HSE706 Research In Clinical Exercise Physiology

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Question:

Jake just switched schools. His teacher has recommended that Jake’s mom visit the GP.

He has been extremely tired and sleepy in class.

He’s also been using the toilet more than his classmates, and it is particularly noticeable after lunch.

She feels that he has lost weight over the first month and that his uniform looks much bigger than before he started.

His mother has noticed that he complains of genitalitching, and she hasn’t changed her washing powder.

His mum noticed that he was using the toilet more frequently, and she believed this was due to itching. He also seems to be drinking more since he is thirsty.

His only major change was moving to a different place and starting a school in a new location.

Before his teacher reached out with more information, she thought it was simply due to Jakes Dad’s relocation stress.

The GP performs some point-of-care testing and takes a finger prick to test the glucose monitor.

Do you need a dipstick to take a urine sample?

These are the results.

* Blood glucose 22.1mmol/l

* A dipstick urine analysis shows that there is glucose ++ / 500mg/dl / 28mmol/l as well as a small amount Ketones.

Jake is referred to Accident and Emergency by the doctor. The doctor orders a complete blood count and a urinalysis.

Discuss all of the results (blood and urine), and give a diagnosis for Jake.

This data should be presented and analysed appropriately.

Discuss the pathophysiology behind the cellular changes that are responsible for Jake’s current health.

You may also need to explain his symptoms.

Jake is admitted and an oral glucose tolerability test (OGTT), requested.

This is performed the next morning.

Table 1: OGTT Results

Jake attended a meeting with his consultant 6 months later to review his condition.

The results were:

* HbA1c of 9.9% or 75mmol/mol

This test detects the presence protein, leucocytes nitrite’s, and glucose.

Photometry results for flames:

Discuss the results and make suggestions for improving Jake’s health.

Answer:

Jake’s laboratory tests were outside the normal range.

Rao & Raju (2016) state that the random blood sugar level of 22 mg/L is significantly higher than the normal level of 7.5 mg/L for a healthy person.

The normal person should not experience this because insulin is responsible for lowering blood sugar by allowing glucose to move from the blood to the cells.

A glucose level of 28 mg/liter in urine is also higher that the normal value between 0 and 0.8 mmol/L (Gu, pp.7191-7197).

Nearly all of glucose is absorbed by the kidney’s proximal convoluted tubes after it has been filtered out by theglomerulus.

This should lead to a reduction in the amount of glucose that is lost through urine.

Jake has been using the toilet more than normal. This is called polyuria (Mahon.et.al 2018.).

This is due to glucose loss in urine. Water follows passively, leading to large amounts of urine.

Polydipsia, which is a form of thirst, has been a problem (Coleman.et.al 2016.).

The patient needs to drink too much fluid to make up for any fluids that are lost in the urine.

A diagnosis of Diabetes mellitus Type 1 can be made based on Jake’s signs and symptoms.

This is caused by polyuria, poldipsia, glucose in urine, and random blood sugar levels above 22 mmol/L.

Type one diabetes can also occur at an early age.

Pathophysiology Type 1 Diabetes Mellitus

Zaccardi and colleagues (2016, pp.

Type 1 diabetes mellitus (pp. 63-69) is an autoimmune disorder that can occur in people who are genetically predisposed and may be accelerated by environmental factors.

These individuals develop an immune response that mimics viral proteins and triggers an autoimmune reaction against pancreatic betacell antigen.

Thus, antibodies are produced which cause destruction of beta cells that produce insulin.

Some people with diabetes mellitus may be in a preediabetes condition for long periods of time, before they develop diabetes mellitus.

If Langham’s islets cells die, the body will have very low or no insulin.

There is an increase in blood glycogen and impaired glucose uptake by muscles, adipose and other cells.

Also, there are no inhibitory stimuli that can inhibit hepatic sugar production, lipolysis and ketogenesis.

This causes an increase in blood glucose.

This can lead to diabetic ketoacidosis, dehydration and osmotic dilution.

Diabetes patients can also suffer from muscle wasting. This is due to a decreased uptake of protein amino acids and failure to inhibit the degradation of protein.

Diabetes is characterized by polyuria and polydipsia.

The excessive accumulation of glucose in blood can cause polyuria (excessive urine production).

When there is too much glucose in the blood, the kidneys attempt to reabsorb it as quickly as possible. However, if it can’t, they eliminate it through urine.

It creates a concentration gradient, which causes water loss from the tissues.

Dehydration is caused by fluid loss.

Therefore, the body will feel thirsty to get more fluids.

The loss of glucose through urine causes weight loss.

In this situation, the body can no longer use glucose as an energy source and will instead turn to fats and structural proteins to generate energy.

This results in weight loss regardless of food intake.

One of these symptoms is fatigue.

Inability to absorb glucose by cells to turn it into energy results in decreased energy levels.

The patient feels tired even after consuming carbohydrate.

Itching could be caused by yeast overgrowth in the genital regions.

A high glucose level can create a favorable environment that allows microorganisms to grow, and the normal flora becomes problematic (Hessler and.al 2016, pp.

An oral glucose tolerance test is a measure of the blood glucose levels two hours after 75mg of glucose was consumed.

Normal glucose levels should not exceed 11.1 mmol/L in a healthy person after an hour, and 7.8 mmol/L for two hours.

Jake completed an oral glucose tolerance testing. His results were 9.8 mmol/L blood sugar after one hour and 12.0 mmol/L after two hours.

This is more than usual.

Low insulin levels can cause diabetes patients to have lower glucose tolerance.

The cells of diabetes suffer from a reduced ability to absorb glucose for energy production and other functions. This results in blood sugar accumulation (Farrar, et.al 2015.

According to the diabetes prevention program (2015, pp.

51-58. HbA1c is a test to determine the plasma glucose concentration in three months.

This test monitors how blood glucose levels have changed over the last three months.

Glycated haemoglobin levels that are higher than normal indicate poor blood sugar control.

Glycated haemoglobin should never exceed 6.5% in well-controlled diabetes.

Jake’s results showed that Jake has a glycated half-life of 9%. This is lower than the norm and is indicative of poor control.

Sodium levels in excess of 200 mg/L are above the normal range of 135 mmol/L to 145 mmol/L.

This is due to fluid and electrolytes imbalance.

Hypernatremia is a condition where fluid loss is greater than fluid intake.

This is essential for the body to reabsorb additional fluids.

Levels of potassium of 5 mmol//L fall within the normal range between 3.5 and 5.0 mmol/L.

What should be changed?

Jake must receive insulin injections at the minimum of six times per day depending on his blood sugar level.

The function of insulin production by the pancreas will be replaced. Blood glucose levels will therefore drop.

The excess glucose is converted to energy, glycogen stored and amino acids in protein synthesis (Beck 2017 pp.371-378).

Jake needs to drink more fluids to balance the fluids and electrolytes.

A higher fluid intake lowers sodium levels.

Jake should avoid foods high in sodium like canned meat, fish, and poultry.

It is important to exercise in order lower sodium levels. Nerves and muscles use sodium for their functions.

As insulin is known to cause hypoglycemia, it is important that he eat a balanced meal at least three times per day. He also needs snacks between meals.

You should eat enough carbohydrates to provide energy for your body and stop protein metabolism for energy.

This will enable the patient gain weight (Laiset.al 2016, pp.

References

Beck, R.W.; Riddlesworth T.; Ruedy K.; Ahmann A. Bergenstal R., Haller S. Kollman C. Kruger D. McGill J.B. Polonsky W., and Toschi E.

Continuous glucose monitoring has a positive effect on the glycemic management of type 1 diabetics who receive insulin injections. This was demonstrated in the DIAMOND clinical trial.

Coleman, S.K. Rebalka I.A. D’Souza D.M. Deodhare N. Desjardins E.M. Hawke T.J.

Myostatin inhibition therapy in insulin-deficient type one diabetes

Scientific Reports, 6, 324955.

Diabetes Prevention Program Research Group. 2015.

HbA1c is a measure of diabetes risk and a result in the diabetes prevention program. A random clinical trial.

Diabetes care 38(1): pp.51-58.

Farrar D.; Duley L.; Medley N.; Lawlor D.A. 2015

Different diagnostic strategies are available to diagnose gestational diabetes in order to improve the health of infants and mothers.

(1). Cochrane Database of Systematic Reviews.

Camden (J.P.), 2016.

Camden, J.P., 2016.

Analytical chemistry. 88 (14), pp.7191-7197.

Hessler D. Fisher L. Polonsky W. Polonsky N. Johnson N.

Understanding the areas and correlates that lead to diabetes-related distress in teens with type 1 diabetes parents.

Journal of Pediatric Psychology, 41(7), pages 750-758.

Cousins R.J.

Effect of a one-week balanced diet upon expression of genes related Zinc Metabolism, and Inflammation in Type-2 Diabetic patients.

Clinical nutrition research. 5(1), pp. 26-32.

(2018). Roche, E.F.

Five-minute consultation: Polydipsia or polyuria.

Archives of Disease in Childhood-Education and practice, pp.edpract-2018.

Rao R. and Raju G.B., 2016.

It is important to know the significance of random blood sugar and pseudocholinesterase levels for organophosphorus compound poisoning.

International Journal Of Community Medicine And Public Health. 3(10). pp.2757–2761.

Zaccardi F. Webb D.R. Yates T. Davies M.J.

Pathophysiology and complications of type 1 diabetes mellitus. A 90-year view.

Postgraduate medical journals, 92(1084). pp. 63-69.

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