BMS 511 Fundamentals in Biomedical Sciences Assignment Sample

• Subject Code : BMS-511
• Subject Name : Medical Sciences

Case Study Analysis: Diabetes

Abstract

There is a famous saying that “Health is wealth” and hence all of us in this world need to be in a healthy state of mind and body at all times of life.

The patient in the given study shows the symptoms of increased thirst, dry mouth, increased hunger, frequent need to urinate, loss of weight, feels lethargic and finds difficulty in concentrating in his home tasks that are assigned to him from school. These are the symptoms of imbalanced blood sugar levels in the blood or what is commonly known as Diabetes (Gilbert et al, 2019). These patients also suffer from chances of influenza or pneumonia on frequent occasions . The patient suffers from loss of weight which may indicate his chances of being suffering from Type-I diabetes. The patient in the case study also suffered from influenza in the past.

The patient has a hereditary history when his 4 year old brother has been diagnosed with type-I Diabetes at a tender age of 10 and is now undergoing treatment for the same. There are thus high chances that even the patient in this case may be diagnosed with Diabetes of either type especially type I which can be determined by blood glucose meter and series of tests following later.

Excess of fat and protein intake can also lead to diabetic symptoms especially in patients having a prior history (Cunha, 2019). We find in the case study, that the patient is a volleyball player and has a habit of eating snacks and other junk food.

There are two kinds of diabetes that lead to low or high blood sugar level. Symptoms for both kinds of diabetes are almost similar and difficult to determine without a blood glucose meter.

The kinds of diabetes are:-

• Type I Diabetes ( Low Blood sugar )
• Type II Diabetes ( High blood sugar)

Symptoms of low blood sugar may include, increased heart beat, strong hunger, dizziness, weakness , clumsiness, confusion and dizziness, loss of weight, difficulty in concentrating in study or work , slurred speech, tingling in the lips or tongue and irritability.

Symptoms of high blood sugar include of increased thirst and hunger, feelings of lethargy in daily activities , dry mouth, frequent need to urinate and blurred vision (Katsarou et al, 2017) . In extreme cases, diabetes type-II may also lead to symptoms like nausea and vomiting or loss of consciousness.

Introduction

Diabetes is a metabolic disorder that causes sugar or glucose to accumulate in blood. High or low levels of sugar in the blood may be caused due to defects in insulin production or insulin action or both. The causes of diabetes could be hormonal defects in the body or hereditary history or even prolonged illness of other kinds. The sugar is generally used as a fuel in our body but diabetic patients are not able to absorb the minimum amount of sugar in the blood and sugar levels in the body increase or decrease and symptoms get reflected in the diseases that occur simultaneously for diabetic patients( Fang, Karakiulakis & Roth 2020). In serious case, diabetes may also lead to lots of serious illness or premature death and hence treatment of diabetes at early stages is indeed very essential. Due to increased pollution, food habits, environmental and hereditary factors diabetes also trap humans of low age group beginning from children of 5 years of age. It is obvious that adults and the aged are more prone to diabetes. Both oral medications and intake of regular insulin injections are usually advised in the treatment of diabetic patients.

Following medical reasons and symptoms are seen with the diabetic patients:-

Type-I Diabetes- It is a rare phenomenon as per the head count in a population. It seen that in a community only 5 to 10% of the people get affected by Type-I diabetes. Insulin is a major requirement for these patients. Many patients do not survive without external intake of insulin. It is autoimmune mediated (Chaudhury et al, 2017). Patients tend to produce extra antibodies in the blood that fight with local cells in the body to deactivate the production of insulin in the body. Hence these patients need to regularly have doses of insulin in their body in perfect measured quantity only. These patients generally lose weight and feel tired and show nerve related problems as well. Even the kids need to take injections for insulin besides the oral medications for diabetes Type –I. Highs and lows of blood sugar level is a major problem in this disease compared to type-II diabetic patients. Whenever these patients take a heavy meal, they go high on blood sugar level and similarly without the intake of measured level of insulin , they tend to go on a lower levels of sugar or even alternately.

Type-II Diabetes- It is frequently seen and holds a remarkable percentage of 90-95% affected people in a community. People suffer from obesity problems in this kind of disease. There are hereditary reasons for this type of disease as well. . There are hereditary and hormonal reasons for its causes majorly (Alves et al, 2018). Patients show insulin deficiency and insulin resistance in the blood . The patients also suffer from high and low blood sugar levels alternately in periods of days and months.

Some of the hormones that cause the twisting effects in blood sugar level are demonstrated as under :-

Insulin generated from Pancreas cause a decrease in blood sugar levels whereas Cortisol, Adrenaline generated from Adrenaline glands located at the top of kidney cause blood sugar levels to rise(Seaquist et al, 2020). Glucagon hormone of Pancreas and Growth hormone of the pituitary gland cause an increase in the blood sugar level. The mismanagement of a-cells and b-cells production in the pancreas also leads to imbalance of hormone generation in the body subsequently causing diabetes in a normal human being. 

Some of the other causes of high blood sugar in patients today are :-

• Dietary factors where people take wrong quantity of food at odd hours of the day
• Missing meals or over intake of food
• Avoiding proper medications at the correct time
• Side effects of new drugs or drugs related to other diseases effect the normal functioning of adrenal and pancreatic glands leading to abnormal release of insulin in the body (Wang et al, 2016)
• Prolonged illness of any other kind in the body
• Stress factor relating to work, examinations etc
• Lack of routine physical activity
• Outdated insulin packs injected accidentally
• Avoiding proper technique of administering insulin and in proper proportion and timings
• Hereditary factors(Chaudhury et al, 2017)
• Injury in diabetic patients
• Seniority in age
• Environmental factors

Diagnosis

Patients suffering from Diabetes are diagnosed with the help of laboratory blood tests. The kind of tests that are undertaken to diagnose diabetes are :-

• Fasting Blood Glucose Test better known as Fasting Plasma Glucose Test
• Oral Glucose Tolerance Test
• Haemoglobin A1c test (Zheng, Ley & Hu ,2018).

The fasting Blood glucose test measures glucose level in patient who has not had food at least for the past 8 hours. Diabetes is rendered as a diagnostic result when the glucose level is higher than 126 mg/dl.

Haemoglobin A1c measures the average blood sugar levels over the last 3 months. Diabetes id diagnosed when A1c in blood level is higher than 6.5% or higher on two separate occasions.

OGTT measures glucose level in blood , 2 hours after the consumption of a glucose liquid. Diabetes is diagnosed when OGTT test of glucose is 200mg/dl or higher.

If any of the above tests is positive , the doctor generally suggests for 2-3 rounds of tests for confirmation of the disease(Wang et al, 2016).

There are also chances of pre diabetes syndrome for patients when the patients yield test results that are on higher mark range of the normal blood sugar level.

Risk Factors

Hereditary factors related to genetic conditions primarily determine the smooth functioning of the pancreatic , pituitary and adrenal glands in the body. A slight disruption in the hormonal levels causes the sugar level to dip or rise in the body. The hormone regulators in the body are primarily located in the genetic make-up of an individual( Tilg, Moschen & Roden, 2017). It is seen that history of patients relating to diabetes in the family also determine the seriousness of diabetes in their body. A prolonged carrier generation of a disease especially diabetes will affect the patient at lower age than expected of a normal person. Hence , In this particular study, the patient who is merely 13 years old has an elder brother who is 17, and got diagnosed with diabetes-I at an early age of 10 and since then has been on treatment(Chaudhury et al, 2017). It is very likely that the patient in the case study also has genetic desecendancy from his parents and brother and is quite likely to show the symptoms at his current age of 13 as well(Wang et al, 2016). In fact genetic history of the family is a major cause of his being affected by symptoms of diabetes-I . A complete diagnostic test will later ensure the type of diabetes the patient is affected with currently.

Besides, the patient is a player and has a habit of over intake of junk food. The kind of food that he eats regularly may deposit extra protein and fat in his body , more than his body can absorb at this age. Due to this, there is a protein and fat accumulation in the body. This is another factor causing diabetes in this particular patient. The patient is also subject to frequent injuries as he is a volleyball player. Frequent injuries may fluctuate blood sugar level in the patient’s body (Seaquist et al, 2020).

The stress that is caused in the patient due to confusion and non accomplishment of his homework could also be a major cause of fluctuating blood sugar level in the patient’s body.

Multiple complications can occur with regards to kidney, liver if diabetes is not diagnosed at an early stage of the disease. High glucose levels for a long term can cause damage to the small and large blood vessels as well. This may lead to heart attacks and strokes in the future. Blood flow problems in the blood due to disturbed blood vessels also lead to foot ulcers or amputations( Tilg, Moschen & Roden, 2017)

A diabetes patient often faces problems with the kidney and prolonged symptoms lead to kidney failure. Due to this patients need to undergo constant dialysis or even kidney transplant in extreme cases.

Many patients also suffer from nerve damages in the body owing to diabetes. They lose sensations in the hands and the feet. Many a times, a patient with a repeated history of low blood sugar, have delayed release of counter hormones and patient may come to know about his disease quite late suddenly causing trauma like a patient going to coma.

Both high and low blood glucose level in the blood affects the eye. Diabetes is the leading cause of blindness in United States of America. Patients suffer from Cataracts, Glaucoma, Macular edema owing to diabetes (Tikkanen-Dolenc et al, 2019). High blood glucose level leads to Microaneurysms of the eye and deposition of hard exudates in the eye. Low blood glucose level causes bleeding inside the idea and there are chances of major haemorrhages.

Treatment

Regular check-ups are necessary for diabetic patients. Blood glucose monitoring is indeed important. Patient needs to do the diabetic tests in periodic intervals. Other tests like Blood cholesterol and triglyceride tests also need to be performed. In the case study2 , periodic urine protein test is also necessary for the patient as he is a player and often eats junk food or may consume eggs and other protein related diet in extra quantity. This would keep a watch on his kidney function (Jensen, Hejlesen & Vestergaard 2020). Correct level of blood sugar in the body needs to be measured and reported for at least 2 concurrent intervals for a proper treatment procedure to start with.

Upon diagnosis , if insulin intake is prescribed, it is very important to administer the intake of insulin at the correct time in proportionate quantity as prescribed by the physicians. The proper technique of injecting the medicines at the proper places of the body is also important. The best areas of the body where insulin could be injected are the abdomen, thighs or the arms. Outdated insulin packs often give derogatory results. Failure of intake of the insulin injection may prove fatal for type-I patients( Tilg, Moschen & Roden, 2017). Similarly, wrong timing of insulin intake prior to or after meal may give dietary impacts in the body. Hence the patient must adhere to the strict guidelines of insulin intake and hours of meals and supper in his daily routine life. A good treatment will respond only if the patient maintains correct food habits and correct timings of medication. 

Pneumonia vaccine and Influenza vaccine are recommended for diabetic patients. Diabetic patients often fall a prey to pneumonia or influenza for varied reasons and hence immunisation of these patients is essential(Katsarou et al, 2017).

Bed time readings of blood glucose level could be diagnosed for the diabetic patients.

Other recommended medications include

• Steroids like Prednisone for arthritis patients suffering from diabetes
• Anti psychotic medications
• Glucose sensors to test sugar levels in the body at frequent intervals
• Water pills like HCTZ(Gilbert et al, 2019).
• Drugs like Cyclosporine, protease inhibitors etc.
• Normal oral drugs
• Insulin in right quantities with proper administration
• Timely conductance of ABC diagnostic tests(Zheng, Ley & Hu ,2018).
  1. A- which measures A1C of blood
  2. B- which measures blood pressure
  3. C- which measures Cholesterol

Conclusion and Summary

Many health complications will cease to exist if diabetes is controlled at an early stage. It is often said that prevention is better than cure. Correct dietary routines and regular physical exercises are very essential for a healthy life(Chaudhury et al, 2017). A target blood pressure level less than 130/80 is mandatory for diabetic patients. In case of patients with severity of the disease correct administration of insulin levels at correct times of the day is an urgent necessity. It is also advisable that patients intake the injections at the proper positions in their body which have been advisable by the physicians(Zheng, Ley & Hu ,2018).

The patient in this case study is an athlete and is prone to irregular junk food at odd hours of the day. He needs to be guided to take proper meals at correct times of the day with proper medicines monitored regularly. He is advised to release his stress levels that arises out of his confusion of delay in his home assignments.

A careful administration of the disease for a lifetime ensures good health and slow down of the ill effects of the disease.

References

Gilbert, L., Gross, J., Lanzi, S., Quansah, D. Y., Puder, J., & Horsch, A. (2019). How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: an integrative review. BMC pregnancy and childbirth, 19(1), 60.

Cunha, M. D. C. S. O. (2019). Self-Care Among Type 1 Diabetes Mellitus Bearing People: Adolescents’ Experience/Autocuidado em Pessoas com Diabetes Mellitus Tipo 1: Vivências de Adolescentes. Revista de Pesquisa: Cuidado é Fundamental Online, 11(2), 289-296.

Katsarou, A., Gudbjörnsdottir, S., Rawshani, A., Dabelea, D., Bonifacio, E., Anderson, B. J., ... & Lernmark, Å. (2017). Type 1 diabetes mellitus. Nature reviews Disease primers, 3(1), 1-17.

Fang, L., Karakiulakis, G., & Roth, M. (2020). Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?. The Lancet. Respiratory Medicine.

Chaudhury, A., Duvoor, C., Dendi, R., Sena, V., Kraleti, S., Chada, A., ... & Kuriakose, K. (2017). Clinical review of antidiabetic drugs: implications for type 2 diabetes mellitus management. Frontiers in endocrinology, 8, 6.

Alves, M. F., Costeira, M., Ferreira, J. D. S., Soares, S., Magalhães, C., & Meireles, C. (2018). Diabetes Mellitus tipo 1 apresentando-se como perturbação do neurodesenvolvimento. Nascer e Crescer, 27(2), 112-115.

Low Wang, C. C., Hess, C. N., Hiatt, W. R., & Goldfine, A. B. (2016). Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus–mechanisms, management, and clinical considerations. Circulation, 133(24), 2459-2502.

Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology, 14(2), 88.

Tilg, H., Moschen, A. R., & Roden, M. (2017). NAFLD and diabetes mellitus. Nature reviews Gastroenterology & hepatology, 14(1), 32.

Tikkanen-Dolenc, H., Wadén, J., Forsblom, C., Harjutsalo, V., Thorn, L. M., Saraheimo, M., ... & Groop, P. H. (2019). Frequent physical activity is associated with reduced risk of severe diabetic retinopathy in type 1 diabetes. Acta diabetologica, 1-8.

Jensen, M. H., Hejlesen, O., & Vestergaard, P. (2020). Association of insulin regimens with severe hypoglycemia in people with Type 1 diabetes‐a Danish case‐control study. British Journal of Clinical Pharmacology.

Seaquist, E. R., Blonde, L., McGill, J. B., Heller, S. R., Kendall, D. M., Bumpass, J. B., ... & Grant, M. L. (2020). Hypoglycaemia is reduced with use of inhaled Technosphere® Insulin relative to insulin aspart in type 1 diabetes mellitus. Diabetic Medicine, 37(5), 752-759

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