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Problem-Based Learning (PBL): Diabetes Medical Challenge

Problem Based Learning

Problem based learning (PBL) is a popular method of learning, currently used by most health professional courses in the UK.

The aim of PBL is for you to read through a complex and broad series of information, to identify areas of interest and areas you would like to explore further, in order to further your knowledge of specific topics, through self-directed learning. 

If you have a passion for Problem-Based Learning (PBL) and are intrigued by witnessing how doctors navigate critical decision-making moments, we invite you to enrol in our Free Virtual Work Experience programme!

Diabetes

John is a 60-year-old man who is living at home with his family on Christmas Eve. He is a type 2 diabetic and manages this with gliclazide. During the festivities, his family starts drinking a couple of bottles of wine together, and John joins in, although he knows that he is not supposed to mix alcohol with his diabetic medication. He hasn’t eaten much recently, as he is leaving room for his Christmas meal tomorrow. 

Two hours later, John starts to feel lightheaded and drowsy, and he goes to the kitchen for a glass of water. His family hear a loud crash, and they hurry in to find John unconscious on the hard kitchen floor. They call an ambulance, and John is admitted to hospital. 

The doctors there working over Christmas do an ABCDE assessment and some blood tests. After taking a collateral history from his wife, who came with him, they also test for insulin. This is found to be raised in his blood, and his glucose levels are very low. They also note that his left leg is shortened and externally rotated. John is treated with an IV infusion of glucose, is given an x-ray and rushed straight to theatre with the orthopaedic surgeons. They end up replacing his left hip. 

Thankfully, John makes a full recovery from the operation, but he unfortunately has to stay in hospital over Christmas. 

Problem Based Learning Challenge Questions:

  1. How does the body regulate blood sugar?

  2. What is the cause and progression of type 2 diabetes?

  3. How is this different to type 1 diabetes?

  4. What is the problem with having too much glucose in the blood for a long period of time?

  5. What are the effects of alcohol on the body? 

  6. How does gliclazide work? 

  7. Why do you think John has collapsed?

  8. What do you think the x-ray showed?

  9. Challenge: Consider the blood supply to the femur. Why is the type of fracture that John likely sustained much more dangerous than a fracture lower down the bone? 

  10. Challenge: Is there anything else you would investigate for John in hospital after he has come in for a collapse and why? 

For aspiring medical students just starting to delve into Problem-Based Learning scenarios, here are some guidance hints to help give you a starting point of where to research:

1. How does the body regulate blood sugar?

– Explore the role of insulin and glucagon.
– Investigate the feedback mechanisms that control blood sugar homeostasis.

2. What is the cause and progression of type 2 diabetes?

– Examine factors like insulin resistance and beta-cell dysfunction.
– Explore lifestyle and genetic factors contributing to the development of type 2 diabetes.

3. How is this different from type 1 diabetes?

– Compare the autoimmune nature of type 1 diabetes with the insulin resistance seen in type 2.
– Investigate the age of onset, genetic predispositions, and treatment approaches for each type.

4. What is the problem with having too much glucose in the blood for a long period of time?

– Look into the complications of uncontrolled hyperglycemia, such as damage to blood vessels, nerves, and organs.
– Examine the long-term impact on the cardiovascular, renal, and nervous systems.

5. What are the effects of alcohol on the body?

– Investigate the interaction between alcohol and medications, especially in diabetic patients.
– Explore the impact of alcohol on blood sugar levels and the potential for hypoglycemia.

6. How does gliclazide work?

– Examine the mechanism of action of gliclazide in managing diabetes.
– Investigate how it promotes insulin release and lowers blood sugar levels.

7. Why do you think John has collapsed?

– Consider the effects of alcohol on blood sugar levels, especially in combination with diabetic medication.
– Explore the symptoms and complications of hypoglycemia.

8. What do you think the x-ray showed?

– Investigate common hip fractures and their presentations on X-rays.
– Explore how trauma and fractures may be related to John’s collapse.

9. Challenge: Consider the blood supply to the femur. Why is the type of fracture that John likely sustained much more dangerous than a fracture lower down the bone?

– Explore the vascular anatomy of the femur and the potential complications associated with hip fractures.
– Investigate the risk of avascular necrosis and delayed healing in proximal femoral fractures.

10. Challenge: Is there anything else you would investigate for John in hospital after he has come in for a collapse and why?

– Consider additional diagnostic tests or screenings based on John’s medical history and symptoms.
– Explore the importance of a comprehensive patient assessment in identifying underlying health issues.

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