Question

CASE STUDY A Diabetes Mellitus Type 1 Mr. M. has had type 1 diabetes for 15 years. He has just been admitted to the hospital with severe pyelonephritis, a kidney infection. 1. Describe the pathophysiology of type 1 diabetes. 2. Explain why urinary tract infections are common in people with diabetes. Explain how acute renal failure could develop Mr. M. has had the infection for a week and has developed mild ketoacidosis because of the infection. Analysis of arterial blood gases indicates that his serum bicarbonate level is low and his serum pH is just below normal range. 3. Explain why infection may lead to ketoacidosis. 4. Describe the characteristics of Mr. M.'s respirations that you would expect to observe while ketoacidosis is present. 5. If Mr. M.'s serum pH continues to decrease below normal, 6. Mr. M. is voiding large volumes of urine (polyuria). Explain 7. Describe three signs of excessive fluid loss. Include the rationale for your answer. how would that pH affect cell and organ function? the reason for this reaction. 8. Mr. M.'s vision has deteriorated in the past 3 years because of retinopathy. Explain how retinopathy impairs vision. 9. Describe two problems related to diabetes that Mr. M. might encounter because of his reduced vision.

Answer 1

1. Pathophysiology of type 1 diabetic melitus

                * Due to genetic,environmental and immunological factors destruction of beta cells

                   of pancreas occur.

                * This type of destruction result in increased level of glucose in the blood leads to

                   type 1 diabetic melitus.

2. UTI common in patient with diabetic melitus

                   * Diabetic patient have lack of control over blood glucose level and increased amount

                     of glucose present in the urine.this urine stays in the bladder for a long time act as a

                     medium for growth of bacteria and cause urinary tract infection.

     Development of acute renal failure

   * Diabetic melitus result in high blood glucose level in the blood which damage filtering

   units (nephrons) of the kidney and along with urinary tract infections lead to acute

   renal failure or acute kidney injury.

3. Infection lead to ketoacidosis          

                    * Infections in the body result in production of higher level of hormones like cortisol,

                    adrenaline etc.

* This hormones make a counter effect to the action of insulin.

* Opposite action of that type of hormones result in less insulin action and ketoacidosis.

4. MR.M.s will show Kussmauls respiration because this type of respiration occurs in patient

with severe metabolic acidosis which develop as a result of diabetic ketoacidosis.

5. Result of low pH in cells and organs of the body.

                * Low pH result in decreasing normal activity of cells and inhibition of entry of calcium

                   into the cells.

                * Low pH result in blood become acidic and oxygen level of body decrease in respiratory

                   acidosis.

                * It lead to impairment in lungs,kidney and heart function leads to multiple organ failure

                   or shock.

6. Reason for polyuria of Mr. Ms.

                  * In diabetic melitus glucose concentration in the blood increases and it result in

                    elimination of excess amount of glucose through urine which leads to osmotic

                    diuresis ( Increased rate of urination caused by presence of sunstances in the

                    tubules of kidney. eg : glucose.).

7. Three signs of excessive fluid loss

                 * Excessive thirst.

                 * Fatigue.

                 * Dizziness.

8. Reason for impair vision in retinopathy

               * In retinopathy damages occur in the blood vessels of retina.

               * Damages of blood vessels result in leakage of blood from vessels and formation

                 of new vessels.

               * This type of leakage result in presence of blood in the center of eye and progressive

                  nerve damage occur all of this leads to impairment in vision.

9. Two problems related to diabetes related reduced vision.

                 * Cataract.(Increased opacity of lens of eye).

                 * Glucoma (Increased intraoccular pressure of the eye).