A Day in the Life of a Doctor Vlog - Rare Tumor?? 

I am an Endocrinology Registered Nurse and an APRN student who plans on going into endo as an APRN. I was attracted to the insulinoma portion of the video. I am sorry that your patient suffered a seizure due to hypoglycemia. I wanted to give some information on insulinomas and my thoughts towards this case you described. You stated that she is a Type 2 IDDM patient who was suffering from persistent hyperglycemia whilst on HMS. That is a bummer than she missed her basal insulin dose the night before. I can guarantee it wasn't the basal insulin that caused the hypoglycemia episode if the basal dose hadn't drastically changed. How long after the bolus did she develop hypoglycemia? If it was only 3 units, it likely wouldn't tank her like that due to insulin resistance, so my guess is that the wrong dose was drawn up. The biggest issue I have seen in the hospital with patient on basal/bolus therapy is getting their prandial insulin too soon before a meal and then take and become hypoglycemic. For this reason, I wish Fiasp or Lyumjev were used in the hospital as the bolus insulin so it can be given AT the meal or even shortly after the meal and still properly control postprandial glucose spikes. When you talked about an insulinoma being a possible cause, I immediately said "no, very unlikely" and not just because insulinomas are rare findings (1-4 per million people), but because the patient has type 2 diabetes and has been dealing with persistent hyperglycemia. Insulinomas are more likely to be found in non-diabetic patients and one of the most common symptoms is noctural and fasting hypoglycemia. Even with nocturnal/fasting hypoglycemia, the cause is more likely to be adrenal insufficiency (addison's) related which can be diagnosed with a fasting cortisol and ACTH, if abnormal, do an ACTH Stimulation Study. Imaging isn't needed due to cost and radiation exposure unless the patient has persistent hypoglycemia whilst NOT on insulin. If it was an insulinoma, she wouldn't be dealing with hyperglycemia and wouldn't need to be on basal/bolus therapy. We commonly will put patients complaining of hypoglycemia on professional continuous glucose monitors (CGM) and have them come back in like 2 weeks for us to download and review their glucose trends and food diary and specific times where patient felt symptomatic and compare it to what the CGM shows. Hopefully this was helpful! I love endocrinology so much! So fascinating!

I became best friends with the case manager during my trauma rotation last month 😂. It truly is frustrating how patients get held up in the hospital due to social work issues.

Someone get this man a tshirt that says ‘Dr Biceps’... fun vid EJ.

Great video, and editing.

Awesome video!! So much snow, it looked very pretty. Did the vaccine make your arm hurt??

Love the editing and consistent uploads! Enjoy the holidays Ethan!

This is what i love to watch. Youre a great motivation, keep it up 😊✌

Oh yeah. Do you love me? 😍💋 💝💖❤️