2. Following her visit to the pediatrician, Cindy undergoes a diabetic care training program, learning how to self-inject insulin subcutaneously and check her blood-glucose level at home with chemstrips. In addition, she learns the importance of carrying candy and glucagon with her at all times as well as eating the right amounts of food at the right times each day.

1. The elevation is due to failure of the beta-cells of the pancreas to produce hormone insulin, which facilitates entry of blood glucose into cells via GLUT transporters. Therefore the level of blood glucose rises, beyond threshold.

2. Lower blood pH is increase in blood acidity. it is due to the process of Gluconeogenesis; (conversion of non -carbohydrate molecule to glucose) where fatty acid is withdrawn from adipose tissues and broken down to ketone bodies by beta oxidation in the liver.Ketonebodies is acidic, therefore lowers the blood pH.(metabolic acidosis) this is complication is called Diabeticketoacidosis(DKA) and it is very common in type 1 diabetes mellitus.

3. the fruity odour is a result of ketone acidosis accumulation in the blood. the smell is that of acetone. this is a volatile ketone that can be released in the lungs. Due to metabolic acidosis, the body compensatory mechanism, buffer up the hydrogen ions; by excretion in the kidney, haemoglobin bonding with formation of haemoglobinic acid(HBB) and increases in breathing -hyperventilation to reduce blood C02 levels.

4.Frequent urination is due to elevated blood glucose levels from gluconeogenesis and glucogenlysis. The high glucose levels is excreted in the kidney, ans since the blood solute potential has increased,water flows out via osmosis. therefore large diluted urine is produced (polyuria); leading to dehydration.

5.The failure of glucose uptake by the cells, and constant massive loss in the urine leads to failure of cellular metabolic reaction and starving of the body cells.The satiety(hunger)center in the hypothalamus is stimulated and Cindy feels hunger pangs. However, in normal conditions GLUT transporters(membrane protein channels) under the regulation of insulin facilitates the uptake of glucose into the cells, for metabolic activities.These transporters are designated;e.g GLUT 1, (brain)GLUT 2,(liver) GLUT 4.(muscles)

1. she has type 1 diabetes mellitus, because of her age and most of her complications which are due to absence of hormone insulin in the blood streams, especially her metabolic acidosis,polyuria, dehydration,and hunger pangs.

2 this can lead to hypoglycemia, low blood glucose level as excessive insulin withdraws blood glucose,into the cells through the GLUT transporters. This depletes blood glucose leading to tiredness, confusion,fainting and constipation. It also leads to activation of sodium-potassium ATPases in the membrane cells, which increases the movements of excessive potassium ions into the cells. This leads to Hyperkalemia.

she needs to constantly maintain her blood glucose level to the threshold; because of massive losses in the kidney.Therefore, she needs candy to supply direct glucose to the cells from the blood, and to placate her thirst from polyuria and dehydration,by keeping her mouth moist,

and

hormone glucagon to break down glycogen to glucose to maintain blood glucose threshold level to the cells.

Explanation:

Chief Complaint: 8-year-old girl with excessive thirst, frequent urination, and weight loss. History: Cindy Mallon, an 8-year-old girl in previously good health, has noticed that, in the past month, she is increasingly thirsty. She gets up several times a night to urinate, and finds herself gulping down glassfulls of water. At the dinner table, she seems to be eating twice as much as she used to, yet she has lost 5 pounds in the past month. In the past three days, she has become nauseated, vomiting on three occasions, prompting a visit to her pediatrician. Questions A. At the doctors office, blood and urine samples are taken. The following lat resuits are noted blood glucose level 545 mg/dl (normal 50 170 mg/di) blood pH level 7.23 urine-tested positive for glucose and for acetone acetoacetate (ie. ketone bodies) (normally urine is free of glucose and ketone bodies) (normal 7.35-7.45) 1. Why is her blood sugar level elevated? (2points) 2. Why is her blood pH level decreased? (2 points) 3. Cindy has a fruity odor to her breath. Why? (2 points) 4 Explain why Cindy is urinating so frequently? (2 points) 5. How is Cindys condition like that of starvation? Address the role of glucose transport in your answer. (3 points) B. Following her visit to the pediatrician, Cindy undergoes a diabetic care training program, learning how to self-inject insulin subcutaneously and check her blood- glucose level at home with chemstrips. In addition, she learns the importance of carrying candy and glucagon with her at all times as well as eating the right amounts of food at the right times each day 6. Given that she is being treated with insulin, what type of diabetes does she have? What dangers confront Cindy as she gives herself insulin artificially ona daily basis? Why must she carry candy and glucagon with her at all times? (3 points)

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