Question

CASE STUDY #1

Review the case below and answer the following questions.

This should be original work, no references or information from online. Please be detailed.

38-year-old female with excessive thirst, frequent urination, and weight loss.

History: Cindy Mallon, an 38 year old Caucasian female in previously good health, she has noticed that in the past month, she is increasingly thirsty. She gets up several times a night to urinate, and finds herself gulping down glassfuls of water. At the dinner table, she seems unusually hungry, yet she has lost 5 pounds in the past month. In the past three days, she has felt lethargic and had noted some visual changes where her vision is blurry.

QUESTIONS:

At the doctor's office, blood and urine samples are taken. The following lab results are noted:

blood glucose level = 445 mg/dl (normal = 50 - 170 mg/dl)

blood pH level = 7.40 (normal = 7.35 -7.45)

urine = tested positive for glucose and negative for acetone / acetoacetate (i.e. ketone bodies)

Answer the following questions, be sure to use proper terminology and detail your answers considering your review of your chapter via textbook, notes and video screen cast of module components:

1. What would be some endocrinological reasons for her blood-glucose levels to be elevated?

2. At the office, you examine her and notice that she has a dark pigmented ring around her neck and is considered to be morbidly obese. The pigmentation is called acanthosis nigricans and is sometimes noted with metabolic disorders. Do those signs have to do with her current condition?

3. Explain why Cindy is urinating so frequently in detail and physiologically how and why it occurs.

4. Explain her constant thirst in detail including what causes it.

5. What are the possible long-term complications of her disease?

Answer 1

1. Cindy is suffering from diabetes mellitus, wherein the amount of insulin hormones secreted in the body declines. There are two types of diabetes; type I, which is genetic caused by loss of insulin producing cells, and type II wherein the body becomes insensitive to insulin. Insulin is secreted by the beta cells of islet of Langerhans of pancreas when food enters the blood. Insulin is required for uptake of glucose by fat cells, liver, and muscles. As a result, the amount of glucose in blood declines. Decrease in glucose stimulates glucagon release by alpha cells of islets of Langerhans in the pancreas. Glucagon stimulates the liver to breakdown glycogen to release glucose. In diabetes, since the insulin production is low or there is no response by body to glucose, glucose levels remain high in blood. This causes excessive weight loss and weakness due to defective glycol sis. Excess sugar is removed by the kidneys. Hence, the burden on kidneys increases and more urine is released to remove excess glucose.

2. Acanthosis nigricans is the formation of dark pigmentation in skin in areas such as neck and armpits. It occurs due to abnormal growth of epidermal cells in skin. In type II diabetes, there is insulin insensitivity. This causes an insulin overload in the body. Excess insulin will cause skin epidermal cells to divide abnormally and form acanthosis nigricans.

3. Excessive glucose is built up in diabetes patients. Glucose is removed from the body by the glomerulus of kidneys. Glucose is absorbed in proximal convoluted tubules. Excessive glucose will damage the glomeruli resulting in less absorption of glucose. Glucose is excreted by the kidneys as urine. As there is high glucose levels, there is an increase in glucose excreted. Hence, Cindy will show increased urination.

4. Glucose is excreted in the urine by kidneys in diabetes mellitus as kidneys cannot function properly. Along with glucose, water is also excreted. This reduces the water content in body fluids. As a result, the thirst center is activated. Thus Cindy will feel excessive thirst.

5. Excessive glucose will damage the kidneys causing nephropathy. Diabetes induce nerve damage, heart disease, amputation and vision problem. Excess sugar buildup causes the blood vessels to bleed and leak causing diabetes retinopathy, diabetic macular edema (DME), cataract, and glaucoma. Due to damage to blood vessels of heart, it will cause heart disease. Tissues do not heal properly when there is excess sugar. Due to defective wound healing, there is a chance of developing wound infection that can cause gangrene. In such cases, amputation is carried out.