Based on “Morgan: A case of Diabetes” by Lisa Rubin and Clyde Freeman Herreid (N
ID: 89817 • Letter: B
Question
Based on “Morgan: A case of Diabetes” by Lisa Rubin and Clyde Freeman Herreid (National Center for Case Study Teaching in Science)
The Patient:
Morgan Water is a 27-year old Native American that lives on a reservation in Oklahoma. Nearly ¼ of Morgan’s tribe has diabetes but she has no direct family history of diabetes, heart disease, or other serious conditions. She is however obese (BMI = 32) and leads a sedentary lifestyle. Morgan has been suffering from an increasing persistence of symptoms including unusual thirst, dizziness, blurred vision, and numbness in her right foot. The symptoms have been developing over several months but as she is planning her wedding she attributed them to nerves. She is finally persuaded to see her family doctor. Her non-fasting blood glucose level was elevated so the doctor has her return the next morning for a fasting blood sample so they could more accurately measure her blood glucose and insulin. Her blood results are below:
Test
Morgan’s values
Normal range
Pre-Diabetic range
Diabetic range
Plasma glucose, mg/dl
260
70 -139
140 - 199
200
Fasting glucose, mg/dl
140
99
100 - 125
126
A1C, %
7.6
~ 5
5.7 – 6.4
6.5
Fasting Insulin, mIU/ml
34
2 - 10
10 - 20
20
Question 1:
Based on her history and blood results, what do you think is the most likely diagnosis for Morgan?
A. Type I Diabetes Mellitus
B. Type II Diabetes Mellitus
C. Pre-Diabetes
D. Cardiovascular Disease
Question 2:
What is the cause of Morgan’s disease?
A. It is an auto-immune disorder that destroys the -cells of her pancreas so she produces less
insulin than normal.
B. She has a genetic mutation that results in less insulin receptor being produced than normal.
C. She has developed insulin resistance, where her insulin receptors do not recognize the insulin her
body produces, likely due to her obesity.
D. There is no known cause, it can happen spontaneously.
Morgan is worried that she will have to spend the rest of her life giving herself injections but her doctor does not prescribe insulin injections.
Question 3:
Why would injections of insulin not help Morgan if she has hyperglycemia?
A. Her body is already producing excess insulin but not responding to it.
B. Her problem is with her insulin receptors responding to insulin.
C. Excess insulin will only exacerbate her insulin resistance.
D. All of the above.
Question 4:
Given Morgan’s metabolic state, which of the following pathways would you expect to be active in Morgan’s cells (select all that apply)?
A. Glycolysis
B. Gluconeogenesis
C. -oxidation
D. Amino acid degradation
E. Protein synthesis
Test
Morgan’s values
Normal range
Pre-Diabetic range
Diabetic range
Plasma glucose, mg/dl
260
70 -139
140 - 199
200
Fasting glucose, mg/dl
140
99
100 - 125
126
A1C, %
7.6
~ 5
5.7 – 6.4
6.5
Fasting Insulin, mIU/ml
34
2 - 10
10 - 20
20
Explanation / Answer
Morgan Water is a 27-year old Native American has developed such symptos like thirst, dizziness, blurred vision, and numbness in her right foot. AS we know from medical point of view that as there are different type of diabetes. There is prediabetes and gestational diabetes, there are no symptoms associated with these kind. However in case of type 1 and type symptoms are usually, tiredness, blurred vision, frequent urination, thirst and hunger, weight loss. Now typically the type 1 is from the birth and generally it develops the symptoms very quickly, but symptoms can develop over several years in type 2.
Moving to the cardiovascular disease is that it caused by many reason associated with heart muscles. Stiffed blood vessels prevent heart, brain and other part to receive enough blood. Symptoms could be, Chest pain, Shortness n breath, pain, numbness, dizziness, blocked vessels in legs and hands, pain in different parts of the body.
Diabetes is related to heart disease too, if the diabetes is persisting for long, there are high risks for heart disease to follow.
A1C test is done to check for the blood glucose level for last 3months, this is one of the most accurate and important blood check. Here it can used with and without fasting condition.
Question 1. B. Type Diabetes mellitus.
Question 2. A and B options cannot be taken as she has got her insulin level very high, also her insulin or diabetic problem has not come from her parents in ancestral route, so B also cannot be take.
The probable reason would be, over time she has developed a resistance mechanism from the insulin produced to control her blood sugar levels. Option C is the right answer choice.
Question 3: D. all of the above would cause in case of hyperglycemia, as the patient is suffering from. It is not recommended as he has already a high level of insulin, this would lead to more of insulin resistance.
Question 4. In hepatocytes glycolysis would be normal, later contributes to hyperglycemia in diabetes. Invarious other cells also glycolysis in related to cell metabolism and insulin production.
Gluconeogenesis was consequently increased in the diabetics, this is also responsible to make the situation worse enough.
Type II diabetes patients are insulin resistance (IR) and beta cell dysfunction. When adipocytes produce pro-hyperglycemic factors and bring about hyperglycemia and insulin resistance. Insulin stops beta oxidation.
Reduced response to insulin in the inhibition of proteolysis at low.
So, here the pathways like A. Glycolysis, B. Gluconeogenesis, E. Protein synthesis would be active and high.