I didn’t mean to come across as “insulted” by the idea. As I said, being diabetic, I think about the scenario when I play the game (and unfortunately in real life… lol).
The biggest issue for Type 1 is the insulin issue. Type 1 is caused by an auto immune disease that causes the body to stop creating insulin, which necessitates continual insulin injection or pretty rapid death. Outside of the reality of making insulin perishable and difficult to manufacture, the REAL problem would be replicating the blood sugar level, insulin injection, and nutrition management.
Type 2, in a nutshell, is when the body still produces insulin (mostly ) but uses it with varying degrees of efficiency. Type 2 is degenerative in that the worse it’s controlled, the worse the insulin production can get, and the harder it gets to manage, etc.
As alluded to this COULD be completely mitigated in a sci-fi way by creating some kind of pancreatic CBM. That’d be pretty realistic actually, as that is where the real scientific hope for the disease lies.
This CBM could be used as a catch-all instead of replicating the whole array of real diabetic data factors (rest, exercise, nutrition, exertion and physical stress, emotional stress, medication, shit, everything essentially).
TL:DR - WITH SCI-FI SUGGESTIONS + LASERS
- OVERVIEW:
- The player would need to strive to keep himself at “Normal” hunger.
- The CBM existence constantly supplies insulin, effectively keeping the player alive, but moderately (and significantly) accelerating hunger to simulate the challenge of balancing one’s blood sugars. Accelerated hunger does two things. Increasing the rate of “Hungry” and transitions to “Really Hungry” and worse, it mimics general blood sugar management. Second, it mitigates, while highlighting, the more dangerous effects of long-term “Fullness” (high blood sugars).
- To add to the challenge, the CBM itself should be viewed as a drastic measure when (a)ctivated. Outside of supplying the “magic” constant stream of insulin, it could provide emergency assistance managing Hunger or Fullness, but at great physical toll.
- LOW BLOOD SUGARS
- Hunger’s negative effects would have to mimic the current Thirst mechanics, and be pretty significant. Hunger effects would be cumulative and increase rapidly on duration. By the time one is teetering between Hungry and Very Hungry, I imagine the stat effects being similar to the common cold, and thirst and tiredness being greater than the common cold. By the time one is Very Hungry or lower, the character would essentially be near-immobile, and left untreated would slip into a diabetic coma, and have a high chance of death. Essentially, reaching Famished would result in player death.
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HIGH BLOOD SUGARS
Having high blood sugar AKA being Full, is ultimately the most nefarious part of the disease. The nuances of dealing with this would be, from a perspective of realism, the most interesting, subtle and difficult to simulate.
Somehow this accumulation would/could permanently lower Strength (body breaking down), lower Perception (diabetic blindness is common), lower Intelligence (complications to the body leading to less clear thinking, more stress, etc), make the body more prone to other sicknesses, recover the hidden health meter more slowly, etc. Not sure if it’s possible, but the degeneration could lead to permanently acquiring other traits, High Thirst, Frail (or whatever), etc.
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MANAGEMENT
- (A)ctivating the CBM would place the character, almost immediately, at Normal hunger, but immediately make the character at “Dehydrated”, and at least “Dead Tired” if not “Exhausted”.
- Additional, non-CBM diabetic resources could be in game. Insulin, sugar pills, emergency glucose, etc could be “gentler” versions of the CBM’s emergency activation. Some kind of, scarce, Type 2 pill could exist that slows the hunger progression to near normal levels…
- Diabetic traits would have to include Slow Healer, and I’m sure there are others that would be applicable. Ironically, High Thirst in itself would not be appropriate, especially if the hunger system was utilized. High Thirst is a symptom of high or low sugar levels, not a standalone trait.
- Typical food consumption as it stands should mimic management adequately. More complex nutrition systems would help, etc but are not super necessary.
- Exercise and exertion would be hugely important. Not sure how they work now, but the goal would be to have exercise type activities helpful in lowering oneself from “Full” without the CBM, while also adding to the challenge of eating enough to not get too Hungry.
TL:DR Part 2
Sorry for the long post, as I said I have thought about this quite a bit as it pertains to game play and real life disaster situations (hurricane preparedness etc). There’s a lot to it. Didn’t want to outright discourage the idea, as I feel understanding how this particular disease works is also very fundamental to understanding how VERY sophisticated hunger, nutrition and exertion management should exist as mechanics in general.
The question is, how realistic are these mechanics to implement, and ULTIMATELY would they even be fun to deal with? This isn’t Sim Diabetes, it’s a zombie apocalypse roguelike. 
