Friday, October 16, 2009

A 14-year-old boy has been suffering from type I diabetes mellitus for the past 6 years. His vision has deteri

A 14-year-old boy has been suffering from type I diabetes mellitus for the past 6 years. His vision has deteri?
A 14-year-old boy has been suffering from type I diabetes mellitus for the past 6 years. His vision has deteriorated in the last 2 years. He voids large volumes of urine and was admitted to the hospital with severe pyelonephritis, a kidney infection. Upon admission, the doctor found that he had mild ketoacidosis. Which type of insulin should be administered? Why? Are there any side effects of insulin administration? Besides medication, would diet and exercise affect blood glucose and insulin level in the patient? How? What could be the reasons for kidney infection and deteriorating vision? Why are kidney infections and vision problems common in diabetics? Why does an infection lead to acidosis and what will be the patient's serum bicarbonate level?
Diabetes - 1 Answers
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I'm hoping that this is for your homework and you're not asking about a real person?! If this is a real person then they need to speak to their dr about what to do! Anyway, assuming homework ... Insulin - upon admission the dr might decide to put him on a sliding scale (glucose/insulin drip) to stabilize blood sugar during the infection. After this normal insulin should be reviewed (because it's obiously not great for him) but continued unless his consultant can suggest something better. Side effects - the good thing is that hypos are meant to be avoided on a sliding scale because it's administered with a glucose drip. On usual injections / pump the main side effect is a hypo (low blood glucose) - this is actually an insulin overdose but v difficult to avoid completely. For your subject another side effect could be that if his blood sugars have been really high for a long time then bringing them down too quickly can make him feel hypo even though he's not and can also accelerate eye disease, so the dr would have to be very careful of this. Improving his diet and increasing exercise may help to stabilize his blood sugars but at this point changing diet and exercise would just throw another variable into the mix and make bringing his diabetes under control even more difficult. Type 1 diabetes is not like type 2 diabetes that can really benefit from diet and exercise changes. Diabetes causes damage to the retina at the back of the eye. This can be treated with laser surgery if it's caught early enough but this is a dangerous procedure so many people opt not to have it done. Left unchecked this kind of eye disease can cause blindness. The risk of it is greatly reduced by good blood glucose control. Diabetes can also affect kidney function and cause kidney damage / failure but a likely cause of this kidney infection is due to a much lowered immune system caused by diabetes - this leaves the body open to infection and particularly to thrush and urine infections - a urine infection left untreated can lead to a kidney infection. I don't think that your patient has dka (ketoacidosis) at this point although he may be heading for it. This is caused by an increase in metabolism during an infection which someone with diabetes can't cope with v well because to deal with dka you need extra carbs and extra insulin - your body makes this itself but the body of someone with diabetes doesn't. dka affects blood chemistry including bicarbonate and potassium levels. Hope that helps xx

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