthy individuals without diabetes that are on keto diet ,or a diabetic ones that maybe are taking insulin or other medicines? You can have zilion non acidotic ketones in you ,if your glucose Is 1 mmol/l you gonna fall down and maybe get some seizures. Keto diet reduces frequency of hypoglycemia because it helps managing diabetes. One does not have extreme fluctuations of glycemia and insulin bursts, endogenous or injected, that usually are the cause of hypoglycemia in diabetics. So please if you could explain little more what is your point, am having difficulty to understand you viza vi the topic of endocrine emergency that is discussed in the video.
Informative, explicitly comprehensive, and direct to the point. Simply EXCELLENT. Thank you
As Cushing Disease patient, with bilateral adrenalectomy so now living with affects of Addisons Disease hoping more physicians will have a better understanding of the endocrin system. Thank you
As always CCME and Dr. Sokolove, thank you very much for the EXCELLENT review for my upcoming exam!!!!
Very good revision I had! Thanks sir. It help me to brush up my knowledge.
Anti-hyperglycemics -Glucagon -like peptide 1 receptor agonists eg semaglutide
Please can you upload part 2 as well!! Thank you so much!
I do not remember where I read that but it is says that if you sugar high up to up to 400 you should use 1.6 formula for every 100, but if your sugar above 400 you should use 2.4 formula.Thank you so much for your lectures
Excellent video, plz upload part 2
SGLT2, an oral agent in diabetes treatment is a game changer in the management of HF, reducing death and rehospitalization by 25% in diabetic and non-diabetic patients. I believe that should be included in your lecture.
yes but that is not as much important in the EM. What could be important in more acute setting is the possibility of severe urogenital infections , even Fourniers gangrene when using SGLT 2 inh.
until they are cheaper than metformin, they will be a luxury instead of a standard
Amazing lecture, such memorable and clear explanations! Thank you!
I beg to differ, ketone bodies can provide a sustainable energy source for the brain as well. The written statement on slide one should be adjusted to a “primary source” in persons who eat a SAD diet, or a diet other than Keto/carnivore.
True. I am a Type 1 Diabetic on a Keto diet, so this statement was a bit irritating.
Just hit the link will listen.... hope you address adrenal insufficiency. My brother has secondary to acromegaly.. fascinating and complicated; at least in my opinion! Thanks EM doctors for all you do! My brother's orthopod diagnosed his acromegaly... he went undiagnosed for 30 years.
No, glucose is not the sole energy source of the brain, just the primary source during the carb fed state.
Not all clear about the mechanism of paradoxal CSF acidosis. But lecture is pretty fine! Thank you ❤️
Thank you very much ... a great lecture indeed.
This really help me
Nice work.............
Excellent presentation
What about ketones? The brain uses them for energy too.
Yeah , when there is nothing else to use .....
@@timosijejovanoski7514 What if you are on a Keto or Low-Carb diet? In this case, your ketones are usually elevated, but you are not hypoglycemic
@@RealMonoid The brain uses glucose primarily. Yes can use ketones too but faaaar less efficient and quick. They are not his cup of tea. Also it takes time for the body to create ketones ,they are not readily available. They are not meant to be used that way. Hypoglycemia happens pretty fast and no keto body can't replace it in a sufficient way that brain won't suffer. And most importantly ketones are produced usually in chronic hyperglycaemia, not hypoglycemia, due to diabetes where there is sulprus glucose but body just can't use it because of the lack of insulin and it's inefficacy. So in this prolonged period of energy insufficiency due to impaired glucose usage, the body slowly changes its metabolism towards burning fats instead of carbohydrates. Side effect of this are the ketones. Brain can use them poorly and they cause acidosis. So you can't compare healthy metabolism with a sick one ,like we get in diabetes. The rules of play changes.
@@timosijejovanoski7514 I think you need to distinguish between Ketosis and Ketoacidosis. They are not the same.
@@RealMonoid I really can't see how that is applicable to managing hypoglycemia in the ED. Yes you are right. But that doesn't matter in the emergency room. Are you talking about healthy individuals without diabetes that are on keto diet ,or a diabetic ones that maybe are taking insulin or other medicines? You can have zilion non acidotic ketones in you ,if your glucose Is 1 mmol/l you gonna fall down and maybe get some seizures. Keto diet reduces frequency of hypoglycemia because it helps managing diabetes. One does not have extreme fluctuations of glycemia and insulin bursts, endogenous or injected, that usually are the cause of hypoglycemia in diabetics. So please if you could explain little more what is your point, am having difficulty to understand you viza vi the topic of endocrine emergency that is discussed in the video.
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Jackson Jeffrey Moore Steven Martin Christopher