Case Studies

Real Life Cases

Case Study - IV

Name	Manoj Kumar	Age	48 years	BMI	21.88
Occupation	Businessman	Height	171 cm	Weight	64 kg
WHR	0.96	Waist	98 cm	Hip	102 cm

Presenting Complaint :

Frequent urination at night – 6 months
Weight loss – approximately 7 kg over the last 6 months, total 9 kg over the past year

Past History

Manoj Kumar is a known diabetic since the past 8 years. He was suspected to have diabetes on the basis of a routine blood glucose examination [random blood glucose 220 mg/dl] performed during hospitalisation for accidental trauma. The diagnosis was confirmed by a repeat fasting and postprandial glucose examination performed a week later [Fasting plasma glucose 170 mg/dl and 2 h post-prandial plasma glucose 280 mg/dl]

Past Treatment History

Manoj Kumar was prescribed the following treatment :

Diet aimed at normalising the body weight [ targeted reduction of 10 kg in 5 years - from 80 kg in 1992 to 70 kg in 1997
Exercise commensurate with his age and physical fitness
Plasma glucose lowering therapy – initially a sulfonylurea in the appropriate dose; and addition of metformin when glycemic control became inadequate 4 years later (in 1996)

Respective plasma glucose concentrations over the past 8 years showed how the diabetic state responded to the treatment

Year	Average FPG mg/dl	Average 2h PPG mg/dl	Drug 1	Drug 2	Body weight	Remarks
1993	150	220	SU	-	80	Weight loss due to planned diet and exercise regimen
1994	140	220	SU	-	78
1995	130	190	SU	-	78
1996	140	240	SU	Metformin	77
1997	130	170	SU	Metformin	75
1998	130	190	SU	Metformin	74
1999	140	200	SU	Metformin	73
2000	220	270	SU	Metformin	64

Type 2 diabetes is a chronic progressive disorder caused by a deficiency or defective action of insulin, the principal glucoregulatory hormone in the body. Glucose is the metabolic fuel of choice in all forms of life, and therefore it is a reactive molecule that undergoes metabolic changes in the body to yield energy for cellular activities. Its reactivity and potentially tissue damaging effects are kept under control by insulin, hormone produced and secreted by the cells of the islets of Langerhans of the pancreas. Insulin enhances tissue uptake and utilisation of glucose and tends to lower its concentration in blood.

In type 2 diabetes insulin secretion is inadequate to keep the plasma glucose under control, and plasma glucose levels rise. Hyperglycemia results in an accentuation of the toxic effects of glucose on cells and cellular structures by causing what is known as ‘non-enzymatic glycosylation’ or ‘glycation’ in which glucose freely reacts with several molecules and cellular structures and alters their structure and function. Hyperglycemia induced glucotoxicity explains the occurrence of several features of the diabetic state e.g. the damage to endothelium, basement membrane thickening, hypercoagulability due to interference with the function fibrinolytic mechanisms, reduced anti-oxidant defences, etc.

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