Question

Jane, a 48 year old woman with no history of health complications had recently noticed that her show and glove sizes had increased and that her rings no longer fit her fingers. As much as she wanted to attribute this to her recent weight gain her lower jaw was protruding and she noticed that her facial features were getting abnormally coarse. To make matters worse she was urinating much more frequently and feeling thirsty. An initial blood test revealed that her blood glucose level was above normal but that her insulin blood level was within normal range.

A) Given the information, explain the reason for elevated glucose levels and polyuria despite normal insulin levels.

B) How ware Jane's recent physical changes connected to her elevated glucose levels? Provide the underlying mechanism.

Answer 1

A) This is due to a condition called Insulin resistance

Insulin: Is a hormone produced by the beta cells of Islets of langerhans in Pancreas, which helps to control the glucose level in the body. It helps in the absorption of glucose from food and promote their storage as glycogen in the liver, adipose and muscle cells.

Insulin resistance

It is a condition in which glucose storage sites like liver, adipose tissue and mucsle cells shows decreased response to insulin. Body cells derive energy for their activity through breakdown of glucose by the process called cellular respiration. As a result of insulin resistance The target organs will be incapable of absorbing glucose for metabolisam leading to the elevated level of glucose in the blood and pancreas produce more and more insulin to over come this situvation. This also causes the reduced uptake and storgage of lipid and incresed breakdown of the stored triglycerides. Intially the glucose level may stay normal owing to the increased production of insulin however it will gradually increase leading to a condition called Prediabetis and latter to Type II Diabetes.

Predisposing factor

• Age : above 40 years
• Obesity
• Life style changes
• Lack of exercise
• Stress
• Heridity

Signs and Symptoms

• Overweight
• Polyuria : Frequent urination
• Increased appetite and thurst
• Fatigue
• Elevated blood pressure

Polyuria: It is also called frequent urination is a usual symptom during insulin resistance and diabetis. During the process of urine formation kidneys filter the blood forming glomerular filtrate. From this filtrate Gulcose, water and other essential molecules are reabsorbed back making the filtrate more and more concentrated before leaving the tubules of the kidney. During insulin resistance enormous amount of glucose will be present in the blood and body tries to eliminate the unwanted glucose molecule through urine and also elevated level of glucose molecule also makes it impossible for the kidney to reabrsorb them. As a result excess amount of water will be used to eliminate the glucose molecule and it also prevents the concentration of urine. Hence patients exhibit frequent urination or polyuria. This can eventually leads to kidney damage.

B) Obesity is connected to insulin resistance. Obesity is a condition caused due to storage of excessive amount of fat in the adipose tissue, It can lead to many unhealthy conditions. The adipose tissue causes increased release of proinflamatory cytokines and free fatty acids in the circulating blood, these inturn attack the the target cells like liver, muscle, skeletal cells and reduce their insulin response and contributing to elevated glucose level in blood. Inadequate glucose in the target cells increases the craving for food making the person more obese. Excessive stress and deprived sleep can also increase the hunger leading to obesity. Obesity can also lead to microbial inbalance within the body causing increased energy harvest leading to insulin resistance.