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DM- ANSWERS TO CASES 1&2

DM- ANSWERS TO CASES 1&2. ANSWERS. 1. How did the insulin deficiency lead to an increase in plasma glucose & ketone conc.?

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DM- ANSWERS TO CASES 1&2

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  1. DM- ANSWERS TO CASES 1&2

  2. ANSWERS 1. How did the insulin deficiency lead to an increase in plasma glucose & ketone conc.? Insulin is responsible for shifting glucose from blood to inside the cells. It also inhibits glycogenolysis and neoglucogenesis. So insulin deficiency leads to hyperglycemia. Also in the absence of insulin lipolysis is increased leading to production of ketoacids. 2. What are the types of DM ? Type 1 DM Type 2 DM Gestational DM Others like Genetic forms 3. What is DKA(diabetic ketoacidosis)? It is a life threatening complication of DM. In the absence of insulin increased level of fatty acids are delivered where ketogenesis occurs this lowers the pH of blood. Presenting symptoms may include Kussmaul’s breathing, abdominal pain, dehydration, nausea vomiting. Patients may have sweet /fruity odour in their breath. 4. What is the most likely diagnosis of this patient? Type 1 DM 5. Why the renal functions are closely monitored in DM? For early detection and prevention of development of diabetic neohropathy, albuminuria and kidney functions have to be monitored.

  3. ANSWERS 6.What are the major renal complication of Type 1 DM? Diabetic nephropathy, Albuminuria , Renal failure 7. What are the other major complications of type 1 DM? Acute complication like DKA Chronic complications like: Microvascular disease ( Nephropathy, Retinopathy, Neuropathy) Macrovascular disease ( Ischemic heart disease, CVA, Peripheral vascular disease)

  4. ANSWERS 8. What are the differences between Type 1 and Type 2 DM

  5. Discussion answers • What type of Diabetes do you think the patient has ? • Type 2 Diabetes mellitus • What are the indicators that favour your diagnosis of this kind of diabetes ? • Patient’s age, Did not present with ketoacidosis, Father has a history of DM on tablets (Type 2 DM) • What is the value of HbA1c used to diagnose DM ? • HbA1c > 6.5 % is one of the criteria used to diagnose Diabetes mellitus • Discuss the complications of uncontrolled Type 2 DM. • Acute : Hyperosmolar Hyperglycaemic State, Hypoglycaemia • Chronic : Macro and Micro vascular complications • Use your knowledge of the pathophysiology of Type 2 DM , and suggest how to normalize this patient’s elevated blood glucose level ? • Main pathology in early Type 2 DM is Insulin resistance, so to improve insulin resistance, we should encourage weight loss, advise appropriate regular exercise and Diet. A medication like Metformin that reduces hepatic glucose production, increases insulin sensitivity and enhances peripheral glucose uptake, can be started for this patient.

  6. This Foot Condition Is Due To A Combination Of A Macrovascular And A Microvascular Complication Of Type 2 DM. What Macrovascular And Microvascular Complications Of T2DM, would Lead To This Foot Ulcer? Macrovascular: Peripheral vascular disease may causing ischaemia to the foot, especially pressure areas. Microvascular: Neuropathy may be contributing to the worsening of this patient’s foot ulcer

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