Diabetes mellitus, commonly referred to as diabetes, is caused by an inadequate amount of circulating insulin found within the body and is an important disease for emergency medical care professionals and those seeking a degree in emergency medical care to understand. In order to fully comprehend how diabetes works let’s take a look at a little bit of physiology. If you study the word “metabolism” and its Greek roots, you will learn it means “to change.”
Metabolism within the body is nothing more than the breakdown, or change, of glucose into energy in the form of ATP with byproducts of carbon dioxide and water. When the patient eats, blood glucose levels increase. Insulin is a gatekeeper that allows blood glucose molecules to be used by the cell. When blood glucose levels are low, glucagon is the primary form of hormone that causes the body to release stored glycogen, or energy.
For the body to make energy, insulin must allow glucose to enter the cell. If insulin is not present, the amount of glucose that is able to go into the cells is much too small to meet the body’s daily demands for energy. In order for this to happen there has to be an adequate amount of insulin, and the insulin must work correctly to allow the movement of glucose into the cell.
Diabetes is a common ailment attended to by emergency medical care professionals and is a leading cause of death in the United States. This comes about as a result of a lack of insulin or the body’s inability to utilize insulin efficiently. Diabetes mellitus is generally classified as Type I or Type II. In the past, Type I diabetes was also known as insulin dependent diabetes mellitus or simply juvenile diabetes. This is because Type I diabetes almost always manifested itself prior to a person entering their teen years. Type II diabetes was called non-insulin-dependent diabetes mellitus or adult onset diabetes. According to the American Diabetes Association, Type II diabetes is a disease of lifestyle. Let’s take a look at each one of these types of diabetes.
When the body is functioning normally, the blood glucose level, also known as a BGL, resides in the range of 60-120 milligrams per deciliter. If a patient fasts after midnight, their BGL should drop to less than 100. The BGL is affected not only by the amount of food eaten but by the types of food consumed as well. The primary components of food are protein, fat and carbohydrates. Each of these substances are absorbed by the body at a different rate.
Foods that are high in carbohydrates provide the fastest form of energy to the body. Once these are eaten, the beta cells of the pancreas immediately releases insulin. This hormone combines with specific receptors on the surface of the cell to allow glucose to enter. The purpose of this is twofold. First, it allows the cell access to glucose to metabolize and, secondly, it provides an assurance that the body will not have to depend on protein or fat for metabolism. Excess glucose is uploaded to the liver where it is converted to and stored as glycogen. Even though you would think that after eating a large amount of carbohydrates the blood sugar would spike, this, generally does not happen as the release of insulin assures that the glucose is available for immediate use or storage.
The liver is limited in the amount of glycogen that can be stored there, so the muscles will assist with this process. It is estimated that as much as a third of the glucose that travels through the liver is converted to fatty acids that are then stored in adipose, or fat tissue, as triglycerides. If insulin is not available for normal metabolism, this fat is broken down and converted to a soluble form that is found within the blood. This is the reason as to why low insulin levels usually have a high level of cholesterol and triglycerides that accompany the condition. This often leads to heart disease, another common health issue seen by emergency medical care providers.
Growth hormone and insulin work together to move amino acids across the cellular membrane. There they are broken down to form new proteins. This process is known as protein synthesis. If there is an insufficient amount of insulin, the storage of protein is hampered, and muscle protein breakdown begins. The protein that is not used, known as protein wasting, is sent to the kidneys and excreted in the urine. High amounts of protein passing through the kidneys can lead to renal failure and dialysis.
In the past, diabetes was an uncommon disease, even among emergency medical care providers. Today, many doctors believe 10 to 12 percent of the American population is diabetic. To learn more about diabetes and the pathophysiology of the endocrine system, listen to The 10 Minute Medic, a podcast by EKU emergency medical care coordinator Dr. Bill Young.
Managing diabetes and knowing what to look for are important topics for emergency medical care professionals. If you’re a licensed paramedic and are interested in pursuing an associate or bachelor’s degree in emergency medical care, complete the form above to learn more.
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