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GCCCD Diabetes Mellitus Case Study Discussion Questions


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Case Study #2

Diabetes Mellitus

Diabetes mellitus is a common chronic disease, and every health professional will need to understand how it works and identify common emergency situations related to it. But an equally important part of the health professional’s role is patient education and explaining what happens in the disease process. After they go home, diabetes patients will have to manage this complex disease every day.

You are working in the free clinic when Father X comes in. You know him well; he is a type 2 diabetic who keeps his sugar under control with diet and exercise but is often in the clinic with homeless patients from the shelter he runs in the Episcopalian church down the block.

1. Diabetes mellitus is a disease of sugar balance. In type 1 diabetes, the body’s immune system gradually destroys the cells that produce insulin. In type 2 diabetes, the body’s cells become less responsive to the hormone insulin. Insulin plays a vital role in carbohydrate metabolism. What is its role?

2. Insulin and glucagon release from the pancreas is a vital part of the negative feedback loop that regulates blood glucose levels. Write out this feedback loop and predict how insulin levels will respond to blood glucose. When will insulin levels be highest during the day? When will they be lowest?

On this visit, Father X has brought in a thin man in his twenties named Joe. Joe appears confused and lethargic. He is breathing heavily and has a strong fruity odor. Father X tells you he is concerned about Joe because last night Joe was up every half-hour or so to use the bathroom and get water. Father X knows these are signs of diabetes, so he wants to get Joe checked out. He also tells you that Joe has not been drinking; they have a breathalyzer at the shelter, and Joe tested clean when he checked in the night before.

Joe’s blood pressure is a little low at 95/60 mm Hg and his heart rate is a little high at 96 bpm. When you take his pulse, you notice that his skin is dry and “tents” up when pinched–a sign of dehydration. His respirations are more rapid than normal, 25 breaths/min., and heavy. His blood glucose is elevated at 320 mg/dL. His urine also contains glucose, and has a lower pH than normal. When you take his history he tells you that type 1 diabetes runs in his family.

3. Normally, urine does not contain glucose. When blood glucose levels are elevated, however, some of the glucose is lost in the urine. Apply the principle of osmosis to explain why Joe was getting up all night to use the bathroom, and why he has low blood pressure and signs of dehydration.

4. In type 1 diabetes, the cells in the pancreas which produce insulin are destroyed. Which cells are these? The cells which produce glucagon, however, are not affected. Which cells are these? What will glucagon cause Joe’s cells to do?

5. People with type 1 diabetes commonly have high blood sugar levels but lose weight. Based on the effects insulin and glucagon have on cells, explain this. What compounds do you expect the cells to release into Joe’s blood?

6. The odor on Joe’s breath is from ketones. Why would a man with type 1 diabetes develop high blood ketone levels?


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