CASE STUDY B Diabetes Mellitus Type2 Mr. F. was diagnosed with Type 2 diabetes m

Question

CASE STUDY B Diabetes Mellitus Type2 Mr. F. was diagnosed with Type 2 diabetes mellitus at age 46. At that time, he was overweight, enjoyed foods with high car- bohydrate and fat content, and led a sedentary life. His family history indicated that his mother and his brother had diabetes Weight loss, appropriate diet, and exercise were recommended to reduce blood glucose levels. 1. List the factors contributing to diabetes mellitus in this case At age 50, Mr. F. noticed that his vision was cloudy, particularly in one eye. Cataracts were removed from both eyes 2. Describe a cataract and explain how diabetes promotes cataract formation. 3. Glyburide (DiaBeta) was prescribed at this time. Describe the action of this drug. At age 56, a blister developed on the heel of one foot, which did not heal. An ulcer formed and persisted. Finally the foot was placed in a cast for 13 weeks to promote healing. 4. Explain several factors contributing to the delayed healing in Mr. F. 5. Why was it necessary in this case, to remove the cast and 5. Wo/ wasit necessary in hs case, t remove the cast and replace it each week? Peripheral neuropathy with total loss of sensory function had developed in both feet. Motor function was not directly affected. Orthopedic shoes were ordered and arrangements made for a podiatrist to provide regular foot care.

Explanation / Answer

ANS. 1: Factors contributing to Type 2 Diabetes:

Pancreas secreting very little amount of Insulin

Amount of insulin section is fine but they are not sensed by cells thus they are not absorbing the glucose form blood stream cause to build high blood sugar.

The risk of type 2 diabetes increases if Diabetes is found in family history. In case of Mr.F. his mother and brother both are diabetic.

ANS. 2: Cataract is the hazy opacifications of the lens which results in the blurred vision. It often developed in one or both eye at old age. Symptoms for cataract are Blurred vision, dazzled by bright light, A Halo around light source, spots in vision etc.

Diabetes promotes cataract formation:

Cataract formation is highly influenced by diabetes. Aldose reductase (AR) enzyme is responsible for the conversion of glucose to sorbitol through polyol pathway. Intracellular accumulation of sorbitol causes osmotic changes on lens fibers. High glucose causes formation of higher sorbitol formation. Moreover polar nature of sorbitol restricts its intracellular removal through diffusion.

The high concentration of sorbitol causes a hyper osmotic effect that leads to an infusion of fluid to countervail the osmotic gradient. These finally lead to a collapse and liquefauction of lens fibers, which results in the formation of lens opacities. Again, these osmotic stress in lens created by sorbitol accumulation induces apoptosis in lens epithelial cells (LEC) leading to the development of cataract.

ANS. 3: After meal blood sugar level increases which is decreased by the hormone insulin secreted by pancreas during this time. But this process is hampered in diabetes. Glyburide causes pancreas to release more insulin into the bloodstream. This drug also helps the cells respond better to insulin, which decreases the blood sugar levels and keep it under better control.

ANS. 4: A high blood sugar level stiffens the arteries which results in narrowing of blood vessels. This restricts the blood supply to the wound and thus healing delayed. Thus the WBC unable to reach at wounded area properly. Due to high blood sugar RBC carries less oxygen which also brings the activity of WBC. High glucose in wounded area causes quicker development of bacteria of fungal infection. In immune deprived situation these reasons together delay the healing process.

Ans 5: The cast helps to protect the wounded area against infection. But regular cleaning and treatment is required.

Ans 6: During high blood sugar the nervous system got affected thus can develop a loss of sensation. This is called diabetic neuropathy. Patient does not sense the pain of blister or ulcer development due to this reason. That is why Mr.F needs to examine his feet every day.

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