Who Is Dr Daphne Lee?

I chose to specialise in endocrinology as I am fascinated by the intricate and elegant mechanisms through which hormones govern our body’s functions. Unravelling this complexity, restoring equilibrium and ultimately witnessing the transformative power of specialised care in a patient’s life strengthens my conviction in the significance and impact of endocrinology on holistic health.

Patients should consider consulting an endocrinologist when they have symptoms or conditions related to hormonal imbalances that require specialised care e.g. if a complex and rare endocrine disorder is suspected, if hormone therapy is required and needs expert monitoring, if they have unexplained symptoms that could be hormone related such as mood changes, unexplained weight gain or loss, severe fatigue, menstrual irregularities.  

Attending medical conferences, CMEs and lectures. Reading medical journals for the latest guidelines and updates on the latest advances in endocrinology.

That every patient deserves to be heard and respected. I believe in shared decision making and not a top-down approach. Ultimately, we may only be able to cure sometimes, but we can comfort always.

We often come across patients who are resistant to taking medications for their condition, e.g. insulin. I had an elderly lady who had been diabetic for >10 years. She was on 4-5 oral diabetic medications. Despite taking her medicines religiously, her Hba1c was always >10% and she was showing early signs of developing diabetic complications. She needed insulin but was reluctant to do so fearing it meant he had “failed” and believing insulin would worsen her condition. It took several months over multiple visits to eventually convince her. It also helped that she was started on a simple insulin regime which was not so overwhelming. Her Hba1c improved to 7.8% after starting insulin and she found that insulin was not as bad as she had imagined. She became more receptive to intensification of her diabetic regimen using insulin which help to maintain her glycemic control and keep diabetic complications at bay.

I realised that misinformation is a major barrier to insulin acceptance. Patients need reassurance that insulin is a life-saving option, not a sign of failure. Gradual introduction and patient involvement in decision-making helps build trust and adherence and addressing emotional concerns is just as important as prescribing the right medication.

Common misconceptions include:

1) That hormone treatment is harmful. Hormone treatment can be beneficial when used appropriately but, like any medical therapy, it carries potential risks and should be personalized to each patient’s needs. Whether hormone therapy is “harmful” depends on several factors, including the type of hormone, dosage, duration of treatment, and a patient’s individual health profile. Have an open discussion with patient, explain why treatment is required, pros and cons of not having treatment, what side effects to expect, what monitoring is required. Encourage questions and feedback.

 2) Only old people get diabetes. Type 2 diabetes is increasingly common in children and young adults due to rising obesity rates and sedentary lifestyles. Stress the importance of early screening and lifestyle modifications, especially for those with risk factors like family history or obesity.

1) Clear communication – I try to avoid using too much medical jargon when speaking to patients, use analogies and metaphors to make complex concepts more relatable. Use visual aids like diagrams and pamphlets to illustrate my explanation. Tailor information to the patient’s values, preferences, and health literacy level

2) Shared decision making – discuss risks, benefits and alternatives, always take patient’s perspective into account, never a top-down approach. Create an environment where patients feel comfortable asking question, encourage active participation in the decision making process

3) Follow up support – allow time for patient to digest the information shared. Schedule follow-up appointments to reassess understanding and address new concerns.

I think it is important to find meaning in my work. I try to focus on the aspects of patient care that bring fulfilment and purpose, celebrate small victories and positive patient outcomes to stay motivated. I also set boundaries between work and personal life and try to complete outstanding work in the office to avoid bringing work home. This allows me to make time for my loved ones when I am at home. Engaging in hobbies that bring joy and relaxation also helps me to maintain a work-life balance.

There are many exciting developments and emerging technologies in the field of diabetes care.

1) Advanced medications that confer organ protection in addition to lowering sugar levels e.g. GLP1 receptor analogues and SGLT2 inhibitors

2) Evolution in sugar monitoring systems. CGMS devices have been available in the market for some time. Newer devices are smaller, have better accuracy, longer wear time and better integration with devices.

3) Automated Insulin delivery systems also called artificial pancreas systems, AID integrates continuous glucose monitors (CGMs) with insulin pumps using AI-driven algorithms. These systems adjust insulin delivery in real time, reducing the burden of self-management.

4) Advanced insulin e.g. “Once a week” insulin are in development

5) Non-invasive glucose monitoring. Research is advancing on non-invasive methods like wearable skin sensors, sweat-based monitors, and even smartwatches that could measure glucose without fingersticks or CGM insertions.

There is good scientific evidence that maintaining long term good glycemic control reduces risks of diabetic complications. We can attain good sugar control by:

• Eating a healthy, balanced diet and controlling food portions – keep in mind the healthy plate concept
• Stay active
• Maintain a healthy weight and BMI
• Learn to check your own sugars. CGMS is now widely available and allows patients to check their sugars without having to prick their fingers
• Keep up with your regular check ups for diabetes. Doctor will check your Hba1c, urine test and other blood tests to make sure you are within target range
• Regular screening for diabetic complications e.g. eye and foot check up at least once a year
• Be compliant to your medications

Don’t forget your blood pressure and cholesterol levels, they are as important as your sugar levels.