Chase

Family Medicine Physician DO

[MrBeast @MrBeast]

I’m gonna give 10 random people that repost this and follow me $25,000 for fun (the $250,000 my X video made)

I’ll pick the winners in 72 hours

[Chase @drcnoel20]

@MichaelAlbertMD @DrNadolsky @DrKarlNadolsky In most cases it is not true hypogonadism, it is increased sex hormone binding globulin leading to an abnormal lab value.

[Chase @drcnoel20]

@AshleyGWinter Testosterone should be checked via free/tot equilibrium to be accurate. TRT is not a benign intervention either.

[Chase @drcnoel20]

@AshleyGWinter A lot of people are misdiagnosed with hypogonadism. The normal total testosterone and free testosterone assay is designed for males between 18-39 with a normal BMI. Obesity, sleep apnea, diabetes increase sex hormone binding globulin which lowers total T in this assay.

[Chase @drcnoel20]

@theliverdoc Do you have any recommendations for a GP to get patients to reveal this in the history? It seems patients are very hesistant to disclose these medications.

[Chase @drcnoel20]

@MSharifpourMD I agree with society guidelines, GLP-1 agonist should be stopped a week prior, SGLT2i should be stopped 3-4 days, but then a patient with an A1c of 7 gets told there glucose is 300, and they need to get there diabetes under control prior to surgery.

[Chase @drcnoel20]

@MelanieStfl This is a great starting point, but to be complete. Continue to titrate basal insulin up until fasting blood glucose is 150. If patient is consistently having to give sliding scale after meals, increase mealtime insulin. Add this to there total and recalculate sliding scale.

[Chase @drcnoel20]

@MelanieStfl FM doc here. To talk about sliding scale it’s important to talk about all insulin. A good starting place is for long acting insulin take the patients weight in lbs and divide by 10. Example 280lb= 28U long acting insulin.

[Chase @drcnoel20]

@MelanieStfl So for example let’s imagine that the patients glucose is 250, and their desired glucose is 150. 100/32=3.1, the patient should give their self 3U short acting insulin.

[Chase @drcnoel20]

@MelanieStfl Now for sliding scale insulin we take 1800 divided by the total daily insulin requirements. So for our 280lb example his long acting insulin is 28U with 9U TID w meals for a total of 56U daily. So 1800/56=32. This number is how much one unit of insulin will drop there blood suga

[Chase @drcnoel20]

@MelanieStfl Now to talk about meal time insulin. Same calculation lbs/10, then take that number divided by 3. So for our 280lb make it would be 28/3 or about 9U short acting insulin TID w/meals.

[Chase @drcnoel20]

@KySportsRadio The loss is on Leary he missed 4-5 deep shots that were open.

[Chase @drcnoel20]

@KySportsRadio Terrible loss, and no excuses, but I’m not ready for any staff changes if that makes sense.

[Chase @drcnoel20]

@MichaelAlbertMD Not off label correct. However insurance companies choose to cover diabetic medications, but not weight loss medications. So tricking the insurance company to pay for weight loss medicine is technically fraud. Whether you believe all insurances should cover it is a different ?

[Chase @drcnoel20]

@AshleyGWinter I’m curious about the addition of testosterone. Is this from your experience or is it something we should routinely be doing?

[Chase @drcnoel20]

@CoryRohlfsen There are no indications for checking vitamin D, outside of hyper/hypocalcemia, or prior to osteoporosis treatment. Routine Vitamin D supplementation has no proven benefits.

[Chase @drcnoel20]

@kidney_boy Why not add FM to fellowship applicants. Nephrology is primarily outpatient. I feel nephrology, endocrinology and rheumatology would benefit from FM applicants. As well this would increase FM interest.

[Chase @drcnoel20]

@olsonplanner The truth is BCBS has a quantity limit on all their inhalers for COPD and asthma. There’s truly no sense in trying to get it approved as it is defined in there drug list. I agree that it may be beneficial for some but I understand as inhaler compliance is notoriously low.

[Chase @drcnoel20]

@YihanYangMD @CoryRohlfsen As with all recommendations, I let my patient take the reigns. If patient is experiencing SAMs or adverse to meds. Stop statin. Ask patient if CAC was high would she take a statin. I likely would not repeat a lipid panel in 6 months as even if LDL was 180 her risk is 1.7%.

[Chase @drcnoel20]

@MichaelAlbertMD @DrAngelaFitch I think this falls back on The pharmaceutical companies. 1300-1500$/month is not reasonable. Drop the price to 500/month and most insurances would cover this product.