Question

JJ is a 13 YOWM who has high hopes of being a basketball star. He is tal coordinated. He loves the game and plays every chance he gets. He has beeohis age and is w was playing basketball after school with some friends when he bece e noticed that he was sluggish and not himself, but they thought he was havi rested his hands on his knees and then collapsed. When his friends rushed to h confused. He had been playing hard but not that hard. They tried to lay him d he was disorielidf ad water, but he was getting worse. He was perspiring excessively. They called his n and give him en healthy weak and nauseous. His friend a bad day. He bent over his parents s who then called an ambulance. JJ was rushed to the hospital and was quickly diagnosed with DKA 20 to Type diaetes (formerty cald ellitus [JODM] or Insulin Dependent Diabetes Mellitus IDDMm E I blood sugar was 620 mg/dl. They started an I.V. with DsW, R insulin, potassium, and phosphons, Soo JJ was awake and back to his normal self. It was necessary for him to remain in the hospital for a whilete regulate his insulin, meal plan, and activity sese sk ee k e te e QUESTIONS: 1. Explain the physiology behind the following symptoms Weak, sluggish: Nauseous: Disoriented and confused:

Answer 1

Type 1 diabetes or Insulin dependent diabetes mellitus is an autoimmune diseases in which body's immune system gets activated to destroy beta cells of pancreas that are responsible for insulin production. when enough beta cells are gone pancreas stop producing insulin or produces little insulin that is insufficient for the body.

High blood sugar often causes weakness and slugishness the reason is that diabetes affects the way body regulates and uses sugar in the body. Glucose is the main source of energy for the cells in the body. normally when person eats food it is broken down in simple sugars and then transported by insulin into the body cells to provide energy . In diabetic people these sugars accumulate in the blood and is not transported into the cells due to low levels or absence of insulin . When body cells are not getting enough sugar it causes symptoms like weakness, fatigue etc.  

when glucose levels in the blood rises due to deficiency of insulin, body tries to use alternate pathway to produce energy. The body tries to burn down the fat of body to produce energy. Excessive burning of fat in the body leads to the production of ketones(acids) as byproducts. Ketoacids decrease the pH of blood leading to dangerous acid base imbalance in the body. This increase in ketoacids cause abdominal pain, nausea and vomiting. Also there is delayed gastric emptying in type 1 diabetes which is also responsible for nausea.

Confusion and disorientation is caused by electrolyte imbalance. Hyperglucemia leads to osmotic diuresis producing electrolyte and fluid loss in the body . Dehydration and electrolyte imbalance along with acid base imbalance in the body due to ketoacidosis cause delirium and disorientation in the patient.

Pathophysiology of DKA

Diabetic ketoacidosis is an acute complication of type 1 diabetes mellitus characterized by hyperglycemia ( high blood sugar level), hyperketonemia ( high levels of ketones in the blood) and metabolic acidosis. when body does not get energy through glucose due to insulin deficiency it utilizes alternate pathway. Body metabolizes triglycerides and amino acids for energy production. Due to excessive breakdown of fats,i levels of glycerol and free fatty acids increase in the blood. Glycerol is used as substrate for hepatic gluconeogenesis which is stimulated by increased glucagon level in the body (when insulin level drops in body glucagon level increases). This glucagon also stimulates mitochondrial conversion of free fatty acids into ketones (Insulin inhibit transport of free fatty acid into the mitochondrial matrix and does not favor ketoacidosis). These keto acids are strong acids and cause metabolic acidosis in diabetic persons.

Type 1 diabetes mellitus can cause following symptoms:

1. excessive thirst due to dehydration
2. Fatigue and weakness
3. confusion
4. Frequent urination due to increased osmotic diuresis
5. increased hunger
6. weight loss due to increased lipolysis
7. Blurred vision
8. Irritability and mood changes

High blood sugar causes osmotic diuresis resulting in fluid loss and electrolyte loss. There is urinary excretion of ketones which cause additional loss of sodium and potassium. Use of insulin R, glucose, phosphorous and potassium through i.v is an emergency treatment for hyperglycemia induced ketoacidosis. The major treatment include electrolyte replacement therapy to compensate the loss of fluid and electrolytes(like sodium , potassium), glucose is used to overcome the general weakness . Low dose insulin is also given  to stabilize the increased sugar levels in blood.

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