Case Study 1: Type 1 Diabetes Mellitus

Question 1

The factor that would be thought to have had the greatest effect on the development of type I diabetes mellitus in K.S.’s case would be:

1. female sex
2. Caucasian race
3. grandmother’s hypothyroidism
4. increasing age
5. recent viral infection

Answer 1

Caucasian race

• increasing age is correct for T2
• Hypothyroidism is not relevant

Question 2

The most likely cause of K.S.’s polyuria and weight loss before her hospitalisation was:

1. inadequate dietary intake and excessive fluid intake
2. lack of functioning insulin
3. reduced sensitivity of insulin receptors
4. lack of functioning glucagon
5. reduced numbers of insulin receptors

Answer 2

lack of functioning insulin ( T1= deficiency in insulin)

Question 3

K.S. has been taught to regulate her insulin pump according to her needs and does this very well. She will most appropriately decrease the rate of insulin injection:

1. before meals
2. when she has a cold
3. before netball practice
4. while studying for school exams
5. none of the above

Answer 3

before netball practice

Question 4

K.S. regulates her insulin successfully for several weeks. One day at school, she notices she is having difficulty concentrating, is irritable, and has blurred vision. She notes that she has neglected to readjust her insulin pump after giving herself a bolus of insulin at breakfast. These symptoms are therefore most likely a result of:

1. neurological malnutrition
2. adrenergic reaction
3. hyperosmolar hyperglycemic non-ketotonic coma
4. diabetic ketoacidosis
5. something else unrelated to her diabetes

Answer 4

neurological malnutrition

Question 5

K.S. is concerned that she will never be able to have a snack with her friends after school. She should be taught that snack food CAN be incorporated into her diet and that her optimal diet should be:

1. low in both fats and carbohydrates
2. sufficient in calories to maintain normal weight.
3. high in proteins and fats and low in simple carbohydrates
4. low in simple carbohydrates.

• 2 only
• 4 only
• 1 and 2 only
• 2 and 3 only
• 2 and 4 only

Answer 5

2 and 4 only

Control BG bc simple carbs can increase BG

Question 6

K.S. becomes ill with flu. Because she is not eating, she also discontinues her insulin for several days. She begins to feel weaker and more lethargic. She voids frequently and notes the presence of acetone in her urine. When she checks her blood glucose by finger stick, she is surprised to find that her glucose is 8.5mM. She tells her parents, “I can’t do anything right! It’s as bad as it was before”. Her parents take her to the local hospital. There, a diagnosis of diabetic ketoacidosis (DKA) is made.

K.S. has most likely developed DKA because she:

1. is experiencing a tremendous growth spurt
2. has not eaten anything for several days
3. has insufficient amounts of both insulin and stress hormones
4. has a deficiency of insulin with an increase in stress hormones
5. has insufficient levels of stress hormones

Answer 6

has a deficiency of insulin with an increase in stress hormones

Question 7

As K.S. matures, the earliest chronic sequence she is likely to develop will be a manifestation of:

1. microvascular disease
2. macrovasular disease
3. sexual disorders
4. other endocrine dysfunction
5. aandc.

Answer 7

microvascular disease

• micro=damage to tiny vessels
• macro= main arteries