SGD CASE: A 45-year-old woman consulted at a clinic due to excessive thirst, fluid intake and urination. She has no signs and symptoms of urinary tract infection. She denies any me... SGD CASE: A 45-year-old woman consulted at a clinic due to excessive thirst, fluid intake and urination. She has no signs and symptoms of urinary tract infection. She denies any medical conditions but has not seen a doctor in many years. On examination, she is obese and has stable vital signs. Her physical examination is otherwise normal. Urinalysis revealed glucosuria (+4) and her random blood sugar level was 300mg/dL. GUIDE QUESTIONS: 1. Discuss the most likely diagnosis? 2. Differentiate the 2 major types of diabetes mellitus? 3. Explain the role of insulin and glucagon on carbohydrate metabolism. 4. Describe the biochemical basis of the patient’s condition. 5. Create a schematic diagram showing the effects of insulin resistance leading to diabetes mellitus.
Understand the Problem
The question presents a clinical case of a woman with symptoms suggestive of diabetes mellitus and asks for a detailed analysis of the diagnosis and related concepts. The high-level approach involves discussing the diagnosis, differentiating types of diabetes, explaining hormone roles in metabolism, describing biochemical aspects, and illustrating insulin resistance.
Answer
1. Type 2 Diabetes Mellitus diagnosis. 2. Autoimmune insulin deficiency vs. insulin resistance. 3. Insulin decreases, glucagon increases blood sugar. 4. Insulin resistance causes hyperglycemia and glucosuria. 5. Insulin resistance leads to diabetes mellitus.
- The most likely diagnosis is Type 2 Diabetes Mellitus. 2. Type 1 Diabetes is characterized by autoimmune destruction of insulin-producing beta cells, leading to insulin deficiency, while Type 2 involves insulin resistance and relative insulin deficiency. 3. Insulin lowers blood glucose by promoting its uptake in cells, while glucagon raises blood glucose by stimulating gluconeogenesis and glycogenolysis. 4. The patient's condition is due to insulin resistance, leading to high blood sugar and glucosuria. 5. [Schematic Diagram: begins with insulin resistance > decreased glucose uptake > hyperglycemia > persistent high blood sugar > diabetes mellitus].
Answer for screen readers
- The most likely diagnosis is Type 2 Diabetes Mellitus. 2. Type 1 Diabetes is characterized by autoimmune destruction of insulin-producing beta cells, leading to insulin deficiency, while Type 2 involves insulin resistance and relative insulin deficiency. 3. Insulin lowers blood glucose by promoting its uptake in cells, while glucagon raises blood glucose by stimulating gluconeogenesis and glycogenolysis. 4. The patient's condition is due to insulin resistance, leading to high blood sugar and glucosuria. 5. [Schematic Diagram: begins with insulin resistance > decreased glucose uptake > hyperglycemia > persistent high blood sugar > diabetes mellitus].
More Information
The presence of glucosuria and elevated blood sugar levels indicate diabetes mellitus, not diabetes insipidus, which would show normal sugar levels but excessive urination.
Tips
A common mistake is confusing diabetes mellitus with diabetes insipidus due to similar symptoms, but the presence of glucosuria points to diabetes mellitus.
Sources
- Diabetes Insipidus - NIDDK - niddk.nih.gov
- Urinalysis - StatPearls - NCBI Bookshelf - ncbi.nlm.nih.gov
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