Why do stress and infection promote hyperglycemia in patients with diabetes

Case Study 1: Alterations of the Endocrine Function

C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.

1. Clinical signs are objective manifestations of a disease that can be identified by someone other than the patient. List a minimum of four signs from the case study above that support a diagnosis of type 2 diabetes in this patient.

2. Why do stress and infection promote hyperglycemia in patients with diabetes?

3. Why should medications other than glipizide or glyburide be considered for management of diabetes in this patient?

Case Study 2: Alterations of the Musculoskeletal Function

G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.

1. Identify four risk factors that have predisposed this patient to osteoarthritis.

2. The primary cause of limited range of motion in a joint afflicted with osteoarthritis is/are:
a. bone spurs
b. loss of proprioceptive reflexes
c. formation of new bone
d. degeneration of articular cartilage
e. cysts that form in subchondral bone

3. Are there any forms of complementary and alternative medicine available for treating osteoarthritis?

4. What are the brand names of two topical pain creams that contain the pain reliever trolamine salicylate and have been widely promoted to temporarily relieve arthritis pain?

5. Cockscomb is a garden plant commonly grown for its flowers. Name a medication derived from cockscomb that is used to treat osteoarthritis.