Block 2 Case 3 Answers

A 12 year old Caucasian boy presents to the Doctors office complaining of polydipsia, polyuria and blurred vision. His mother notes that he has had a significant weight loss and is chronically fatigued. His glucose level is 312.

1. What is the most likely diagnosis? IDDM

2.What is the treatment for this condition - and why is it necessary?

 Insulin, autoimmune destruction of the beta cells of the pancreas renders them unable to produce insulin. Without insulin the body cannot bring the sugar from the bloodstream into the cells to be converted to energy. 

3. The doctor measure the boys Hemoglobin A1C to be 8 - what does this mean?

The amount of sugar in the bloodstream can be measured by the Hemoglobin A1C. It measures the amount of glycosylated RBCs and gives an estimate of the RBCs exposure to sugar over the past 3 months (because a RBC lives 120 days).  For a person with diabetes the goal is to keep the Hemoglobin A1C under 6.5-7%. 

4. List three major complications from this disease if it is poorly managed:

• atherosclerotic disease: increased stroked, PVD, CAD
• renal failure
• increased risk cataracts/glaucoma
• retinopathy
• peripheral nervopathy
• increased UTIs

A biopsy of the pancreas is taken years after the child is diagnosed:

http://www.diapedia.org/type-1-diabetes-mellitus/pathogenesis

2. What pathology is seen in this slide?

This is a slide of the pancreas. The islets of Langerhans (where the beta cells that produce insulin are located) has been infiltrated by lymphocytes. Auto-antibodies against the cells leads to their destruction and therefore an insulin deficiency necessitating the need for insulin therapy. Note: below is a normal islet. 

3. What 3 major cell types are found within the islet?
Alpha: 15-20% of the cells - makes glucagon
Beta: 65-80% of the cells - make insulin
Delta: 3-10%: makes somatostatin

4. Type II diabetes

5. The amorphous acellular deposition is amyloid. If it were stained with congo red stain it would show apple green birefringence.