Question

Please help me with these questions about diabetes!

The provider suspects that the patient has developed type 2 diabetes (DM) and orders the laboratory studies shown below. Laboratory Test Results Fasting glucose Hemoglobin A1c 184 mg/dl 8.8% 256 mg/dl +'glucose, ketones Total cholesterol Urinalysis (UA) 1. Explain each of the patient's laboratory values and how these add to the diagnosis of type 2 diabetes. 2. Explain 3 methods used to diagnose diabetes. 3. Describe the functions of insulin. 4. Describe the major pathophysiologic difference between type 1 and type 2 diabetes.

Answer 1

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Q.1. Following are the clinical findings for type 2 Diabetes

Hypoglycemia may occur suddenly in a patient considered hyperglycemic because their blood glucose levels may fall rapidly to 120 mg/dL or even less.

Serum glucose: Increased 200–1000 mg/dL or more.

Glycosylated hemoglobin (HbA_1C): Evaluates glucose control during past 8–12 wk with the previous 2 wk most heavily weighted. Useful in differentiating inadequate control versus incident-related DKA (e.g., current upper respiratory infection [URI]). A result greater than 8% represents an average blood glucose of 200 mg/dL and signals a need for changes in treatment.

Urine: Positive for glucose and ketones; specific gravity and osmolality may be elevated.  

Q.2. 3 methods to diagnose Diabetes

• Polyuria – the need to frequently urinate, particularly at night.
• Polydipsia – increased thirst & need for fluids.
• Polyphagia – an increased appetite.

Q.3. Functions of insulin

THE ROLE OF INSULIN IN THE BODY

Insulin is a hormone which plays a number of roles in the body’s metabolism.

Insulin regulates how the body uses and stores glucose and fat. Many of the body’s cells rely on insulin to take glucose from the blood for energy.

INSULIN AND BLOOD GLUCOSE LEVELS

Insulin helps control blood glucose levels by signaling the liver and muscle and fat cells to take in glucose from the blood. Insulin therefore helps cells to take in glucose to be used for energy.

If the body has sufficient energy, insulin signals the liver to take up glucose and store it as glycogen.

The liver can store up to around 5% of its mass as glycogen.

Some cells in the body can take glucose from the blood without insulin, but most cells do require insulin to be present.

Q.4. Difference between tpe 1&2 Diabetes

Type 1 diabetes

Type 1 diabetes can occur at any age, but is most commonly diagnosed from infancy to the late 30s. With this type of diabetes, a person’s pancreas produces no insulin. It occurs when the body’s own defence system (the immune system) attacks and destroys the insulin-producing cells in the pancreas. The only treatment for type 1 diabetes is insulin, which is usually injected or infused via a pump.

Type 2 diabetes

People with type 2 diabetes either don’t make enough insulin or don’t make insulin that the body can use properly. The cells in the body become resistant to insulin, making a greater amount of insulin necessary to keep blood glucose levels within a normal range. Eventually, the pancreas can wear out from producing extra insulin, and it may start making less and less.

Type 2 can usually be managed through diet, exercise, and self-monitoring blood glucose, at least in the first few years following diagnosis. However, type 2 diabetes is a progressive condition, and most people will need to take tablets and/or inject insulin after living with it for five to 10 years.