Type II Diabetes Diagnosis

Endocrine Case Study

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.

Initial Diagnosis

The symptoms presented are characteristics of early onset of type I diabetes with a secondary diagnosis of diabetic ketoacidosis (Wherrett et al., 2018). The patient presents with polydipsia and polyuria, classic symptoms of diabetes, and due to her age, these fit with type I diabetes. Her Kussmaul respirations combined with the fruity breath are indicators for diabetic ketoacidosis, typically seen in type I diabetes.

Pathophysiologic Explanation(s)

The patient is urinating more than usual due to the overworking of the kidneys. There are large amounts of sugar in the patient’s body, and the kidneys need to make more urine to pass out these extra amounts of sugar from the body. The kidney process results in more water being used up in the body, and the patient gets dehydrated fast, resulting in their increased consumption of fluids (Wherrett et al., 2018). The patient lacks enough insulting, meaning that glucose cannot be processed to enter the cells in the body for use as fuel. Therefore, the body and body cells lack enough energy leading to the patient feeling tired. The body is forced to break down fat to produce energy, causing the patient to lose weight.

Tests To Confirm the Diagnosis

The primary screening test for type I diabetes in children is a random blood sugar test. A blood sample is obtained from the patient at a random time (Wherrett et al., 2018). If the blood sugar level is 200 milligrams per deciliter (mg/dl) or higher the patient does have diabetes.

Glycated hemoglobin (A1C) test. An A1C test will indicate the patient’s average blood sugar level for the past three months. Diabetes is confirmed if the A1C level is 6.5 percent or higher on two separate tests.

Fasting blood sugar test. In this test, a blood sample is taken from the patient after they have fasted overnight. The test measures the patient’s blood sugar level after fasting. A fasting blood sugar level of 99 mg/dl or lower is normal, a level of 100 - 125 mg/dl indicates the patient has prediabetes, and a level of 126 mg/dl or higher indicates the patient has diabetes.

Recommended Treatment(s)

Treatment aims to keep the patient’s blood sugar level as close to normal as possible. Therefore, treatment will include taking insulin, eating healthy meals, exercising regularly, and frequently monitoring blood sugar levels. Insulin is needed so that glucose can move from the blood to the patient’s cells for energy. Insulin will be given via injection or insulin pump. Eating healthy foods offer the child the right balance to keep their body on a healthy range. Different foods affect the child’s blood sugar. The patient will be given a meal plan that offers guidance on the meals the child should consume, and parents are taught how to count carbs. Exercising regularly ensure the patient strengthens their muscles and bones and controls their blood sugar levels. Exercise makes insulin work better. The child should exercise for at least 60 minutes each day. Monitoring blood sugar levels ensures the patient has healthy sugar levels allowing for corrective action to be taken early. Monitoring is done about four times a day.

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).

Initial Diagnosis

The symptoms presented by the patient are characteristics of diabetes mellitus type 2 with chronic complications of diabetic neuropathy, diabetic nephropathy, and diabetic retinopathy.

Pathophysiologic Explanation(s) and Lab Results Obtained

Type 2 diabetes mellitus pathophysiology is characterized by peripheral insulin resistance, declining ?-cell functioning, impaired regulation of hepatic glucose production, and eventually leading to ?-cell failure (Bullard et al., 2018). Insulin secretion deficit is the initial process that leads to the development of type 2 diabetes mellitus. Insulin resistance does also contribute towards the type 2 diabetes mellitus. The patient presenting with type 2 diabetes mellitus is usually overweight, hyperinsulinemia, dyslipidemia, and hypertensive. The patient will present with polydipsia, polyuria, recurrent infections, visual changes, fatigue, weakness, and paresthesia. In normal people, the pancreas secretes digestive enzymes and insulin into the bloodstream for controlling the amount of glucose in the body. People with type 2 diabetes mellitus either do not have enough insulin, or the cells in the person’s body ignore the produced insulin (Bullard et al., 2018). Either way, it leads to an increase in blood glucose in the blood. Instead of the glucose being absorbed in the cells, it remains in the blood, causing far-reaching health problems like nerve damage, heart disease, and kidney damage (Bullard et al., 2018).