Mark was a healthy active 7-year-old boy with seemingly unlimited energy. About

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Mark was a healthy active 7-year-old boy with seemingly unlimited energy. About a month prior to the doctor's visit, however, things had begun to change. He was, over the last month, showing signs of less energy, and in fact was tiring quite easily. He had a markedly increased appetite, so it seemed that he was always hungry. He had until now showed a steady normal weight gain for a child his age, but recently had lost weight, about 5 pounds, in spite of his increased food intake. The other change is mother had noted was that he was frequently thirsty, and had to urinate more than usual. In fact, he had even wet the bed once last week. It seemed to his mother that he was "always in the bathroom."

These changes troubled Mark's mother enough to call their family doctor for an appointment. A physical exam confirmed the weight loss of 5 pounds. The results of a routine urinalysis were alarming. While most of the tests were normal, two were not. The dipstick test showed significant glucose and ketones in his urine, likely indicators of diabetes mellitus. The doctor followed up with a finger-stick blood glucose test which showed a blood glucose level of 600, confirming the doctor's suspicions.

The physician explained that all of Mark's signs and symptoms were consistent with diabetes mellitus, a serious disease in which the pancreas does not produce insulin, and therefore a person's body cannot use sugar properly for energy. Furthermore, he explained, Mark had "insulin-dependent diabetes mellitus" which was different than the type which commonly develops in adults in which the pancreas actually produces insulin, but not enough to meet the body's needs. Mark's mother was relieved to know that his condition was not caused by eating too much sugar and that they really had not done anything to cause it. He explained that the cause is not really well understood, and that it probably is not connected to any family history. In fact, in Mark's case, there was no known family history of diabetes

After a brief hospitalization during which Mark began insulin replacement therapy, his blood sugar was stabilized. He and his family were instructed on how to check his blood sugar, how to administer insulin, and how to manage his diet and insulin to keep his blood sugar in control. Fortunately, Mark was a cooperative child and his blood sugar was controlled relatively easily. Except for the inconveniences involved, he returned to a relatively normal childhood.

Eight years later...

With the help of his parents and his family doctor, Mark had been able to keep to the strict regimen of diet, blood glucose monitoring, and insulin injections, and was successfully keeping his diabetes under control. There were, however, times when it was difficult to maintain the necessary discipline. Two crises, both potentially life-threatening, served to re-focus him on the necessity of keeping in control. One was in his own life, the other in the life of a friend.

The first incident occurred on a particularly busy Saturday. Mark ate breakfast and injected the appropriate amount of insulin as usual. He had a basketball game that morning, but was not anticipating playing much. However, this day two starting players were sick, so he started and played all of the first half. Midway through the 3rd quarter, he began feeling light-headed. Soon after returning to the bench, his condition worsened and he became disoriented. Fortunately, his coach knew of his condition, and knew to give him some orange juice. He revived within a few minutes.

The second incident occurred two months later to a neighbourhood friend. Tim, another 15-year-old, had experienced many of the same signs and symptoms as had Mark, fatigue, weight loss, increased appetite, and excessive thirst and urination. These changes went unnoticed for over a month until a crisis developed.

One evening he didn't feel well and his father noticed that his breathing was rapid and shallow, and that his breath had an odd odour, sort of a "sweet" smell. He was getting noticeably drowsy. His father called their family doctor who sent them immediately to the local emergency room. On the trip there, he lost consciousness. Immediately upon arrival, the doctor ordered blood work done. Especially significant were the results that showed a blood glucose of 650, well above the normal level. Arterial blood gases were also drawn. They revealed a very serious situation, a pH of 7 (normal of 7.35-7.45), a low PCO2, and a low HCO3- level. These results all were consistent with diabetic ketoacidosis, a serious complication of diabetes. Fortunately, Tim was treated in time and responded well to insulin injection and intravenous fluid therapy. He was diagnosed with insulin-dependent diabetes mellitus.

3. In situation 2, Tim's high blood glucose was accompanied by acidosis. What acidic products accumulated in his blood? How were they formed?

4. How does lack of insulin result in excessive use of fatty acids for energy?

Please discuss/explain your answers in detail.

Explanation / Answer

3) since I he energy requirements of the body were not met by glucose due to its poor uptake, the cells begin the break down of fats and mucles which results in to the format kon of ketones. These ketones are acidic in nature and are thrown out by the cells into the blood stream. It's causes a pH imbalance in the blood making it acidic.

4)lack of insulin disturbs (lowers) the ATP/ADP ratio as no glucose is available for the cell to oxidize and generate energy in the form of ATP . To fulfil it's energy requirements, the cell reaches out to the secondary, stored source of energy it has which is fat. Low ATP and high ADP, a private enzymes specific for fat catabolism 8n order to carry out this process.

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