Question

1. Explain blood values during her previous hospitilization.

2. Outline characteristics of her new insulin(Lispro, Lantus)

! - TYPE 1 DM CASE: (partially adapted from Medical Nutrition & Disease. A Case-based approach. Ark L, Morrison G. Wiley-Blackwell. 2009) Maria is a 21 year old Hispanic woman with Type 1 for four years. Her Alc is 7.9, Height 5'4", weight 130 lbs. Blood sugar records shows fasting between 80 - 185, with above 150 mg/dl about 50% of the days. She rarely drops below 60 mg/dl. Eyes and kidneys are normal. She complains of fatigue and feeling light-headed in the afternoon, but this is helped by eating her snack. She works long hours and tries to exercise 3 times a week before work, but feels tired. Maria was briefly hospitalized 3 weeks ago when she had URI. At that time she had ketones of 4+ based on urine test, and blood test showed: glucose 720 (normal 70-99), Ale 8.5% (normal 4-6%); Acetone 4+ (normal negative), pH 7.1 (normal 7.35-7.45), BUN 35 (normal 7-18), Na/K 148/5.4 (normal Na:133-143; Normal K 3.5-5.3). She is now discharged and now seen by MD as an outpatient to follow-up.

Answer 1

No 1.

In Maria's previous admission

The blood glucose was 720 mg/dl and her Glycosylated hemoglobin was 8.5%. Which was in very high range shows a lack of insulin in the body.

Urine ketone was 4+. Which shows excessive ketone(Which is an acid) production in the body.

And pH was in the Acidic range I.e 7.1.

These are the features of Diabetic Ketoacidosis.

Diabetic Ketoacidosis is a complication of DM.

The body cells can't able to use glucose as a source of energy in the absence of insulin because insulin acts as a key for glucose for entering into cells. In the absence of glucose, the body uses fat as a source of energy which produces ketone bodies.

No 2.

Insulin Lispro - It is very short-acting insulin, which action starts within 15 minutes of administration. Peak hours is between 1 to 2 hours and actions last for 3 to 4 hours. Which helps to maintain immediate increase of glucose after food.

Lantus - It is a long-acting insulin, which actions start within 4 to 6 hours and it lasts up to 30 hours. which helps to maintain baseline glucose.