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Va ings Revew Ve AaBbCcD AaBb 1 Normal 1 No Spac... Heading 1 Heading 2 Title Subtitle Subtle Paragraph Styles st we need to close some apps. Update now Diane could not remember whether she had taken her 6 PM insulin dose when, in fact, she had done so. Unfortunately, she decided to give herself the evening dose (for the second time). When she did not respond to her alarm clock at 6 AM the following morning, her roommate tried unsuccessfully to awaken her. The roommate called 911 and Diane was rushed to the ER in a coma. Her skin was flushed and slightly moist. Her respirations were slightly slow. Her vitals were: heart rate -75 bpm, blood pressure - l12/87, respiratory rate: 10 rpm, oxygen saturation-100% at room air. 1. What is Diane's diagnosis? What is the mechanism involved? 2. What clinical signs and symptoms help to distinguish a coma caused by an excess of blood glucose and ketone bodies due to a deficiency of insulin (DKA) from a coma caused by a sudden lowering of blood glucose (hyperglycemic coma) induced by the inadvertent injection of excessive insulin? What is the pathophysiology leading to the elevation of blood glucose after a meal differs between patient with insulin-dependQt diabetes mellitus(IDDM) and those with non-insulin-dependent diabetes mellitus (NIDDM)? Explain both. 3. 4. What are the types of treatment available to help Diane in the future?Explanation / Answer
1-This Seems to be Hypoglycemic Coma.
Diane took insulin twice. Insulin is a hormone secreted by Beta cells of pancreas and is required for glucose uptake by cells.It acts mainly on three organs- liver, muscles and fat, thereby enabling glucose uptake in these tissues.
Type 1 diabetes is condition where there is less insulin production because of immune- mediated destruction of beta cells. Insulin is the drug of choice. Insulin is to be taken very cautiously. Excess amount as in this case leads to more and more glucose uptake by liver, muscles, fats and hence there is less glucose in blood. Less glucose in blood is called as Hypoglycemia. Hypoglycemia leads to less availability of glucose to brain. This leads to symptoms like Confusion, irritability, rapid pulse, sweating, dizziness, headache and if Hypoglycemia is profound as in this case can lead to coma and death.
2- The patient experiences following symptoms before coma-
In DKA- incresed thirst, frequent urination, nausea and vomiting, abdominal pain, dry mouth, shortness of breath.
In Hypoglycemia- Confusion, irritability, headache, dizziness, anxiety, weakness.
When patient comes in coma, the doctor notices following signs,
In DKA- dehydrated state of patient, Fruity breaths, incresed heart rate
In Hypoglycemia- Flushing of skin, sweating, Rapid pulse.
The immediate step is to check blood glucose levels by Glucometer. It tells whether glucose is high or low and hence the treatment can be started accordingly.
3- In Insulin dependent Diabetes( Type 1 ), there is immune-mediated destruction of beta cells of pancreas. Therefore the insulin is deficient in these individuals . Therefore after meals there is no insulin to cause glucose uptake into cells and therefore blood glucose level increases.
In Insulin independent Diabetes ( type 2) , there is insulin resistance i.e, despite high levels of insulin the cells are not able to utilize it. There is defect in signalling pathway. Therefore after meals, though there is insulin but its effect is nill, thereby increasing blood glucose level.
4- If Diana is suffering from Type 1 Diabetes, Insulin is the only drug . She is on it, therefore she has Type 1 diabetes. Insulin can be given in type 2 diabetes whenever there is complications, or person has a surgery to undergo.
Diana should include dietary modification, Regular excercise.
Type 2 diabetes is treated with oral Hypoglycemic drugs such as Sulfonylureas ( Glibenclamide), Metformin, etc.
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