CASE STUDY A Diabetes Mellitus Type 1 Mr. M. has had Type 1 diabetes for 15 year

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.

Explanation / Answer

1. PATHOPHYSIOLOGY OF TYPE 1 DIABETES MEELITUS :

Due to etiological factors such as autoimmune mechanism and genetic there is a severe deficiency or absence of insulin secretion due to destruction of beta - islet cells of the pancreas. There is evidence of an autoimmune mechanism involving autoantibodies that destroy the beta cells. Dectruction of beta cells hampers the production of insulin which thereby leads to increase in the sugar level in blood.

2. WHY UTI IS COMMON IN DIABETES MELLITUS :

Diabetes mellitus is a metabolic disorder which and usually occurs when there is deficiency or absence or insulin, It also weakens the body immune system which makes the diabetic patient prone to infection, however in diabetes mellitus the patients are unable to empty their bladder which leads to storage of urine in the bladder for longer period which causes infection in the urinary tract.

HOW ACUTE RENAL FAILURE COULD DEVELOP:

In diabetes mellitus the blood sugar levels are usually high which damages the arteries and other blood vessels, once the arteries and the blood vessels are damaged the kidneys do not work normally thereby reducing in the glomerular filtration rate and kidney function that is often reversible over days or weeks if treated.

3. WHY INFECTION MAY LEAD TO KETOACIDOSIS :

This nearly affects people with type 1 diabetes. Ketoacidosis develops owing to increased insulin requirement or increased resistance to insulin due to some added stress, infection, infarction or cerebrovascular accident. Infection is one of the cause in which the body produces hormones called adrenaline or cortisol which is known to affect the insulin.

4. EXPECTED CHARACTERISTICS OF RESPIRATION IN KETOACIDOSIS :

The classic sign of respiration in diabetic ketoacidosis is kussmaul's respiration which is a kind of hyperventilation, the signs and symptoms involve deep breathing, due to deep breathing pattern the carbon dioxide is reduced in blood.

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