Patient 1 – The parents of an 11 year old girl bring her for an office visit. She has been developing normally and has been healthy and active. Her parents report that for the past several weeks, she has been feeling tired and weak, drinking more fluids than normal, and has been urinating so much she has wet the bed at night. Two days ago, they noticed that her breath smelled “like fruit” and she lost 8 pounds these last weeks. Yesterday she began breathing fast and deep.
- Present your initial diagnosis.
- Describe the pathophysiologic explanation(s) to support your diagnosis and the clinical symptoms presented.
- List the test(s) you would perform to confirm your diagnosis, the rationale for each test ordered, and the results you would expect if your diagnosis is correct.
- Describe your recommended treatment(s) and the rationale to support your recommendation(s).
Patient 2– A 45 year old man is being seen because he has been experiencing vision changes, a burning sensation in his feet, and decreasing amounts of urine when he uses the bathroom. He has a long-standing history of hypertension and hyperlipidemia. Your physical exam reveals retinal hemorrhages in both eyes, and decreased sensation to moderate touch in the soles of his feet. A spot urinalysis shows microalbuminuria and a stat Basic Metabolic Profile (BMP) shows decreased Glomerular Filtration Rate (GFR).
- Present your initial diagnosis.
- Describe the pathophysiologic processes related to your diagnosis that explain the signs/symptoms, and lab results obtained.
- State the effect of his symptoms on his life expectancy and the rationale for your answer.
The patient presents with type I diabetes evidenced by weight loss, fatigue, polydipsia, and breath smelling fruity. Also, she might have Ketoacidosis secondary diagnosis indicated by her fruity-smelling breath, Kussmal inhalations and is tired and weak.
Pathophysiologic Explanation Clinical Symptoms
Juvenile diabetes usually is discovered when a kid suffers from ketoacidosis. Glucose loss in urine and incapability of the cells to use glucose because of insulin shortage cause the body to starve. After the body recognizes this reduction in glucose levels, hormonal compensatory means are sparked and expand catabolism by hastening lipolysis and lipogenesis. Respiratory compensation to battle the metabolic acidosis gets in and the patient starts taking deep hasty breaths. The present patient is experiencing weight loss because the body’s cells cannot pull the glucose required for fueling it out of the bloodstream, so it begins breaking down body fat and other tissues for energy (Banday et al., 2020). To lessen sugar in the blood, the kidney continuously filters it out and dumps it into urine. Hence, this develops more urine and the necessity to pee more, like the present patients’ experience. The patient feels tired and weak because the brain, muscles and other body parts are not receiving adequate energy to work accurately.
Tests to Confirm Diagnosis, Rationale for Each Test Ordered, and Results
The A1C test, which depicts the average blood sugar level for the last two or three months should be done. A1C results beneath 5.7 are normal, while above 6.5 alludes to diabetes. An antibody test is done to distinguish between juvenile diabetes. The test demonstrates if the kid’s immune system is confronting the pancreas. The kid will test positive for various autoantibodies. An outcome of 200 mg/dL signifies diabetes for blood sugar test.
Recommended Treatments and Rationale
Diabetic education and counselling of the teenager and parent to guarantee observance to insulin and dodge the mental impact of any behavioural alterations is recommended. Dietary alterations and intake of low-fat, high-fibre food and constant exercises to instigate weight loss and evade the formation of insulin resistance is also recommended. Continuous glucose monitoring to recognize the start of complications and improve early interventions is necessary. In addition, the kid will need to check their blood glucose four to ten time daily to decide on insulin dosages, exercise selections and food. Hence, a home glucose meter can be used to do this. Also, the child will need to take insulin daily by injecting herself.
The patient has typical characteristics of patients diagnosed with type II diabetes.
Pathophysiologic Processes, Signs/Symptoms, and Lab Results Obtained
Diabetes type 2 is described by peripheral insulin resistance, impaired control of hepatic glucose manufacture and decreasing β-cell function, ultimately leading toβ -cell failure. When the cells cannot keep the sugar, it builds-up in the blood triggering high blood sugars (Kahn et al., 2014). Thus, this extra sugar destroys the blood vessels inner lining and causes organs damages that are given blood by those vessels. Therefore, this happens often in small vessels that deliver blood to the eyes, nerves and kidneys when diabetes is poorly handled, and the patient blood sugar is high. Likewise, this explains why the patient indicated feeling a burning sensation in his feet, which means neuropathy and uncontrolled diabetes. Also, the patient started having reduced urine amounts and frequented the bathroom, and the lab work indicated a reduced GFR rate and microalbuminuria. Thus, these signs signify kidney damage called nephropathy.
Effect of Symptoms on Life Expectancy and Rationale
Ageing, low energy consumption, obesity, smoking, alcohol drinking are independent risk elements of pathogenesis. The peripheral neuropathy experienced by the patient can have a significant effect on the patient’s life expectancy and quality of life (Kahn et al., 2014). The reduced sensation the patient feels on his foot can lead to a sore or blister on their feet. If left untreated, the infection can spread to the bone, and the foot might be amputated. Managing the disease can increase his life expectancy by exercising, eating healthy, monitoring blood sugar, and taking anti-diabetic drugs.
Banday, M. Z., Sameer, A. S., & Nissar, S. (2020). Pathophysiology of diabetes: An overview. Avicenna Journal of Medicine, 10(4), 174.
Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet, 383(9922), 1068-1083.