Morning guys. I'm Siobhan, a 3rd year medical resident. I'm currently on my endocrinology rotation.
So the specialists that deal with hormones. So this morning is a diabetes clinic and then this afternoon
we'll be going and covering all the hospitals in the city, doing consults about anything to do with hormone abnormalities.
So it's going to be an exciting day!
Diabetes is a disease that causes high blood sugars.
This can happen if your body doesn't make insulin or if it doesn't really know how to use insulin properly.
And insulin is a really important hormone that helps to move glucose, sugar, from your blood into your cells.
And over time these high blood sugars causes a huge amount of damage to blood vessels and nerves in the body.
And that's why diabetes leads to kidney failure, heart attacks and even blindness. So it's a really serious issue.
This first patient that I've seen is a type 1 diabetic.
Type 1 meaning that it was an autoimmune disease that attacked and destroyed her pancreas.
So since a very young age she just doesn't make insulin, so she always has to be giving it to herself.
She happens to be using an insulin pump.
So it's attached to her all the time and she's able to input
how much insulin she needs, depending on what she eats and how much activity she has. So she's incredibly aware of her body
and what's going on and she's doing an amazing job.
I mean...
Can you imagine checking your sugars, poking your finger at least 6 times a day? Doing mental math,
figuring out how many carbs you can be eating and what to do when you have a low sugar or a high sugar,
while you're working or going to school.
It's, yeah, really impressive!
Okay, so this next patient has type 2 diabetes.
So different from type 1 diabetes, because it normally happens later in life and it's really strongly linked to obesity.
There are some genetic factors, environmental factors,
medications that can make it worse. But overall what I think is exciting about this disease,
is that it's something we can prevent with good exercise, keeping a normal body weight.
Those things can prevent the disease and all the complications that come with it. Because diabetes can affect so many different organ systems,
I like to take a super
systematic approach with each patient, so that I don't forget anything. For each visit I ask about
acute events like a low blood sugar or getting admitted to the hospital.
Then I think about damage to the large blood vessels, like a heart attack or stroke.
Then I think about the small blood vessels.
So asking if there's numbness in the feet or if their stomach is emptying slowly. If they're getting their eyes checked regularly,
or even if they get lightheaded when they stand up.
Then I move on to the physical exams and that always includes checking for numbness in the feet.
So we use a special wire called a monofilament to apply pressure and basically poke the patient's foot.
The cool thing is that the wire is designed to bend under a specific amount of force.
So that makes the test standardized and then we can compare it and the results from one appointment to the next.
There's no doubt that diabetes is difficult. It's difficult to treat, difficult for patients to manage
and what's so wonderful about this clinic is that you can have regular follow-up appointments.
We have nurse clinicians and get education from the dieticians and even work through barriers with the psychologists and social workers.
So there are lots of supports to help people succeed.
Alright,
so it's just after noon and
I guess you guys don't see that every time I see a patient I then go and review with my staff physician and
we kind of work on the plan together and then go back and see the patient.
Now that doesn't leave me with a lot of time to do my dictations and notes between patients.
So now I'm left with a pile of dictations to do, just part of the reality of medicine.
And then we're gonna get to go and see some of the inpatients.
Okay, done.
Now I'm gonna text the
endocrinology fellow who will know what's up in the hospital system and tell me where we need to go.
There are 4 different hospitals in the city and we could be called to any of them to see consults. So we never know.
Okay, so we've been called to go to a different hospital and see a patient who just had brain surgery.
So they have a pituitary tumor that was removed
and
we'll see how they're doing. This is a really interesting surgery. They go up the nose, through the skull and into the brain.
It's the easiest way to access the pituitary gland, which is inside the brain and just behind the eyes.
So the pituitary controls many really important hormones like the thyroid hormone, growth hormone,
estrogen, testosterone and lots of others.
So after the surgery
it's our job to check all the hormone levels, to make sure they're working properly.
And if they aren't, we need to really carefully replace them.
Alright, so got out early today and now I've got an extra 30 minutes of my day, which feels amazing!
So I've just come home and I'm gonna play a little bit of violin
before I have to go back to the hospital for my Royal College study group tonight.
But we've got this holiday party/ talent show coming up this weekend. So I've got some some fun duets on the go.
Back to the hospital. This time for my Royal College study group, not for work.
So I guess that's different, but it kind of feels like a deja-vu from this morning.
And because we're talking about diabetes, I want to remind you guys that
so much of your health is in your hands. Not all of it, I know that.
But try to get out there, do something fun and active, because you're gonna feel great in your mind in your body.
And if you're super busy and you feel like you can't do anything, then do a couple of stairs,
walk to go and get groceries or walk to work, but try to get those steps in.
Alright guys, I'm probably not gonna see you until 2020.
It's crazy to think of! So for now: Happy holidays, Merry Christmas, Happy Hanukkah.
I hope you have wonderful times with your friends and family.
I'll see you guys in the next video, in the new year. Bye for now!