Last week, I had the great pleasure of being able to shadow consultant, Dr Emmanuel who is part of the NHS trust.Dr Emmanuel completed his training in Diabetes and Endocrinology and his PhD in Obesity at UCL. I went to St Bartholomew’s hospital which is one of the oldest Hospitals in Britain! I had the pleasure of shadowing Dr Emmanuel at the diabetes and obesity clinic for the day.I managed to see the clear link between obesity and diabetes.A quick overview of diabetes;
This is a metabolic disorder where the body cannot make use of the glucose so it builds up in the blood, therefore giving you a high blood glucose concentration.With type 1 diabetes, there is no insulin or very little insulin present to unlock cells.The treatment of type 1 diabetes usually would consist of frequent insulin injections/ using an insulin pump.This would ensure that there would be insulin present for the correct blood glucose levels to be achieved by being able to break down the glucose.The insulin pump would allow the correct level of insulin to remain in your blood stream without you having to inject yourself on a timely basis.
Type 2 diabetes is much more common and usually develops later on in life.Type 2 diabetes means one who suffers from this would produce no insulin at all as your body looses the ability to respond to insulin.Obesity has a very strong link to diabetes and is common in most type 2 diabetes patients.
Medication mentioned to help with diabetes; Furosemide, metformin.
Talking to Dr Emmanuel I was able to understand with more detail the link between diabetes and obesity and seeing as the clinic was for both diseases, and the patients who were obese did have diabetes I understood that obesity increased your chance of developing type 2 diabetes.Dr Emmanuel explained that people who are obese, tend to produce less and less of insulin as their BMI increases.Therefore the pancreas has to make up for the little insulin produced and therefore is under a lot of stress,Essentially the pancreas runs out of steam and therefore destructs itself,leading to diabetes. In response to accumulation of unfolded/misfolded proteins, cells adapt themselves to the stress condition via the unfolded protein response then ER homeostasis is disrupted, the ER generates adaptive signaling pathways, called the unfolded protein response to maintain homeostasis of this organelle. However, if homeostasis fails to be restored, the ER initiates death signaling pathways.Some new research and observations suggest that both chronic hyperglycemia and hyperlipidemia, known as important causative factors of type 2 diabetes (T2D), disrupts ER homeostasis leading to insulin producing β-cell death.Hyperglycemia is when there’s an excess of glucose in the blood stream, hyperlipidemia is where there are high lipid levels.Both of these can come from the diet of someone who is obese and therefore can lead to diabetes.
I also was curious to learn more about the relations between blindness and Diabetes.Dr Emmanuel spoke about small blood vessels sustaining tissues and supplying blood to the retina so the retinal electrons and epithelia are maintained.This allows the retina to function well and to convert light into electrical signals.New blood vessels form in the retina and a high blood sugar level can lead the blood vessels to leak blood and narrow.In order to correct this ophthalmologists will perform surgery and try to prevent the bleeding, this should prevent the blindness as you only require a small part of the retina to see.
When sitting in on the appointments between patients I learnt vital information about the speacialty and in general rules as a doctor.The first patient was a new patient and therefore had the longest consultation meeting.This was due to the fact the consultant had to receive an in depth patient family history as well as his current lifestyle and eating patterns etc.This consultation highlighted the strong heritable nature of diabetes as many of the patients family, also had diabetes.Dr Emmanuel asked about each side of the family and their health conditions if any.He then went and asked about the frequency of exercise the patient undergoes and his meals,whether he smoked,how much he could walk without becoming breathless etc.
The vitality of lifestyle also become very apparent to me as the patient would have one very heavy dish in the late afternoon and sleep during the day.As he worked night shifts he would also eat late at night and have to stay up.This also affects how much calories you burn as eating and sleeping straight after can cause much more weight gain.
Over the next few consultations, I picked up on the set areas the consultant would ask questions around.He would check for symptoms of Sleep apnea,mood levels,any cardiac issues as this would tie in with obesity.The main goal for the patients who were very obese,(obese being a BMI of 30) was to have surgery done.Either sleeve gastrectomy or gastric bypass.
Dr Emmanuel would try and set goals for the patient by discussing their abilities in performing the tasks he would set, for example he would ask each patient how far they could walk comfortably without feeling too restless.The solution would then be to ensure they were getting their exercise,be it by walking the last 3 bus stops of your journey, participating in a sport the patient enjoys etc.He would then refer them to a psychologist if needs be to help tackle any issues in their mood and help them to become more positive and happy people.This is because after surgery,for around 2 months the patients who’d undergone sleeve gastrectomy would be having liquids and soft textured food for 2 months.As food can be very comforting and these patients particularly gain comfort from food, it would be a struggle for them nd this may indeed affect their mood after surgery.It would take around 6 months for the effect of surgery to no longer have an affect in the patients lives for various reasons.It would be important for the patients to be able to hopefully be mentally prepared for the stress of surgery and not become overwhelmed by it all and let it bring them down.The consultant also requested a test of the heart for stress, and lungs for the patients.He checked for fluid in the foot as this is common if you’re overweight,
This experience was extremely useful in allowing me to gain better knowledge with obesity and diabetes and the ways to tackle it.