糖尿病内科を志したこと①　Becoming a specialist in Diabetes Care ①｜京都烏丸 六角 田中クリニック｜ 内科・糖尿病・内分泌疾患・肥満症・漢方

私が初めて糖尿病と出会ったのは大学生の時に母が脳炎で倒れた時でした。

その時病院でHbA1c(ヘモグロビンエーワンシー　血糖値の指標のことです)が高くて、免疫力が落ちたから脳炎になったと聞かされました。恥ずかしながら当時の私はHbA1cという言葉もまだわかっておりませんでした。脳炎は重症で致死率30%と聞かされましたが、治療のおかげで無事自宅退院できました。

その後大学を卒業し、研修医になって京都府北部の病院で医師生活をスタートさせました。

医師になってはじめにローテート(研修医が色々な科を回って研修すること)したのは外科でした。外科の先生方はとてもかっこよく、重症患者さんが搬送された時や院内の患者さんが急変された時の様な緊迫した場面でも、冷静に指示を出し、黙って手術場に向かわれます。私はその後ろ姿を見つつ、畏敬の念を抱いていました。そんな外科の研修では毎朝患者さんの術後の創部(手術で切った部分のこと)を確認し、洗浄するというルーチンがありました。若くて体力のある人は数日で綺麗に傷が治るのですが、高齢の人、栄養状態が悪い人、糖尿病の人、透析中の人は代謝が悪いために傷がなかなか治らず、時には化膿して入院が長期化するケースがありました。朝のカンファレンスでは、栄養療法が疎かになっていたケースがあると厳しく叱咤され、「お前は栄養療法の威力をわかっていない」と仰られていました。手術場での華々しい手技や急性期の全身管理に目が行きがちな外科の研修において、当時の未熟な私にはある種“地味”なように感じられた代謝、栄養というものが、とても重要であることを思い知ったのでした。→②に続く

The first time I encountered diabetes was when my mother fell ill with encephalitis during my college years.

At that time, her HbA1c (Hemoglobin A1c, a measure of blood sugar levels) was high, and I was told that her weakened immune system had led to encephalitis. I must admit that at that time, I didn’t even understand the word “HbA1c.” Her encephalitis was severe, and we were informed of a 30% fatality rate, but thanks to treatment, she was able to safely return home.

After graduating from college, I started my medical career as a resident physician at a hospital in the northern part of Kyoto Prefecture.

During my early days as a physician, I began my rotations (where resident doctors rotate through various medical specialties) in the field of surgery. The surgical mentors were highly impressive; they remained calm and composed, giving orders even in tense situations such as when critically ill patients were brought in or when patients within the hospital suddenly deteriorated. As I observed their actions from behind, I held them in deep respect. In my surgical training, there was a routine of checking and cleaning postoperative incisions every morning. Young and healthy individuals would often heal cleanly within a few days. However, older patients, those in poor nutritional condition, diabetics, and those undergoing dialysis had slower healing due to poor metabolism, and in some cases, their wounds became infected, leading to extended hospital stays.

During the morning conferences, if there had been neglect in the nutritional care of patients, they were scolded harshly. I distinctly remember being told, “You don’t understand the power of nutritional therapy.” In the midst of the dazzling surgical procedures and the management of critically ill patients in the acute phase that often drew attention during surgical training, I, as an inexperienced physician at the time, came to realize the importance of metabolism and nutrition, which seemed somewhat “subtle” in comparison. This awareness stayed with me.　⇨continue to ②