Case Study num22

please answer 1-5

Diabetes Mellitus

Diabetes mellitus is a common chronic disease, and every healthprofessional will need to understand how it works and identifycommon emergency situations related to it. But an equally importantpart of the health professional's role is patient education andexplaining what happens in the disease process. After they go home,diabetes patients will have to manage this complex disease everyday.

You are working in the free clinic when Father X comes in. Youknow him well; he is a type 2 diabetic who keeps his sugar undercontrol with diet and exercise but is often in the clinic withhomeless patients from the shelter he runs in the Episcopalianchurch down the block.  

1. Insulin and glucagon release from the pancreas is avital part of the negative feedback loop that regulates bloodglucose levels. Write out this feedback loop and predict howinsulin levels will respond to blood glucose. When will insulinlevels be highest during the day? When will they be thelowest?

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On this visit, Father X has brought in a thin man in histwenties named Joe. Joe appears confused and lethargic. He isbreathing heavily and has a strong fruity odor. Father X tells youhe is concerned about Joe because last night Joe was up everyhalf-hour or so to use the bathroom and get water. Father X knowsthese are signs of diabetes, so he wants to get Joe checked out. Healso tells you that Joe has not been drinking; they have abreathalyzer at the shelter, and Joe tested clean when he checkedin the night before.

Joe's blood pressure is a little low at 95/60 mm Hg and hisheart rate is a little high at 96 bpm. When you take his pulse, younotice that his skin is dry and “tents” up when pinched--a sign ofdehydration. His respirations are more rapid than normal, 25breaths/min., and heavy. His blood glucose is elevated at 320mg/dL. His urine also contains glucose, and has a lower pH thannormal. When you take his history he tells you that type 1 diabetesruns in his family.  

2. Normally, urine does not contain glucose. When bloodglucose levels are elevated, however, some of the glucose is lostin the urine. Apply the principle of osmosis to explain why Joe wasgetting up all night to use the bathroom, and why he has low bloodpressure and signs of dehydration.

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3. In type 1 diabetes, the cells in the pancreas whichproduce insulin are destroyed. Which cells are these? The cellswhich produce glucagon, however, are not affected. Which cells arethese? What will glucagon cause Joe's cells to do?

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4. People with type 1 diabetes commonly have high bloodsugar levels but lose weight. Based on the effects insulin andglucagon have on cells, explain this. What compounds do you expectthe cells to release into Joe's blood?

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5. The odor on Joe’s breath is from ketones. Why would aman with type 1 diabetes develop high blood ketonelevels?

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