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Diabetes - Case Study Example

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It is possible that enteroviruses may have a triggering role while there are microorganisms that might hold protection against those triggers. The etiology of type 1 diabetes has been identified to be associated with at least ten different genes. Carel (2010) states that “the known functions of these genes indicate the primary etiological pathways of this disease including HLA class H and I molecules binding to preproinsulin peptides and T-cell receptors, T- and B-cell activation, innate pathogen-viral responses, chemokine and cytokine signaling and T-regulatory and antigen presenting cell functions” (p. 218). 2. Assess the patient’s physical examination. What is consistent with diabetic ketoacidosis (DKA) and give the physiological rational for all that you identify? The case study states that his symptoms were ‘fatigue, nausea, vomiting, and intense thirst. The ER physician noticed that his breath smelt of acetone’. Only about 30% of the population can smell the scent of acetone in a patient in DKA, so the patient was lucky on this count. The signs of fatigue, nausea, vomiting and intense thirst are only the beginning of the diagnosis, but the scent of acetone leads the diagnosis in that direction. His dryness and the noticeable irritability can also be signs of DKA. The difficulty that he is having breathing coupled with the existence of a fever for the last two weeks also suggest that he has dropped into a state of DKA. Although he has a history of taking care of himself nutritionally, he has lost weight (15.4 lbs) which also suggests that he is in DKA. 3. Examine the biochemical indices of the patient and list which are consistent with DKA and discuss why. In the incidence of DKA, certain biochemical measures will be shifted, primarily as a counterbalance to regulation of insulin through hormone shifts. Examples of these shifts can be seen in epinephrine, growth hormone, the plasma levels of glucagon and increases in cortisol. The changes in these chemicals are usually due to an insufficiency of insulin. The result is hyperglycemia which occurs as the production of ketone production increases. Glucose is decreased in being drawn into the tissues and gloconeogenesis and glycogenolysis are increased. Lipolysis is triggered due to the counter-regulatory hormones which are caused by the increased ketogenesis. As a result, low pH and low bicarbonate is the result of being consumed through the resulting buffering of the keto acids. Respiratory distress is caused by metabolic acidosis (Joshi & Mishra, 2009). Potassium and chloride will be in short supply during DKA, which is being shown in the patient. Phosphorus is increased, which is not normal for DKA. Mental status is known to change when osmolality is over 340 and the patient is dangerously close to that level when he is admitted, with CO2 levels being low which is due to the breathing difficulties. Glucose is well over normal, indicating that insulin is not enough. BUN, which stands for blood urea nitrogen is the result of protein breaking down. It is clear that after being in the hospital and under care it has dropped from 29 to 21. Begbi, Barber, Reddy, and Simpson (2010) discuss the correlation of HbA1c which correlates to high glucose and this is represented in the patient. Good measures of HbA1c are below 7%, but the patient’ ...Show more
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Summary

Running Head: QUESTIONS Questions for 1 Questions for Diabetes type 1 Name Date Questions for Diabetes type 1 1. Discuss the latest information in detail regarding the etiology and genetics of type 1 diabetes. Diabetes is an autoimmune disorder which requires insulin and is complicated by numerous other issues…
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