• Michael Kleerekoper, MD, MACE
  • Michael Kleerekoper, MD, MACE, has joined the faculty at the University of Toledo Medical School where he is Professor in the Department of Internal Medicine and section chief of the Endocrinology Division. The author of numerous journal studies, Dr. Kleerekoper serves on the editorial boards for Endocrine Today, Endocrine Practice, Journal of Clinical Densitometry, Journal of Women's Health, Osteoporosis International and Calcified Tissue International. Dr. Kleerekoper is also a founding board member of the newly formed Academy of Women’s Health.

Friday, March 28, 2014

Personal memories of diabetes fuel a professional outlook

Michael Kleerekoper, MD, MACE

The February issue of Endocrine Today highlighting the history of diabetes and its management really caught my attention.

Tuesday, January 7, 2014

Plasmaphoresis — Yes or No?

Michael Kleerekoper, MD, MACE

It is no secret that I am a “bone head,” literally and figuratively, but from time to time, I encounter uncommon non-skeletal conditions, in this case marked hypertriglyceridemia.

Friday, December 6, 2013

Out-of-control RAI uptake

Michael Kleerekoper, MD, MACE

Over a period of 6 weeks I received hard to believe results from radioactive iodine uptake in three patients with well-documented hyperthyroidism.

In each of them, the 6-hour uptake was 85% to 90% and 90% to 92% at 24 hours.

Wednesday, November 27, 2013

Darier's sign and osteoporosis

Michael Kleerekoper, MD, MACE

Melissa, a 61-year-old woman, was referred for evaluation and management of osteoporosis. She was “petite,” with a weight of 115 lb and heigh of 64 inches. She had a bone density study performed at that time (data not available) and was started on alendronate. After 2 years, the therapy was discontinued.

Shortly before this clinic visit, she had a follow up DXA study, which demonstrated a spine T-score of –4.6 and a proximal femur T-score of –5.1 — both values that you and I see infrequently.

Thursday, November 14, 2013

Caring for patients undergoing gender identity change

Michael Kleerekoper, MD, MACE

Some months ago I got a call from a psychologist asking whether I would agree to work with him regarding a patient seeking a gender identity change. Having been involved in this for a few years, albeit with only a few patients and all of whom were adults and men, I accepted the referral with the condition that the patient would continue regular visits with the psychologist.

Since I accepted that first patient, I have been asked, and accepted, to assist in the care of this group of patients by several other psychologists.

Friday, September 27, 2013

Such a sad story

Michael Kleerekoper, MD, MACE

My patient is a woman in her 20s with long-standing type 1 diabetes who has chronic renal failure (estimated glomerular filtration rate of 20 to 30) requiring dialysis. What’s worse is she has just lost her vision.

She is a wonderful, stalwart young woman working desperately to maintain her composure; tolerate her dialysis; and try very hard to control her blood glucose to the extent possible. However, despite best intentions by her caregivers, glycemic control in the hospital is proving to be a very difficult task.

Friday, September 13, 2013

A few thoughts on reimbursement

Michael Kleerekoper, MD, MACE

Health care is getting out of control and I am not referring to “Obamacare” — I readily admit to not being up to date with what has or has not been passed on Capitol Hill.

Early this morning, I got an email from a patient requesting I put in a prior authorization for his Freestyle test strips. He had purchased a new meter a few months ago but was told that test strips for his new meter were no longer approved. Prior authorization worked, but at what expense? See his email below.

Monday, August 26, 2013

Ward it off

Michael Kleerekoper, MD, MACE

The International Society for Clinical Densitometry published the following position paper in 2002 in the Journal of Clinical Densitometry: “Which central dual X-ray absorptiometry skeletal sites and regions of interest should be used to determine the diagnosis of osteoporosis?”

Wednesday, July 17, 2013

Iodine deficiency vs. iodine excess: Which is worse?

Michael Kleerekoper, MD, MACE

The recent AACE Annual Meeting and Clinical Congress included many excellent sessions, with only a few that did not live up to my expectations. One of the best plenary lectures was delivered by Michael Zimmermann, MD, and was titled, “Iodine Deficiency and Excess: Worldwide Status.”

I listened most attentively to the reports on iodine deficiency but was in for quite a surprise when I returned to clinic a few days later.

Tuesday, April 16, 2013

Why don't patients care about their diabetes care?

Michael Kleerekoper, MD, MACE

It’s no secret that most of my clinical and research activities involve in bone and mineral metabolism, both in the lab and the clinic. In my new position I am faced with most of my patients coming to clinic for management of diabetes.

In my role as a clinician, I view myself as a teacher to my patients with diabetes, but for the most part, it is an uphill battle. More than 30% of my new patients with type 2 diabetes turn up at the clinic without a glucose meter and/or a blood glucose diary. If they do bring a meter, it is immediately obvious that they do not look at serial blood glucose data and do not know that they should have been taught how to adjust their insulin dosing, or preferably their eating habits, to maintain a more stable capillary blood glucose. When they are concerned about a high fasting glucose (ie, >300mg) they tend to overdose with insulin. Most often they elect to inject glargine twice a day.