Introduction to Human Disease  Tags: health_sciences human_diseases  

Ms. Darling: Managing a Chronic Disease

1. List and describe five differences between type I and type II diabetes mellitus (i.e., may be epidemiologic, genetic, molecular, etc.), and two similarities.  Explain insulin resistance using the terms insulin receptors, glucose transporters, & insulin blood levels.  Define the metabolic syndrome.
2. Explain what Hemoglobin A1C (HgbA1c) is and how is it formed.  Describe what leads to elevated HgbA1c levels and why HgbA1c levels are useful therapeutic guides.       
3. Briefly describe the development of the hyperosmolar state in the type II diabetic.  Explain how a diabetic may become volume depleted (or, dehydrated).   Ms. Darling describes some symptoms that suggest that she might be volume depleted: what are they?  Define orthostatic hypotension, and explain why it is important to check for this in a patient suspected to be volume depleted.  Demonstrate by role playing in your group how you would check for this during a physical exam. 
4. Distinguish the difference between diabetic microvascular disease and macrovascular disease.  Discuss, at the cellular level, three pathways by which hyperglycemia could cause microvascular end-organ disease leading to retinopathy, nephropathy, and neuropathy.  Focus on the main pathway, accelerated nonenzymatic glycosylation.  
5. Define macrovascular disease, and list the risk factors for coronary artery disease.  Why is it postulated that diabetics are at increased risk for macrovascular disease?  Role play in your group how you would advise a patient, such as Ms. Darling, to minimize her risk of macrovascular disease: give her three specific instructions.
6. Briefly explain what biochemical changes related to acute hyperglycemia caused Ms. Darling’s visual symptoms, and explain why this is not due to microvascular end-organ disease.   
7. Discuss three secondary preventive screening procedures recommended for patients with diabetes.

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