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. 8. Mr. M.'s vision has deteriorated in the last 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 type1 diabetes: In short the exact cause of type 1 diabetes is unknown.

• we all have our own immune system in the body to fight against any infection or disease
• but sometimes this system unknowingly destroy the islets of Langerhans in the pancreas ( that produce insulin)
• resulting in no secretion of insulin, hence leading to type 1 diabetes
• Thus it is an autoimmune disease.

2) it is true that urinary tract infection is common in diabetic patients because of 2 main reasons:

• the bladder is not fully emptied even though the person has to empty it
• presence of sugar in the urine which helps the bacteria to grow rapidly.

There is a chance to develop kidney failure

• when the blood sugar level is high, it distroy the tiny filtering unit of both the kidney.
• which eventually lead to kidney failure. in short this may take years to happen.

3) An infection can lead to ketoacidosis:

• during the time of infection, our body will increase the production of adrenaline and cortisol
• these hormones counter the effect of insulin.
• thus leading to ketoacidosis.

4) the respiration that occurs due to ketoacidosis is labored breathing or Kussmaul breathing since the patient is diabetic ( is a stage of metabolic acidosis ) when the acidosis increases the patient may have deep and labored breathing.

5) when ph level in lower, it affects the cells:

• it alters the acid-base buffer system.
• it also changes the structure and chemical reaction of cellular molecules.

when the ph level is lower, it affects the organs:

• when ph level is less your body will be acidic.
• thus leading to excess acid accumulation in the body.

6) Polyuria is common in a diabetic patient because:

• normally the kidney absorbs the sugar and passes it to the bloodstream.
• but in a diabetic patient, due to excess sugar in the blood,
• the kidney cannot reabsorb it to the bloodstreams, thus this excreted into the urine along with fluid from the tissue and water resulting in urination.

7) Three signs of excessive fluid loss

• sunken eyes
• dry skin
• dehydration
• lack of sweating.

8) Retinopathy

• occurs due to the blockage of blood vessels that lines the back of the eye ( retina)
• leading to cloudy or blurred vision.
• where the retina is known as the light-sensitive tissue.

9) Mr.M need to encounter the problem such as glaucoma, cataract, and blindness in severe stage.

• sometimes he can also develop diabetic macular edema which occurs due to the swelling in the retina.