Ms. Rita is a 15 year old female. She is a known case of poor control of sugar level since one month without regular medication. When patient was admitted to hospital her random blood sugar =300mg/dl. She had no history of vomiting, breathlessness, altered sensorium or bowel trouble. She had a history of weight loss. On her initial examination she was calm, conscious and cooperative and well oriented to time, place and person. Her BP was 140/90mmhg, pulse-80 per minute, abdomen soft non- tender and no organomegaly. She had a history of polyuria and weight loss and increased thirst. Chest vesicular breathing, no added sound. CVSSI, S2 heard normally.
Investigations
| Urine Color | Pale, turbid |
| Reaction | 6.0 |
| Albumin | + + + |
| Sugar | + + |
| Ketones | Negative |
| Glucose (F) | 303mg/dl |
| Hb | 8.3gm/dl |
| TLC | 9000/Ul |
| DLC | N-49%L-47%M-2%E-2% |
| Platelets | 4.15 lacs |
| Total cholesterol | 160mg/dl |
| DHLcholestrol | 30mg/dl |
| LDL | 100mg/dl |
| VLDL | 30mg/dl |
| Triglycerides | 150mg/dl |
| T. Cholesterol ratio | 5.33 |
| Glucose (F) | 253mg/dl |
FINAL DIAGNOSIS
Type 1 Diabetes mellitus
Diabetes Mellitus type 1 is a chronic disorder of carbohydrate, fat and protein metabolism. A defective or deficient insulin secretary response, which translates into impaired carbohydrate (glucose) use, is a characteristic feature of diabetes mellitus (Goodman and Gillman’s, 2001).
Type 1 diabetes is also called Insulin Dependent Diabetes Mellitus (IDDM) and was previously referred to as juvenile oonsetdiabetes. It occurs due to decreased insulin production and unchecked glucose production by the liver. Insulin enables the sugar to get out of the blood and into the cells where it is needed for the cells to function.Diabetes results from a severe, absolute lack of insulin resulting in reduction in beta cell mass. Beta cells are a type of cell in the pancreas in areas called the islets of langerhans. These beta cells produce insulin. The function of insulin is to counter the action of a number of hyperglycemia-generating hormones and to maintain low blood glucose levels. Due to lack of insulin sugar will not be able to get into the cells so, there will be a high concentration in the blood. On the other hand, high amount of insulin shifts too much sugar into the cells and there will be not enough sugar left in the blood (Mohan, 2000). Lack of insulin affects them because insulin allows for the absorption of glucose by cells in the body and is secreted by the beta cells, in response to elevated glucose in the blood (Chatterjea, 2000).
To treat the high level of glucose insulin was given to the patient. Insulin works to lower blood glucose by promoting the transport of glucose into cells and by inhibiting the conversion of glycogen and amino acids to glucose (Smeltzer, 2004).
Ms. Rita was suffering from polyuria which is increased amount of urine (Smeltzer, 2004). When the blood glucose level is significantly elevated, (it is also mentioned in the above paragraph) the kidneys are unable to handle the workload and therefore allow the excess glucose to spill over into the urine. The glucose in urine acts osmotically means higher concentration to lower concentration to draw more water into the urine, resulting in polyuria (Cotran, 2000).
Mrs. Rita’s urine was pale and turbid color. It occurs because concentration of glucose in the blood rises. The renal threshold for glucose is, usually 180 to 200mg/dl. When blood glucose increases, the kidneys may not reabsorb all the filtered glucose and the glucose than appears in the urine making it pale and turbid (Smeltzer et al, 2004).
She had a problem of Polydypsia which means excessive thirst. As explained above glucose in the urine is increase, rising the osmotic pressure of the urine, this ways pulls the water along with the glucose in to the urine which leads to excessive urination called polyuria, causing a lack of overall body fluids making the blood hypertonic. This hypertonicity provokes the brain to initiate thirst as a compensatory mechanism of dehydration so that loss of water can be fulfill (Chaudhuri, 2002).
She was suffering from problem of weight loss. Loss of tissue mass occurs in the insulin- dependent form of the disease (the consequence of glycosuria) that characterizes the illness. Role of insulin is to provide entry of glucose into the cells. Insulin deficiency result in non utilization of glucose as it cannot enter into the cells leading to impaired synthesis of protein, fat and simultaneously cause accelerated breakdown of proteins and fats for production of energy causing a catabolic state. It means there is accelerated breakdown of fat and muscle secondary to insulin deficiency leading to weight loss.
Ms. Rita’s blood pressure was 140/90mmhg. The reasons for the increased blood pressure are hyperinsulinemia, glucose intolerance and reduced level of HDL cholesterol. In a normal physiological state nitric oxide synthesis is stimulated by insulin besides decreased synthesis and responsiveness to non insulin resistant states have been associated with increased level of endothelin-1 and potent vasoconstrictor and proarthero sclerotic vascular hormone associated with hypertension 4ia,, e.of Pathologrica..outh.within the central nervous system, all these hormonal changes may play a major role in the gastr(Kumar and Clark, 2005).
Overall management was good and Ms. Rita discharged in satisfactory condition.
