Mr. R is a 48-year-old Hispanic man who has
worked the past 10 years as a warehouse worker. He is 5’6″, weighs 175
pounds, and has a waist circumference of 38″. At his last visit at your
office, his blood pressure was 140/60 mm Hg. Prior to the visit, he had fasting
blood work done, and his primary care provider plans to review the results with
him today. The pertinent diagnostic results are as follows: a fasting plasma
glucose level of 137 mg/dL, an HDL level of 27 mg/dL, LDL level of 247 mg/dL, a
serum triglyceride level of 210 mg/dL. Use the following prompts as guidelines
while performing and writing your case study:
1. Identify what this individual is most at
risk for based on the information presented in this case above.
2. Explain the significance of this
individual’s weight and waist diameter. Explain how this individual is at
increased risk for insulin resistance.
3. Explain briefly the differences between
hypoinsulinemia, hyperinsulinemia, hyperglycemia, and hypoglycemia as each
relate to an individual with type 1 diabetes mellitus and type 2 diabetes
mellitus.
Expert Solution Preview
Introduction:
This case study involves a 48-year-old Hispanic male, who presents with high blood pressure and abnormal blood work results. As a medical professor responsible for designing and conducting medical college assignments, I will provide answers to the questions raised in this case study.
1. What is the individual most at risk for based on the information presented in this case above?
The individual is most at risk for developing type 2 diabetes mellitus (T2DM). The abnormal blood work results, including a fasting plasma glucose level of 137mg/dL, an HDL level of 27mg/dL, LDL level of 247mg/dL, and a serum triglyceride level of 210mg/dL, are indicative of metabolic syndrome. Metabolic syndrome is a cluster of conditions that increase the risk of developing T2DM, cardiovascular disease, and stroke.
2. What is the significance of this individual’s weight and waist diameter? How is this individual at an increased risk for insulin resistance?
The individual’s weight and waist diameter are both significant indicators of insulin resistance. Excess weight, specifically abdominal fat, increases the risk of insulin resistance, whereby the body’s cells become less responsive to insulin hormone. Insulin resistance results in high levels of glucose in the bloodstream and, eventually, the development of T2DM. Additionally, the presence of abdominal fat promotes the release of adipokines, which cause inflammation and further reduce insulin sensitivity.
3. Can you explain the differences between hypoinsulinemia, hyperinsulinemia, hyperglycemia, and hypoglycemia, as they relate to an individual with type 1 diabetes mellitus and type 2 diabetes mellitus?
Hypoinsulinemia refers to a deficiency in insulin production, resulting in high levels of glucose in the bloodstream. In type 1 diabetes mellitus (T1DM), the immune system attacks and destroys the cells in the pancreas that produce insulin, leading to an insulin deficiency. Hyperinsulinemia occurs when the body produces excess insulin hormone, leading to low glucose levels in the bloodstream. In T2DM, hyperinsulinemia occurs as the body’s cells become insulin resistant, and the pancreas produces more insulin to compensate for the resistance. Hyperglycemia refers to high levels of glucose in the bloodstream and is a hallmark feature of both T1DM and T2DM. In contrast, hypoglycemia refers to low levels of glucose in the bloodstream, which can occur in individuals with diabetes who take insulin or other medications to reduce glucose levels.
