Diabetes Mellitus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Teaching the Mechanisms of Type 2 Diabetes Mellitus to College Anatomy/Physiology Students 

Kevin E. Yocum

New York Chiropractic College

 

 

 

 

 

 

 

 

 

 

Abstract

According to the Center for Disease Control (CDC), the number of individuals diagnosed with disorders involving the malfunction of glucose transport mechanisms has been steadily increasing over the last thirty years (Center for Disease Control 2011). Malfunction of glucose transport mechanisms involves common diseases such as type 2 diabetes mellitus (T2DM), obesity, and metabolic syndrome. In order for a leveling off or a decline of the numbers to occur over the next thirty years, a collective understanding by our healthcare students of how to prevent or minimize disturbances of these important mechanisms is necessary. This analysis will provide creative ideas about introducing college-level A/P students to the various mechanisms involved during consumption and transport of glucose and the pathogenesis of type 2 diabetes mellitus. 

Keywords: glucose, glucose transport, diabetes, obesity, metabolic syndrome, insulin, type 2 diabetes mellitus, VARK

 

 

 

 

 

 

 

 

 

 

 

Teaching the Mechanisms of Type 2 Diabetes Mellitus to College Anatomy/Physiology Students 

Basic human survival is dependent on the ability of our cells to produce energy. The recipe for producing energy includes a simple ingredient called glucose. Glucose is a monosaccharide sugar that is obtained by consuming carbohydrates. Certain organs and tissues are also able to store and re-manufacture glucose in the body. Due to the constant need for and the availability of sugars, providing the body’s cells with glucose would seem to be a simple process that occurs quite naturally. For many Americans, this simple process has become complicated by sedentary lifestyle and consumption confusion. Metabolic disorders, including type 2 diabetes mellitus (T2DM) and obesity have risen dramatically in the United States over the past thirty years and there do not appear to be any signs of reversal to this disturbing trend in the years ahead (Center for Disease Control 2011). In order to begin the process of attempting to reverse this trend, it is essential that a more widespread understanding of how glucose is attained, transported, and metabolized is considered.

Many college students that are taking anatomy/physiology (A/P) have intentions of working in the healthcare field and some will eventually be caring for patients with T2DM. Providing students with a clear picture of T2DM will enable them to educate their patients. This discussion focuses on techniques for teaching glucose transport and the pathogenesis of T2DM to college A/P students, with specific attention to the VARK learning styles, a student-centered classroom structure, and social learning theory.

Glucose homeostasis is one of the most important negative feedback regulatory functions of the body. (Kumar et al., 2010) If there is not enough glucose in the blood for cellular energy and respiration, the cell will starve, leading to tissue and ultimately organ death. If there is too much glucose in the blood over long periods of time, the brain and kidneys will suffer severe damage. The pancreatic hormones insulin and glucagon assist with regulating blood-glucose levels. When blood-glucose levels rise, the pancreatic beta cells release insulin into the blood stream. Insulin coats glucose molecules, allowing for facilitated diffusion of the glucose into cells. When blood-glucose levels are too low, pancreatic alpha cells release glucagon, which stimulates liver and skeletal muscle glycogen conversion to glucose. When blood-glucose levels are problematic to control, many physiological disorders can occur. The most common group of metabolic disorders involving glucose transport mechanisms is known as diabetes mellitus (DM). Discussing these concepts requires attention to each student’s unique learning style.

Using the VARK scale, the visual learners will benefit from seeing a short video that shows how insulin attaches to glucose and facilitates the diffusion into the cell. There is a two minute YouTube video (http://www.youtube.com/watch?v=QeT1V8RmIbU) that shows glucose transport and digestion in a visually appealing way. The audio learners will also benefit from watching this short video, as the lecturer provides a simple and clear explanation to go with the video. Additionally, both the audio and read/write learners will be listening and taking notes on the content Powerpoint presentation that I have created, which includes checkpoint questions. The kinesthetic learners will also appreciate the YouTube video, as it displays fundamental molecular movement within organs and tissues that they will be dissecting in the lab. The lab environment is typically where the kinesthetic learners thrive. The lab portion of understanding glucose transport and T2DM will be discussed later.

The signs and symptoms of diabetes mellitus are easily detectable. Sugar has diuretic properties, so increased blood-glucose levels usually lead to frequent urination. Due to excess sugar in the interstitial space, osmosis will often lead to extra fluid movement from the cells into the interstitial space. This edema leads to more work for the kidneys, including more urine output, or polyuria. Polyuria leads to excessive thirst. An increase in appetite and hunger usually goes with DM due to the need for energy from protein and fat. If cells are unable to receive optimal amounts of glucose to produce energy, the overall fatigue level of the individual will dramatically increase as well (Werner 2005).

Accurately diagnosing diabetes mellitus involves the help of a physician. After a patient intake and vitals examination are done, if the physician suspects metabolic problems, a urinalysis and a series of blood tests will be ordered. A urinalysis test strip will show if there are glucose levels in the urine. Dr. Jayendra Shah, MD found that a diabetics’ perception of tasting sweets is deficient, so he devised a test involving seven different glasses of water mixed with varying amounts of sugar. All glasses contained eight ounces of water and 0, .25, .5, 1.0, 1.5, 2.0, and 3.0 teaspoons of sugar. The glasses were put into a random order and the patients were asked to take a drink from each glass, with a rinse between each drink, and rate the sweetness. Non-DM patients recognized the sweet taste with one or less teaspoons of sugar in eight ounces of water, while DM patients only recognized the sweet taste at one and a half to two teaspoons of sugar in eight ounces of water (Shah 1994).

The lab portion for understanding glucose transport and T2DM includes performing a glucose urinalysis of the student’s lab partner, the Shah sugar taste test, and a cat or fetal pig dissection of the stomach, pancreas, liver/gall bladder, and duodenum region. The social learning within the lab setting is essential for our healthcare students. In addition to learning the A/P aspects of this exercise, they also get to play the role of nurse or medical assistant by collecting and analyzing their partner’s urine and assisting their partner with performing the Shah sugar test. Visual learners appreciate being able to see the urinalysis results, while also seeing how complex the pyloric/duodenal digestive region is. The audio learners will benefit from playing the part of clinician and practicing active listening with their lab partner. Communication is extremely important while performing lab tests and the audio learners enjoy listening to their peers discuss their findings and interpret their results. The read/write students will find that interpreting the urinalysis dipstick and checking off their lab list for the dissection is the most beneficial, while answering the pre- and post-lab questions and writing the lab report also are appealing. The entire lab exercise is very appealing to the kinesthetic group. They get to walk to the restroom, clinical role-play, drink a variety of sugar-water mixes, and dissect part of the GI tract of a cat or fetal pig.

Treatment of diabetes mellitus generally addresses the need for increased insulin production by the beta cells of the pancreas, while increasing the affinity of the target cells for insulin. A decrease in glucose release from the liver and decreasing carbohydrate absorption rate in the small intestines are also addressed during the treatment of DM.  Treatment for T2DM includes consumption or diet changes, movement or exercise routines, and oral medication. Over one-third of T2DM patients are treated with insulin supplementation. Lifestyle education, stress management, and consumption awareness are typically part of the treatment protocol as well.  If T2DM is not prevented, recognizing the signs and symptoms early is essential. Recognition of the signs and symptoms of T2DM may lead to lifestyle awareness and positive alterations in lifestyle that are consistently maintained could result in less reliance on medication. In 2007, the direct and indirect costs of treating DM totaled 174 billion dollars (Center for Disease Control 2011). A DM patient costs twice as much to treat as a patient who does not have DM. DM individuals are more susceptible to heart disease, hypertension, strokes, blindness, amputations, and bacterial and viral infections and many DM patients will eventually need frequent hemodialysis. Due to a greater susceptibility to these pathologies, lifespan is greatly decreased for people who have been diagnosed with diabetes mellitus. I would also include a link to the website www.choosemyplate.gov and require each student to complete a one week consumption and movement journal, beginning on the day of their lab. They would bring their journal to the following week’s lab and I would show them how to log their consumption and movement data into the website template. They would have another week to compose a three page analysis of their consumption and movement based on the Choosemyplate results. Within their analysis they would be required to discuss whether, based on their results, they are at risk for T2DM now or in the future and how they would implement Choosemyplate into a clinical setting.

            Metabolic disorders, particularly type 2 diabetes mellitus, are nearing epidemic proportions in the United States. With affordable pricing and readily available quick food sources continuing to rise, expectations for a decline in metabolic disorders would appear to be bleak. Public understanding of the mechanisms controlling glucose transport may lead to increased preventative action against metabolic disorders. A greater awareness can begin in the college anatomy/physiology classroom, as many A/P students will be affecting the lives of their patients every day once they enter the workforce. It is essential that they are exposed to a variety of techniques for understanding the pathogenesis of type 2 diabetes mellitus.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

References

Center for Disease Control (2011). National diabetes fact sheet, 2011. Retrieved from

            http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.

Krishnapuram, R. & Kirk-Ballard, H.(2012). Insulin receptor-independent upregulation

            of cellular glucose uptake. International Journal of Obesity, 7. doi:  10.1038/ijo.2012.6.

Kumar, Vinay, Abbas, Abdul, Fausto, Nelson, & Aster, Jon (2010). Robbins and Cotran

            Pathologic Basis of Disease, Eighth Ed. Philadelphia, Pa: Saunders and Elsevier.

Martini, Frederic, Nath, Judi, & Bartholomew, Edwin (2012). Fundamentals of Anatomy

            and Physiology, Ninth Ed. San Francisco, CA: Pearson Higher Education, Inc.

Shah, Jayendra (1994). Kitchen test detects taste defect. Retrieved from

            http://www.thefreelibrary.com/Kitchen+test+detects+taste+defect.-a015911375.

Werner, Ruth (2005). A Massage Therapist’s Guide to Pathology, Third Ed. Baltimore,

            MD: Lippincott, Williams, and Wilkins.