Extra Credit for BIOC 460 Final

1. Biochemical Case
Study
MADISON JENSEN

2. Patient’s Symptoms
Mary, a 52 year old diabetic women, has recently been feeling more weak and fatigued than
usual. She has recently been under a lot of stress at work. Mary has noticed that her blood sugar
has been slightly higher than usual. Her family members notice she is not being herself and think
that this could just be due to the stress that she is going through. After a few days, however,
Mary seems confused and is often short of breath. She is also always drinking water and is
constantly leaving to use the restroom. Mary takes insulin shots everyday to help control her
type II diabetes that she was diagnosed with 6 years ago. After about five days of this odd
behavior, Mary’s husband decides that she should go in to see the doctor. During examination,
the nurse notices that Mary’s breath is very sweet and almost fruity smelling. After looking at
Mary’s medical charts to verify that she is a diabetic, the nurse immediately informs the doctor of
Mary’s symptoms.

3. 1.How would you diagnose the
patient? What tests would you
perform?
2.What is the diagnosis?
3.What treatments would you give?
Questions to Consider...

4. Diagnostic Testing
 The doctor immediately asks for urine samples
and a test of ketone levels in the urine.
 Results show that the urine is positive in ketones.
 Because of this, the doctor orders a blood test.
 Beta-hydroxybutyrate (a common ketone) is
measured in the blood.
 Results depict a high level of beta-
hydroxybutyrate in the blood.

5. Biochemistry
 Without enough insulin, the body cannot use sugar properly
for energy. This leads to the release of hormones that break
down fat as fuel which produces acids known as ketones.
 Ketones are produced in the liver when fat cells break down in
the blood.
 Excess ketones can build up in the blood
 This excess build up will lead to higher acidity (lower pH) in
blood

6. Diagnosis: Diabetic Ketoacidosis (DKA)
 The doctor comes to the conclusion that Mary is
experiencing Diabetic Ketoacidosis.
 The doctor keeps Mary overnight and
administers fluids, electrolytes (chloride,
potassium, sodium), and insulin therapy. He also
increases Mary’s daily insulin dosage.
 DKA commonly occurs in those with Type I
diabetes, however like in Mary’s case, it can also
occur in those with Type II.

7. Treatments/ Drugs
 Fluid replenishment
 Electrolyte replenishment
 Insulin therapy:
-insulin reverses the process that cause DKA
- insulin is secreted by B-cells of the pancreas
-insulin secretion is regulated by plasma glucose
levels
-insulin regulates glucose metabolism in blood
-stimulates lipogenesis, diminishes lipolysis, and
increases amino acid transport into cells

8. Insulin Pathway- Glucose Stimulated
1. Increase blood glucose leads to uptake by
pancreatic B-cells through GLUT2
2. Glucose is oxidized to pyruvate via glycolysis
3. Pyruvate is oxidized by PDKc resulting in
acetyl-CoA
4. Acetyl CoA is oxidized by TCA cycle
5. Resulting NADH and FADH2 are oxidized via
oxidative phosphorylation machinery leading
to higher ATP levels
6. Increased ATP inhibits KATP channel
7. Membrane depolarizes leading to an influx of
calcium ions
8. Migration of insulin-containing vesicles to the
plasma membrane occurs
9. Insulin is released into the bloodstream

9. Impact of DKA
 Very treatable
 Sometimes previously undiagnosed diabetes is found because of DKA
 Complications
-low blood sugar (hypoglycemia): results from blood sugar levels dropping too
quickly
-low potassium (hypokalemia): fluids and insulin used for treatment can cause
potassium levels to drop to low which can impair activities of the heart, muscles, and
nerves
-swelling in the brain (cerebral edema): adjusting blood glucose level too quickly
can lead to this; appears most commonly in young children, especially those with newly
diagnosed diabetes
 Most seriously- if left untreated can lead to loss of consciousness or even death

10. Statistics: Diabetes is becoming more
common **COST- With an annual average of 135,000
hospitalizations for DKA, average cost per
patient ~$17,500. The annual hospital cost
may exceed $2.4 billion per year.