Medical interns learn what it's like to live with diabetes
By Carey Hamilton
The Salt Lake Tribune
The last thing Shawna Yates expected on her first day as a medical intern was to inject herself with needles, measure her blood sugar levels and count carbohydrates.
But that's exactly what she and the three other family practice interns at St. Mark's Hospital in Millcreek were asked to do in a class designed by -- believe it or not -- an 18-year-old college freshman who aspires to be a doctor.
The class is intended to teach new doctors how to treat patients with diabetes -- one of the fastest growing health epidemics in the nation -- and understand how intrusive the disease is on their lives. Some diabetics have to take four shots a day, check their blood sugar levels up to eight times a day and carefully plan their diets.
The interns pretend to be insulin-dependent diabetics for three days. The crash course requires them to frequently check their blood, watch their diet and self-administer saline shots.
"If they do this they can gain compassion and empathy for patients," said John Robinson, St. Mark's family medicine residency director. "They don't actually take insulin because that would be dangerous, but they have to follow a rigorous regimen."
Yates, a graduate of Western University College of Osteopathic Medicine, rubbed her upper arm after the first shot.
"That doesn't feel very good," she said. "My arm hurts now."
But Yates, although surprised by the assignment, saw much value in becoming a quasi patient.
"It's great because I had to do diabetes education for a woman at a low-income clinic, and I didn't know much about it," she said. "This is really going to be good for me to see all the details that go into it."
Daniel Robinson came up with the idea for a hands-on diabetes class at age 16. When he was 13, he was tested for diabetes at the behest of his dad, John Robinson, after showing symptoms of Type I diabetes: urinating constantly, craving sugary drinks and foods and feeling drained all the time.
"We were shocked when he was diagnosed," John Robinson said. "He's actually healthier in a lot of ways. He watches what he eats and exercises and started this program."
About 120,000 Utahns have diabetes, the sixth leading cause of death in the state. Diabetes is caused by a deficiency of insulin, the hormone needed to metabolize carbohydrates, and characterized by an excess of sugar in the blood and urine.
Daniel Robinson has Type I diabetes, the more serious form in which the body does not produce insulin. Type I typically is diagnosed in children and young adults.
Type II diabetes is the more common form of the disease. Although a growing number of young people are being diagnosed with it, the disease typically occurs later in life when, for various reasons including diet and weight, the body slows and does not make as much insulin. Type II diabetics often can manage the disease by changing their diet, taking medications and adding daily exercise to their routine. But some need insulin shots.
Speaking with the authority of a professor, Daniel Robinson teaches the interns how to check their blood using a finger prick device, which draws a tiny amount of blood. Most diabetics, he said, alternate fingers because they tend to get sore. He instructs them how to interpret the levels and determine how many units of insulin they need to inject.
Always do this before meals, he tells them.
Next, he gives them tips on the shots. Injecting the shots in the same area can leave scarring, which may turn into a hard lump.
"Alternate areas," he said. "It saves you from going to the doctor and saying, 'What is this lump? Do I have cancer?' "
When it's time for the shots, he advises: "Choose a spot that's not going to make your neighbor blush."
The most common areas doctors recommend patients inject insulin into are the buttocks, arms, abdomen and thighs.
The last part of the class involves learning how to count carbohydrates to regulate sugar levels. Doctors discourage diabetics from indulging in food and beverages high in sugar and starches because it elevates their blood sugar levels, which could lead to a diabetic coma if not handled properly.
Daniel Robinson gives the students a nutrition handbook that displays carbohydrates for easy reference. He also hands out a short book he wrote entitled Through the Eyes of the Patient: A Type I Diabetic Experience.
David Brinton, the chief resident of family practice, took Robinson's class and found it beneficial.
"It was painful initially, but it helped us understand what it is like to be an insulin-dependent diabetic," Brinton said. "Now we know where those patients are coming from."
