Immediate Treatment: MW was rehydrated with normal saline given intravenously (IV). She also was given insulin IV. Blood glucose, ketone bodies, and electrolytes were measured periodically. Antibiotic treatment of her UTI was started.
Long-Term Treatment: Diabetes increases the risk for macrovascular complications (such as coronary artery disease and stroke) and microvascular complications (such as retinopathy, nephropathy, and neuropathy). Ongoing monitoring for these complications will be continued.
Prognosis: Diabetes is the seventh leading cause of death by disease in the United States. Individuals with diabetes have a reduced life expectancy relative to those without diabetes.
Nutrition Nugget: Monitoring total intake of carbohydrates is primary in blood glucose control. Carbohydrates should come from whole grains, vegetables, legumes, and fruits. Low-fat dairy products and nuts and fish rich in ω-3 fatty acids are encouraged. Intake of saturated and trans fats should be minimized.
Genetics Gem: Autoimmune destruction of pancreatic β cells is characteristic of T1D. Of the genetic loci that confer risk for T1D, the human-leukocyte antigen (HLA) region on chromosome 6 has the strongest association. The majority of genes in the HLA region are involved in the immune response.
Review Questions: Choose the ONE best answer.
RQ1. Which of the following statements concerning T1D is correct?
A. Diagnosis can be made by measuring the level of glucose or glycated hemoglobin (HbA1c) in the blood.
B. During periods of physiologic stress, the urine of an individual with T1D would likely test negative for reducing sugars.
C. T1D is associated with obesity and a sedentary lifestyle.
D. The characteristic metabolic abnormalities seen in T1D result from insensitivity to both insulin and glucagon.
E. Treatment with exogenous insulin allows normalization of blood glucose (euglycemia).
RQ2. DKA occurs when the rate of ketone body production is greater than the rate of utilization. Which of the following statements concerning ketone body metabolism is correct? Ketone bodies:
A. are made in mitochondria from acetyl coenzyme A (CoA) primarily produced by the oxidation of glucose.
B. are utilized by many tissues, particularly the liver, after conversion to acetyl CoA.
C. include acetoacetate, which can impart a fruity odor to the breath.
D. require albumin for transport through the blood.
E. utilized in energy metabolism are organic acids that can add to the proton load of the body.
RQ3. Adipose lipolysis followed by β-oxidation of the fatty acid (FA) products is required for the generation of ketone bodies. Which of the following statements concerning the generation and use of FA is correct?
A. Mitochondrial β-oxidation of FA is inhibited by malonyl CoA.
B. Production of FA from adipose lipolysis is upregulated by insulin.
C. The acetyl CoA product of FA β-oxidation favors the use of pyruvate for gluconeogenesis by activating the pyruvate dehydrogenase complex.
D. The β-oxidation of FA utilizes reducing equivalents generated by gluconeogenesis.
E. The FA produced by lipolysis are taken up by the brain and oxidized for energy.
TQ1. At admission, MW was hypoinsulinemic, and she was given insulin. Why did MW’s hypoinsulinemia result in hyperglycemia? Hint: What is the role of insulin in glucose metabolism?