DAY IN THE LIFE OF A DOCTOR: Diabetic Ketoacidosis
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DAY IN THE LIFE OF A DOCTOR: Diabetic Ketoacidosis

October 30, 2019

Morning guys. I’m Siobhan, a second year medical resident. I just got to the hospital and today you are gonna be joining me for a typical day on the internal medicine service. So I didn’t have any pages between 8:30 p.m. and like 5:00 in the morning, so I had like a period of like 8 hours or so without any pages. I actually thought that both pagers weren’t working, but then thankfully at about 5:00 a.m. they started going off again. Every morning I start by assigning each patient to a member of the medical team. They will be responsible for seeing the patient, examining them and coming up with a plan that they’ll then review with me and the attending physician. Alright, so now I’m heading down to the emergency department to meet up with the attending physician on my team, so my supervisor and we’ll be seeing all the new patients that got admitted overnight together. I get to make a plan, I do physical exam and I get that all reviewed by my staff. So it’s a phenomenal learning opportunity for me. Heading back upstairs now. So one of the patients that we got was very sick when they came into the emergency department and they were diagnosed with something called DKA, so that’s diabetic ketoacidosis. People with type 1 diabetes are not able to produce insulin, which is a very important hormone that helps regulate glucose, your blood sugar. Without insulin, cells can’t use glucose as energy. Instead they rely on the breakdown of fat into ketones, which actually makes the blood acidic. Since your cells aren’t using glucose properly, the kidneys pee out extra sugar, making the person very very dehydrated. So that’s how patients with DKA come to the hospital with very high sugars, ketones and acidic blood. To reverse this we treat patients with IV insulin and tons of fluid to correct their dehydration. Alright, so it’s time to look over the morning blood work for all 30 patients on our team and then I’m going to focus on the 3 that we’re planning to discharge today. Hi, can you please page GI? Thank you. Hey, this is Siobhan from team C medicine. Right, thank you so much for calling back. So we’ve got a patient here with liver disease. It’s had this significant drop in their hemoglobin and they’ve been having melina. So we’re hoping that you’d be able to take a look and see and consider maybe even scoping as an inpatient. Great. Thanks so much, okay. Bye. Alright, heading for our noon hour teaching now. We have pre-code sessions, which means we do simulations of patients who are very sick on the ward. And as if the medical student was called, they start up doing what they can. Then they’ll call the junior resident and then finally I’ll get called, the senior resident. And you’re trying to do this real-time, what you would actually do. So it’s exciting, it’s really good learning actually. Okay, teaching is done now. So my plan is to head down to the emergency department and follow up on that patient with DKA, as well as some… There are new patients who got admitted to hospital. When they are more recently admitted, things have been faster and you want to actually track their progress. So seeing them multiple times a day is usually a good idea. Hey, you got a moment? Yeah, what’s up? Do you know patient number 27? . Ehhh… Yeah yeah yeah. He’s having increased pain. He has the bilateral hip ulcers. Oh, yeah. He’s been complaining of more pain than usual. Do you think we could perhaps take a look before they are dressed up? Oh, they are open now? Yeah, they are open right now. Has he been having fevers or anything? No, he sees afebrile. Yeah, okay. Let’s do that. Okay, so our patient with DKA is getting blood work every two hours. They are getting their sugars checked every two hours. So let’s just trend them, see how it’s doing on the computer and we may have to switch up some of their medications, depending on what we find. Okay, just getting set up for a family meeting. Ehm, they’ll be in this room in a couple of minutes. We often do this with patients and their families, sometimes together and to give a medical update about what’s been happening in hospital. But also there are times when patients require more services, more support than they’d acquired before they came into the hospital. So in this particular case we’re going to be discussing options of either giving more supports at home for this patient or if they’re gonna need to be start thinking about things like retirement home or long-term care. Which I think is sometimes very very difficult to start that conversation, but it’s also rewarding, it’s about safety at home. Okay, 3:00 p.m. now, so we’re heading to meet up with the team and review all the patients seen for the day and hopefully tidy things up, so people go home. Hey guys. Ready to review if you’ve had a chance to see all your patients. Yeah. Awesome. Okay, perfect. Okay, so 5 p.m. now. Nikola, you’re on call tonight. Yeah. So you’re gonna be holding down the team. Well, of course I have the doctors. Yes, there’s a staff on tonight who’s gonna be helping out. And we’re just gonna go and hand over to that staff about any issues to follow up on tonight. Thought I was done for the day, but a patient is having trouble in terms of their discharge. Anyway, I can’t really go into the details of it. But I need to go up and try to sort this out, so it’s not all on be the night time person, because that’s not really fair and they don’t know the patient, so Hopefully this will be fast. Oh, just about 6 p.m. Finally done. Although actually, I just want to pop in one more time on that patient with DKA in the emergency department. Patient was quite sick today and just makes me feel better when I’m going home. Alright, so the patient’s doing well and the resident overnight is totally aware of this patient, so I feel very comfortable going home now. Anyway, if you want to see more videos like this, don’t forget to subscribe and take a look at some of these videos over here for something similar. Otherwise, I’ll be chatting with you guys next week. So bye for now!

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  1. I found your videos yesterday when I was supposed to study for my exam but ended up cruising on youtube instead. I was wondering why you are allowed to use your own clothes instead of scrubs and also wearing rings and your hair down? I'm a med student from Sweden and it's a very big no-no for those things here. I absolutely love your vids! Keep up the good work!

  2. I am a T1D patient and loved this video hahaha is just nice heard someone talking and educating the people about this disease… most of the times the people had wrong ideas about it so I just wanna say thanks for that!!

  3. 3:30 I miss those old Nortel PCM-based desk phones. So reliable, so straightforward to configure, and lot fewer things to go wrong than the VoIP-based phones most places are putting in, these days. If you hear about your hospital planning to "upgrade" the phone system, protest! The upgrade will actually be a downgrade, and the IT staff will have finally learned to set them up properly about the time the entire system is replaced with some other new, problematic VoIP system.

  4. I love ❤️ the way you edit your video on YouTube you make an amazing 😉 video on YouTube I love 💕 watching your video on YouTube you make awesome 👏 video on YouTube

  5. I love your videos 😍 Thanks for sharing your days with us. Im getting addicted about your vlog ❤️ Im from Canada too but from Laval city 😊

  6. Over the last day or two I've been binge watching the shit out of your videos lol love them, BUT just wanted to say your voice is amazing!!!! lol – so soothing and crisp and IDK BUT I LOVE IT!!!!! I feel like you have the perfect asmr voice!!!!!

  7. the fact that you're working such long hours but at the same time you have such a positive attitude will never cease to amaze me. Good job!!

  8. Could you do a video showing how you schedule your time outside of the hospital? I'm a film student which is very different from medicine but similar timing restraints.

  9. Hey lovely ❤️
    We need videos outside hospital
    To see how you living 😂😂😂
    I have question, if you are not diabetic type one and the ketosis around 8 mmol/l this is a bad or good. And normal person maximum ketosis what it should be?!?

  10. I wish you were my doctor! Maybe I would have a diagnosis by now… thank you for being so professional and committed to improve/save people's lives!

  11. I’m a new subscriber! I love your videos! Is there any video where you explain the hierarchy of your medical residency?!

  12. This video was super interesting because I have type one diabetes and I’ve been in DKA before and I was in the hospital for a week. It was interesting to see the other side of it.

  13. I'm type 1 diabetic so I know how it feels to not feel well .. Ive never had a serious case of ketoacidosis to were ive needed significant medical treatment thank god

  14. I was diagnosed with type 1 diabetes when I was 8 one week before my 9th birthday not I'm almost 20 ive had diabetes for almost 12 years give or take and all I can say is it never gets easier , I hope and pray everyday for a cure so I don't have to live with this for the rest of my life … Thank you for showing this , not many people know what diabetes even is or the different types as well as dka and such 🙂

  15. @ViolinMD you talked about T1D patients getting DKA but you didn't mention anything about T2D patients… Can T2D patients get DKA as well? I assume they can but idk for sure. Also, if they can is the treatment the same or different as a T1D patient? My mom is a T2D patient. I had gestational diabetes (I never had to use insulin and only had to take 1 pill, 1 time [I dont remember what the med was] it ended up dropping my sugar levels to low, I feel asleep luckily, when I woke up I was fine bc I was home alone when it happened) I just watched what I ate, somewhat and I was fine. On that note, Can women with GR get DKA and if so, how would their treatment vary?

  16. I am a type one diabetic and I haven’t personally gone into kedoacidosis myself thankfully. But it is still a struggle. When I was first diagnosed my blood sugar was 600!

  17. I've always wondered how nurses deal with their periods. I can't imagine them having time to change their tampons between patients.

  18. Siobhan you are awesome please can you explain what kind of emergencies you see and how you handle each one

  19. Great Video! My dad has type 1 diabetes and his pancreas still works but whenever it wants to not whenever it has to do my dad goes into low blood sugar a lot. Can you please do a video that's more about Keytones? My dad is also on Dialysis and what is dialysis? Thank you

  20. When do u have time to eat? I get very impatient and cranky when I'm hungry- I could never handle all that teaching!!

  21. I'm a physical therapist assistant turned into stay at home mom… now I realllyyy want to go back to work!

  22. I have been watching your videos off and on for a while now and decided to subscribe tonight. I'm curious, have you ever worn a pedometer or step counter, maybe fit bit, to see how many steps you take each day? I would love to know that number! You are such a bright spot in what is often a person's worst moments being in a hospital. Thank you for giving yourself to each patient. It shows even through your videos just how caring you are.

  23. This is so awesome!!! i see a lot of DKA in the hospital, compounded with diabetic foot infections. I will be documenting how I deal with diabetic foot infections with and without the complication of DKA on my channel

  24. You know what I love about you?? It is the fact that every time I pause the screen, YOUR SMILING!! You are so positive, EVEN when you have to deal with NO sleep, or when you have to run AROUND the hospital to get to your hard working patients!! You are so positive!!

  25. I grew up in the medical field from my grandparents and your videos are a joy to watch, thank you kind soul

  26. I'm type 1 diabetic and was in the ICU for 3 days at diagnosis. I went into DKA after being undiagnosed for 2 months! I was literally on my death bed when the lab technician called me at 12 am to tell me to rush to the ER immediately.

  27. It's like a ghost town inside that hospital. Where's the nursing staff? Where's the transports? Where's the patients? Lol. But then again what do I know I'm just an ekg technician.

  28. Omg I love your videos! Currently in school for the medical field and watching your videos inspires me so much! 💗

  29. There's just one i want to tell you.. You motivate me alot whenever i feel low and I'm very grateful for that.
    Second year medical student from India.

  30. Thank you so much for your videos!!! You seem like a lovely docter! I love ur editing and how u explain your cases. Subscribed!!!

  31. I am so glad you made at video of this. My mom has had type 1 diabetes since she was 10. Now I understand it so much more. Thank you!❤❤

  32. I LITERALLY LOVE THIS CHANNELLLL ❤️❤️❤️ you’re so positive from the start with your greeting omg ily ur an icon

  33. I was admitted to the hospital with DKA exactly a month after this was uploaded. Wish I would have seen this sooner! (I am type 2). A week in the hospital, including 4 days in ICU, as well as fluids and electrolytes.

    Keep up the great content!

  34. Hey so I’m wondering if you could do a video about HBP i currently have it i take medicine for it (Labetol) and im only 25 i wasn’t taking it at first cause i didn’t want to depend on medicine at such a young age it sucks. I want to know is it possible to reverse these side effects with a good diet and maybe drinking more water which i don’t do because all i hear is “you will have to take medicine for the rest of your life” Thank you ! love your videos 💕

  35. I’m very happy that you explained this! I was 6 years old when I was diagnosed with type 1 diabetes, and I had dka but I wasn’t aware what was happening at the time. This video would have been very helpful when I was younger, and I hope that younger kids with type 1 diabetes are able to learn from it 🙂

  36. Hi, I was watching this video and I noticed your accent sounds Canadian. Are you really from Canada?

    Thx for the video S2

    Greetings from Brazil!

  37. I discovered your channel yesterday and I am not a medical student or interested in the medical line but YOU MADE IT SO INTERESTING! I learnt alot and I can say that you are such a bubbly person!

  38. Hey! I just got finished taking the TEAS exam I was wondering if you had any tips on passing it! Thank you

  39. Please do more videos educating people like this! I'm a type 1 diabetic and I loved seeing this information .

  40. A person with t1d myself thanks for educating people about the disease, many people I know are ignorant about type 1 and dka.

  41. Siobhan! I just started watching your videos, and I am in love! Your personality and great spirits are exactly what hospitals need. I am a type 1 diabetic, and I was recently released from ICU after being treated for DKA, so I just wanted to say thank you for educating the public and for of course, treating the patient. It is very scary

  42. hi, I am 10 and I have type 1 diabetes. thanks for educating me more because I am newly diagnosed. I love your videos as well. they educate me a lot.

  43. I had DKA twice. It’s a scary thing. I’m always very happy when people shed light on this because many children die from it. Thank you!

  44. As a T1 who came across this video just about 2 months after being diagnosed (when in DKA), I deeply appreciate how you touched on it. The education is really needed to many non-diabetics.

  45. my ex, my son’s father, is a type one diabetic and goes into DKA constantly. i know a couple times in a life time is normal but it happened twice in august. it happens every few months. so i’m really really looking forward to this video.

  46. What diet would you suggest for someone who has PCOS and continuously gains weight because of it? I wanna stop the weight gain and lose weight but every diet and exercise plan ive tried hasnt worked

  47. New follower, never heard DKA my husband is type 1 from having pancreatic cancer had his pancreas removed 5yr ago. Lately he had a few 600 high numbers when his insulin pump is running low he thinks its malfunctioning. Any suggestions?

  48. I'm Type 1 Diabetic and watching this is fun because I understand everything you say. In other videos I watch from you I don't understand what's happening!

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