Episode Details

Episode 4 - A Sweet Refreshment: Diabetes The sun rises over the San Joaquin Valley, California, and today is March, 23, 2020. We are excited to announce our new group of residents [drum roll] Daniela A., Daniela V., Valerie, Namdeep, Anabel, Ariana, Yosbel, and Ikenna. Welcome to the club, doctors! This is the beginning of the most exciting chapter in your medical career. We are so thrilled to have you! COVID 19 has changed the way we train as residents, the way we live, socialize and interact with each other. On Thursday March 19, 2020, the Governor of California, Gavin Newsome, issued a statewide “stay at home” order to protect the health and wellbeing of our great people and to halt the spread of this devastating disease. The World Health Organization warned us about the acceleration of COVID 19. It took 67 days from the first reported case to reach the first 100,000 cases, it then took 11 days for the second 100,000 cases, and just 4 days for the third 100,000 cases(1). These days our clinics are more quiet than usual with most visits as phone encounters, we get a glimpse of what telemedicine is all about. Our didactics are canceled, and instead we are on self-quarantine and becoming master home test-takers. Our inpatient team is working hard to care for our patients and help prevent the spread of disease. Some of us have found a new love for all indoor cooking, yoga, dancing and being quarantined. Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program, recorded weekly from Bakersfield, California, the land where growing is happening everywhere. The Rio Bravo Family Medicine Residency Program trains residents and students to prevent illnesses and bring health and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971. [Music continues and fades…] "I know that I know nothing" (Socrates) Today our guest is Greg Fernandez. He is on his last months of residency training. He is on his third year! He is famous for his grilling skills. Welcome, Greg! As you know we have 5 questions in our podcast. Let’s start with question number one. 1. Who are you? Hello my name is Dr. Gregory Fernandez, I was born and raised in Santa Fe, New Mexico, did my undergrad University of New Mexico in Biochemistry. Then, attended Medical School at the Medical School in Guadalajara, Mexico. Now I’m a 3rd year resident in Bakersfield. 2. What did you learn this week? What I learned this week and would like to share with you, is the recommendations for diabetic management. The topics Including: 1. New recommendations for A1c screening. 2. New recommendations for lipid management and screening. 3. New guidelines for microalbumin screening 4. New recommendations for protein intake in patients with CKD 5. Recommendations of ACE and ARB's for primary prevention of diabetic kidney disease. 6. New exercise guidelines Pathophysiology of diabetes Pathophysiology of type 2 diabetes: Diabetes is multisystemic. The key management of type 2 diabetes is to restore and sustain beta cell function. The more irreversible the beta cell function becomes, the more resistant the patient becomes to treatment and the more likely patient will require insulin. Our role as physicians, is early intervention to preserve beta cell function. Once damage has been done to the beta cell, this damage can become irreversible and is the reason early intervention is key. If we think of the beta cell function in terms of an ejection fraction and the ability of the beta cell to secrete insulin. As the ejection fraction of the cell decreases to about 25%, our patients can become more insulin resistant. For example: If our patients HbgA1c continues to not be at goal despite optimizing diabetic medications. We often blame our patients for diet and noncompliance. However, this patient mi