Question

1.How does a patient with diabetes mellitus have hyperglycemia?

2. samples of urine could be an indication of diabetes insipidus with no ketones in urine how can i indicate diabetes insipidus?

3.How would hyperglycemial lead to hyponatremia? my answer: Hyperglycemia causes osmotic shifts of water in your cells from intracellular to extra cellular space diluting causing hyponatremia.

Answer 1

Ans 1) Diabetes mellitus - A group of diseases that affect our body blood glucose utilization and result hight blood glucose level.

Blood glucose and Insulin -

- Blood glucose mainly control by insulin

Insulin is a anabolic hormone made by pancreas. There are specialised areas within the pancreas called islets of Langerhans. The islets of Langerhans are made up of different type of cells that make hormones, the commonest ones are the beta cells, which produce insulin.

The main actions that insulin has to allow glucose to enter cells to be used as energy and to maintain the amount of glucose found in the bloodstream within normal levels. The release of insulin is regulated in healthy people in order to balance food intake and the metabolic needs of the body. This is a complex process and other hormones found in the gut and pancreas also contribute to this blood glucose regulation. When we eat food, glucose is absorbed from our gut into the bloodstream, raising blood glucose levels. This rise in blood glucose causes insulin to be released from the pancreas so glucose can move inside the cells and be used. glucose moves inside the cells, the amount of glucose in the bloodstream returns to normal and insulin release slows down. Proteins in food and other hormones produced by the gut in response to food also stimulate insulin release.

ACTIONS OF INSULIN

- Stimulation of the activity of glycolytic enzymes

-Reduces the activity of the enzymes of gluconeogenesis

- Increased synthesis of glycogen

- Increased uptake of of glucose by resting skeletal muscles

- Reduction of blood glucose level

- Reduction of lipolysis and stimulation of lipid synthesis

There are 2 type of Diabetes where blood glucose tend to high because of insulin deficiency and resistance of insulin receptors

Type 1 DM -

Another name Insulin Dependent diabetes mellitus or Juvenile onset DM.

- Average onset is in childhood or early adulthood

Pathology - Due to pancreatic islet destruction predominantly by an autoimmune process.

- Cell mediated response Type 1 diabetes is caused by a T cell mediated autoimmune destruction of the pancreatic beta cells.

Low insulin results Hight Blood glucose or Hyperglycemia.

Type 2 DM -  

Another name Non insulin dependent DM.

-Most common type Comprises 90 to 95% of DM cases

Most of type 2 DM patients are overweight and most are diagnosed as adults (after 40 years of age)

Pathophysiologic defect in type 2 DM -

- Insulin secretary defect of the beta cells

- Increased production of glucose by the liver

- Peripheral resistance to insulin especially in muscle cells

- Obesity contributes greatly to insulin resistance

-Insulin resistance generally decreases with weight loss

So ultimately in Type 2 DM also Blood glucose level high (Hyperglycemia) because of Insulin function ultered.

Ans 2) in the given question

in Diabetes insipidus diagnosis by urine analysis specialiy by low urine osmolarity (50 - 200 mOsm/kg of water)

Diabetes insipidus -

Diabetes insipidus is a disorder of the posterior lobe of pituitary gland characterized by a deficiency of antidiuretic hormone (ADH) or vasopressin. Great thirst (polydipsia) and large volumes of dilute urine characterize the disorder.

Type of DI

A) Central DI

- Loss of vasopressin-producing cells,

- Causing deficiency in antidiuretic hormone (ADH) synthesis or release

- Deficiency in ADH, resulting in an inability to conserve water leading to extreme polyuria and polydipsia

B) B) Nephrogenic DI

- Depression of aldosterone release or inability of the nephrons to respond to ADH

- causing extreme polyuria and polydipsia

Diagnosis of DI

-High serum osmolality usually above 300 mosm/kg of water

-Low urine osmolarity usually 50 to 200 mOsm/kg of water

-low urine-specific gravity of less than 1.005

- Increased creatinine and blood urea nitrogen (BUN) levels resulting from dehydration

- Positive response to water deprivation test Urine output decreases and specific gravity increases

Treatment - Replacement vasopressin therapy with intranasal or IV DDAVP (desmopressin acetate)

-Correction of dehydration and electrolyte imbalances