Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests

Adolescent With Diabetes Mellitus (DM)
Case Studies
The patient, a 16-year-old high-school football player, was brought to the emergency room in a
coma. His mother said that during the past month he had lost 12 pounds and experienced
excessive thirst associated with voluminous urination that often required voiding several times
during the night. There was a strong family history of diabetes mellitus (DM). The results of
physical examination were essentially negative except for sinus tachycardia and Kussmaul
respirations.
Studies Results
Serum glucose test (on admission), p. 227 1100 mg/dL (normal: 60–120 mg/dL)
Arterial blood gases (ABGs) test (on admission),
p. 98
pH 7.23 (normal: 7.35–7.45)
PCO2 30 mm Hg (normal: 35–45 mm Hg)
HCO2 12 mEq/L (normal: 22–26 mEq/L)
Serum osmolality test, p. 339 440 mOsm/kg (normal: 275–300
mOsm/kg)
Serum glucose test, p. 227 250 mg/dL (normal: 70–115 mg/dL)
2-hour postprandial glucose test (2-hour PPG), p.
230
500 mg/dL (normal: <140 mg/dL) Glucose tolerance test (GTT), p. 234 Fasting blood glucose 150 mg/dL (normal: 70–115 mg/dL) 30 minutes 300 mg/dL (normal: <200 mg/dL) 1 hour 325 mg/dL (normal: <200 mg/dL) 2 hours 390 mg/dL (normal: <140 mg/dL) 3 hours 300 mg/dL (normal: 70–115 mg/dL) 4 hours 260 mg/dL (normal: 70–115 mg/dL) Glycosylated hemoglobin, p. 238 9% (normal: <7%) Diabetes mellitus autoantibody panel, p. 186 insulin autoantibody Positive titer >1/80
islet cell antibody Positive titer >1/120
glutamic acid decarboxylase antibody Positive titer >1/60
Microalbumin, p. 872 <20 mg/L
Diagnostic Analysis
The patient’s symptoms and diagnostic studies were classic for hyperglycemic ketoacidosis
associated with DM. The glycosylated hemoglobin showed that he had been hyperglycemic over
the last several months. The results of his arterial blood gases (ABGs) test on admission
indicated metabolic acidosis with some respiratory compensation. He was treated in the
Case Studies
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2
emergency room with IV regular insulin and IV fluids; however, before he received any insulin
levels, insulin antibodies were obtained and were positive, indicating a degree of insulin
resistance. His microalbumin was normal, indicating no evidence of diabetic renal disease, often
a late complication of diabetes.
During the first 72 hours of hospitalization, the patient was monitored with frequent serum
glucose determinations. Insulin was administered according to the results of these studies. His
condition was eventually stabilized on 40 units of Humulin N insulin daily. He was converted to
an insulin pump and did very well with that. Comprehensive patient instruction regarding selfblood glucose monitoring, insulin administration, diet, exercise, foot care, and recognition of the
signs and symptoms of hyperglycemia and hypoglycemia was given.
Critical Thinking Questions

Why was this patient in metabolic acidosis?
Do you think the patient will eventually be switched to an oral hypoglycemic agent?
How would you anticipate this life changing diagnosis is going to affect your patient
according to his age and sex?
The parents of your patient seem to be confused and not knowing what to do with this
diagnoses. What would you recommend to them?(500-600 words)

Sample Solution

Answer:
This patient was in metabolic acidosis because of his high glucose levels. Hyperglycemia causes a shift in the body’s pH balance, resulting in an increase in H+ ions and a decrease in bicarbonate (HCO3) levels. This is known as metabolic acidosis, and it can be life-threatening if left untreated.
It is possible that the patient will eventually be switched to an oral hypoglycemic agent, but this will likely depend on how well he responds to the insulin pump therapy that he has been using since his initial hospitalization. As with any diabetes management plan, teaming up with a healthcare professional who specializes in diabetes can help ensure that the individual’s needs are being met and that they are receiving appropriate support from both medical personnel and family members.
Considering the patient’s age (16 years old), sex (male), and diagnosis of type 1 diabetes mellitus, it is likely that this life-changing diagnosis will have far-reaching effects on all aspects of their life.

Firstly, there may be physical changes due to having to monitor blood sugar levels more frequently or adjusting diet/exercise routines for longer term health goals – such as reducing risk for cardiovascular disease or maintaining healthy weight/body composition throughout adulthood. There may also be psychological implications due to increased stress or anxiety related to managing this chronic condition long term; additional support through counseling might prove beneficial depending on individual circumstances. Finally, there may also be social impacts due to lifestyle changes necessary for better diabetes management or potential financial burdens associated with ongoing treatments or medications required for maintenance of glycemic control over time (especially if insurance coverage isn’t ideal).
The parents of this patient should first seek out accurate information about type 1 DM so they may better understand what their child is dealing with now and how it could potentially affect them going forward into adulthood/old age. They should also look into proper education regarding nutrition/meal planning so their son can maintain safe blood glucose levels while enjoying food – especially during times when carbohydrates must make up part of his daily meals but would still like variety beyond just starches at each mealtime! Additionally, talking openly about feelings related to managing T1D can help normalize those emotions within the family unit while improving communication between all involved parties; enlisting outside resources (like counselors) could even further facilitate discussions concerning difficult topics during challenging times throughout treatment journey(ies). Lastly, finding local support groups specific towards T1DM care & management would allow them access not only knowledgeable peers who have gone through similar experiences themselves but possibly even new friends who share common interests & passions!

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