This article is part 4 of a series of posts related to physiology, with this article introducing the physiology of diabetes. Some simulation team members may have a limited background in physiology or medicine. An understanding of basic physiological concepts can enable non medical simulationists to better understand medical simulation. (Note: See the entire series linked at the bottom of this article).
Diabetic patients are prone to fluctuating blood sugars which must be treated promptly to prevent serious consequences. Later articles will discuss treatment of high blood glucose (hyperglycemia) and low blood sugar (hypoglycemia). Both situations make ideal simulation scenarios.
An estimated 30.3 million people of all ages—or 9.4% of the U.S. population—had diabetes in 2015. This total included 30.2 million adults aged 18 years or older (12.2% of all U.S. adults), of which 7.2 million (23.8%) were not aware of or did not report having diabetes. At least one in four hospitalized patients has diabetes. Medical simulation provides an opportunity for learners to care for patients with diabetes either as the primary admitting diagnosis or as a comorbidity.
Diabetes is a progressive disease that interrupts fuel metabolism within the body. Diabetes is not just a disease of carbohydrate (CHO) metabolism but also of protein and fat metabolism.
Exocrine function: Secretes digestive enzymes into the gut to breakdown food.
Endocrine function: Secretes hormones (chemical messengers) that respond to changes in blood sugar.
Glucagon – secreted in response to low blood sugar, low protein intake, exercise, starvation and low CHO diet.
Promotes excess storage of glucose in the liver in the form of glycogen.
Note: the brain and livers do not need insulin for glucose uptake.
Remember the body tries to maintain body functions within a certain range – homeostasis.
Insulin is measured in units – typically 40 to 50 units are secreted daily.
Diabetes is the sixth leading cause of death in the US.
Absolute – pancreas produces no insulin or very little insulin.
Requires exogenous insulin – from outside the body.
Lose weight rapidly since glucose cannot be used for metabolism, instead fats and muscle tissues are catabolized.
Type 2 diabetes – 90% of diabetic patients.
Relative – pancreas produces normal or excessive amounts of insulin but body is unable to use it effectively aka insulin resistance.
Increases with age – half cases >55 but not called late onset.
In the US increasing obesity in young people has led to a significant rise in Type 2 diabetes in this age group.
No major weight loss because enough insulin is produced to prevent the breakdown of fat and muscle tissue.
Type 2 pts are mostly obese.
When blood sugars start to rise to the renal threshold of 180 mg/dL, glucose spills over into urine.
Cells are starved of fuel so pt. is excessively hungry and eats a lot more – polyphagia .
The three cardinal signs are most often associated with Type 1 diabetes. In a simulation scenario a parent should report that their child has been noticeably thirsty, hungry and needs to urinate frequently.
Glucose attaches to red blood cells which have a lifespan of approximately 90 days.
Diabetes can be incorporated into any existing scenario thereby increasing the complexity of the scenario. Alternatively a significant change in blood glucose levels can form the basis of a standalone scenario. Examples of learning outcomes related to care of the diabetic patient.
Healthcare professional responding to grieving associated with the diagnosis of a new progressive disease.
Prevention of serious complications associated with diabetes.
Patient and child education for diagnosis.
Assessing insulin and CHO requirements.
Rapid response/treatment for hyperglycemia and hypoglycemia.
This article has introduced the basics of diabetes. In the coming months other articles will be published that will review the physiology behind specific treatment modalities for diabetic patients.
Learn more about Diabetes here!