Liv Martin ’26 and Chloe Shaller ’26: Beth Israel Deaconess Medical Center
- The Rivers School
- Oct 20
- 5 min read
Updated: Oct 23
This summer, we had the amazing opportunity to shadow Dr. Deborah Riester, an internal medicine specialist and endocrinologist working at Beth Israel Lahey in Wayland, Massachusetts. We were able to observe a variety of different cases, including prediabetes, both type 1 and 2 diabetes, Cushing's disease, Down syndrome, hypothyroidism, and more. During our appointments, we would fill out a small slip for the patient to bring to the front desk, which would help them check out. We would then research their conditions, taking note of the cause, symptoms, and different treatments.
In addition to shadowing Dr. Riester, we also had the privilege of working with the rest of Dr. Riester’s team: Lisa, Emma, Bella, and Lindsey. Before appointments, we helped bring patients to their observation rooms and measured their height, weight, blood pressure, pulse rate, and oxygen level. For some patients who came in for diabetes-related appointments, a hemoglobin A1c test and a lipid test were done. An A1c test measures the average blood sugar level over the past two to three months. A lower number indicates a lower risk of complications related to blood sugar. A non-diabetic A1c count is under 5.7%. An A1c between 5.8% and 6.4% indicates prediabetes, and an A1c of 6.5% or higher indicates diabetes, which should be treated.
Another common test that diabetic patients could check at home and bring the results to Dr. Riester was blood pressure. Blood pressure is shown as two numbers: systolic over diastolic (for example, 120/80). The top number, systolic pressure, measures the force of blood against the artery walls when the heart is pumping. The bottom number, diastolic pressure, measures the pressure on the artery walls when the heart muscles are relaxed between beats. For diabetic patients, a reading less than 120/80 is considered normal, 120-129/<80 is elevated, 130-139/80-89 indicates hypertension, and anything above 140/90 is classified as stage 2 hypertension.
Our daily routine also gave us insight into the practical side of medicine. By observing how rooming patients is done, we were able to help with vital signs collection, including height, weight, blood pressure, pulse, and oxygen levels, which are crucial for monitoring chronic conditions. We saw how important it is for the medical team to communicate clearly and compassionately with patients, answering their questions and guiding them through complex treatment plans. We then observed how Dr. Riester goes through the patient’s medical history, medications, and symptoms to collect as thorough an understanding of the patient’s issues or concerns as possible.
Empty exam room Chloe and Liv together Machine for checking blood pressure
During our time with Dr. Riester, we observed a wide variety of patient cases that helped bring our research to life. For example, we saw patients managing diabetes with lifestyle changes and medications such as Metformin, as well as newer injectable drugs like GLP-1 receptor agonists, which mimic natural hormones to help regulate blood sugar and appetite. We learned that managing diabetes is not only about controlling blood sugar but also about addressing complications, such as high blood pressure, kidney health, and cardiovascular risk. We witnessed a patient with Cushing’s disease who shared their long journey of symptoms, including weight gain and fatigue, and how starting cortisol-blocking medication led to significant improvements in their health and well-being. They also shared their struggle of being diagnosed with Cushing's, as it is very underresearched and underdiagnosed.
One of the medications we researched is Metformin. This is often the “first line” treatment for type 2 diabetes. It works by inhibiting gluconeogenesis, the process by which the liver produces glucose. It activates AMP-activated protein kinase (AMPK), a cellular energy sensor, which works to suppress gluconeogenesis. Metformin also enhances the body’s response to insulin, meaning the cells become more effective in glucose uptake. This is especially important in type 2 diabetes patients whose cells have become resistant to insulin. Some side effects of Metformin can include gastrointestinal issues, fatigue, and decreased appetite. Many of the patients we saw reported having these symptoms, especially the gastrointestinal issues. In some cases, the side effects outweighed the benefits of the medication, and the treatment plan had to be adjusted.
We also looked at both oral and injectable medications as treatments for type 2 diabetes. The injectable medications are GLP-1 receptor agonists. GLP-1 is a hormone that plays a crucial role in appetite and blood sugar regulation by stimulating the pancreas to produce more insulin, inhibiting glucagon secretion (preventing the pancreas from producing glucagon, a hormone that raises blood sugar), reducing appetite, and slowing the absorption process. The medications can mimic the effects of this hormone and help the body regulate blood sugar levels and weight. Common injectable medications include Ozempic and Mounjaro. Even though they are also used to treat type 2 diabetes, oral medications work a little differently as they are SGLT2 inhibitors. SGLT2 is a protein in the kidneys that helps reabsorb glucose from urine back into the bloodstream. Oral medications block this protein, preventing glucose from being reabsorbed. This leads to more glucose excretion in urine and, therefore, decreased blood sugar levels. Some also help to lower blood pressure through sodium excretion. Common oral medications include Jardiance, Farxiga, and Invokana. Both oral and injectable medications are used along with changes in diet and lifestyle to make the most of the medication and help decrease symptoms to the best of their ability.
In addition to chronic diseases, we also saw how acute and complex cases are handled, such as a patient with hypothyroidism who had undergone thyroid surgery, and another with memory issues possibly related to spinal stenosis. We learned how to palpate abnormal thyroids using a swallow test and placing our thumb and fingers around the thyroid accordingly. Dr. Riester instructed us on how to palpate, and we were able to feel an enlarged thyroid gland of a patient. We were introduced to the detailed hormone pathways controlled by the pituitary gland, understanding how deficiencies or excesses in hormones like ACTH, TSH, and growth hormone impact overall health.
Our main project was to create an educational handout and poster that explained the basics of the endocrine system and detailed common conditions such as prediabetes, type 1 and 2 diabetes, hypothyroidism, and Cushing’s disease. We also included information about the medications commonly prescribed for these conditions, as well as management and treatment plans. This project helped us understand how hormones regulate many bodily functions and how imbalances can lead to complex diseases that require personalized care.
We were also able to experience the more personal side of primary care. We observed how deep Dr. Riester’s bond with her patients is, especially the ones she’s had for a long time. Many of the patients came to her not only for medical help but also for advice on situations in their personal lives. It was amazing to see how much she was able to help her patients.
Finally, we would like to sincerely thank Dr. Riester and her entire team for welcoming us so warmly during our internship. Their willingness to share their knowledge, answer our questions, and include us in the daily workings of the clinic made this experience truly meaningful. We greatly appreciate the opportunity to observe firsthand the compassionate care they provide to their patients. This internship has been truly inspiring! Lastly, we want to thank Mr. Schlenker for allowing us to take a deep dive into internal medicine and endocrinology!
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