Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes and the most common cause of hospitalization and death in diabetic children. Given the complexity of DKA—from recognizing signs of hyperglycemia to managing insulin administration and fluid replacement—it is imperative that every nursing student understands how to manage it. Simulation-based education allows students to improve their clinical reasoning and decision-making through experience in a safe, controlled environment.

Here are five DKA nursing simulations that educators can use to prepare students for real-life endocrine emergencies. These strategies are designed to enhance clinical skills, teamwork, and confidence when treating patients with DKA.

1. Low-Fidelity Task Trainers

Low-fidelity simulations use basic task trainers to focus on skill acquisition. Although these simulations don't mimic full patient scenarios, they are crucial for teaching the foundational nursing techniques required to care for DKA patients.

For example, task trainers can help students practice insulin administration, including drawing up and administering rapid-acting insulin and using insulin pens. Other DKA-related skills that can be practiced on a task trainer include initiating IV fluid therapy and checking blood glucose levels. These simulations give students hands-on experience in performing the procedural aspects of DKA management that are often time-sensitive in real settings.

2. Standardized Patients

Standardized patients (SPs)—trained actors who portray patients—offer an interactive, realistic way to learn about the early symptoms of DKA. In these scenarios, SPs can present with symptoms like fatigue, excessive thirst, fruity breath, or confusion. Nursing students must then interview, assess, and identify signs and symptoms that correspond with DKA.

This type of simulation builds communication skills, empathy, and real-time critical thinking. It’s especially effective for exploring the psychosocial aspects of diabetes education. For example, students can practice explaining complex concepts like blood glucose monitoring, insulin titration, and the risks of skipping doses. They can also learn how to answer patient questions and how to assess patient learning through the teach-back method.

3. High-Fidelity Manikins

High-fidelity manikins are computerized patient simulators that can display physiological responses such as altered breathing patterns, heart rate changes, or drops in blood pressure. These simulations are ideal for demonstrating full-blown endocrine emergencies, where students must recognize and respond quickly to a patient’s deteriorating condition.

A high-fidelity DKA simulation might begin with a type 1 diabetic presenting with confusion, tachycardia, and dehydration. As the scenario progresses, students can analyze lab values (e.g. blood glucose > 300 mg/dL, low bicarbonate, high anion gap), initiate IV fluids, administer insulin, and monitor potassium levels.

High-fidelity simulations offer a comprehensive, hands-on opportunity to link pathophysiology with appropriate nursing interventions.

4. Immersive Virtual Reality (VR)

Immersive virtual reality simulation transforms nursing education by bridging the gap between theory and clinical practice. With a VR headset, learners enter a 360-degree virtual care environment where they can assess patients, prioritize interventions, collaborate with virtual colleagues, and build critical clinical judgment skills—safely and repeatedly.

These lifelike simulations are ideal for preparing nursing students to respond to complex, high-stakes conditions like diabetic ketoacidosis. In UbiSim’s DKA scenario, for example, learners care for a pediatric patient experiencing DKA symptoms. They must assess the situation, initiate evidence-based interventions like fluid resuscitation and insulin therapy, and deliver age-appropriate patient education.

UbiSim’s VR platform is designed by nurses for nurses. It empowers learners to gain confidence and competence through immersive, hands-on practice, so they’re ready to deliver real-world care from day one. 

5. Unfolding Case Studies

Unfolding case studies are dynamic simulations presented in segments over time, mimicking the real evolution of a patient’s condition. They are powerful tools for teaching DKA pathophysiology and progressive nursing interventions.

For example, a case study might start with a patient calling a clinic about feeling “off” and progress to an ER visit for severe hyperglycemia. With each phase, new data is presented—vital signs, lab results, and patient behaviors—challenging students to reevaluate and update their care plan.

Unfolding case studies also work well in classroom or online discussions, allowing students to reflect on clinical judgment, collaborate in groups, and analyze outcomes.

Final Thoughts

DKA is one of the most critical endocrine emergencies that nursing students must be prepared to face. Integrating a variety of DKA nursing simulations into your curriculum—from low-fidelity task trainers to high-tech virtual reality—ensures students develop the critical thinking skills needed to respond effectively to endocrine emergencies.

Whether you're teaching the nuances of hyperglycemia response, insulin administration, or the complexities of diabetes education, simulations bridge the gap between theory and practice. These five types of simulation-based education can equip future nurses to make life-saving decisions with confidence and competence.