Type 2 diabetes.

Zane is 37-year-old man who plays videos games as frequently as possible especially
if there aren’t any good shows on TV. He lives in his mum’s bungalow and has never had a
girlfriend. He presents to his GP with constant thirst and excessive urination. Although he
has great hand-eye coordination from playing so many games he has a poor diet and
doesn’t exercise regularly, and is overweight. He has elevated fasting insulin levels and is
diagnosed with type 2 diabetes.
Investigations:
Blood pressure: 145/90 mmHg (above normal range)
Pulse: 80 beats per minute (in normal range)
Weight 125 kg (well above normal for height)
Height 177 cm
Respiratory rate: 19 breaths per minute (in normal range)
Temperature 37oC (normal)
Electrocardiograph (ECG): Normal
Glucose and lipid profile after overnight fasting:
Glucose: 7.1 mmol/L (diabetic)
Insulin: 25uU/mL (above normal range)
Lipid profile -High cholesterol, high LDL cholesterol and low HDL cholesterol.
The main concepts to be reviewed:
Part A:
What body systems and/or parts of the system would be involved?
What is the normal structure and function of these body systems and/or parts?
Part B:
On the basis of fluid composition, diffusion and osmosis explain why diabetes would
affect electrolyte homeostasis, leading to either hyponatremia (low sodium) or
hyperkalemia (high potassium) in the serum.
How would this affect nerve conduction?

DIABETES 2
Why is there an increase in urination?
Briefly describe the association of obesity and type 2 diabetes.
Main body system affected: Endocrine system.

Case-Based Learning Assignment

The bod is composed of several organs that carry out specific functions. Some of the organs’
functions carry out coordinated functions, making up a body system. To achieve a particular task
in the body. Therefore, an effect of a condition on one organ or body system facets several
organs that are involved in the respective body system (Uhlén, Fagerberg, Hallström, Lindskog,
Oksvold, Mardinoglu, & Olsson, 2015). The following essay will discuss the e organs involved,
their anatomy and structure in the case scenario presented.

DIABETES 3

Part A

Body Systems Involved
The organs involved in the case scenario are; the liver, the blood vessels, the pancreas,
the kidneys and the brain and the adrenal glands. The body systems involved are the nervous
system, the cardiovascular system, and the endocrine system. The pancreas and the liver are
involved in the control the blood sugar levels through the production of glucagon and insulin.
The patient in the case scenario has abnormally increased levels of glucose and insulin.
Specifically, the liver is the site where chemical reactions involved in the control of blood
glucose take place. When the blood glucose rises, the receptors in the surface of the beta cells of
the pancreas are stimulated, triggering a cascade of intracellular metabolic events that finally
lead to the production of insulin hormone (Dupont, Falcke, Kirk, & Sneyd, 2016). The hormone
is secreted into the blood and targets the cells, specifically the adipose cells and the skeletal
muscle cells. The insulin receptors on the surface of these cells initiate a cascaded of intracellular
vents that trigger the transport vacuoles of the cells to move towards the cell membrane and are
expose d to the extracellular matrix, which contains the elevated glucose levels. The glucose
transporter vacuoles take up glucose, and as a result, the amount of glucose outside the cells
reduces. Additionally, insulin lowers the concentration of blood glucose by inhibiting enzymes
that catalyze the breakdown of glycogen into glucose and the enzymes that catalyze the
conversion of amino acids and fatty acids into glucose. Therefore, the pancreas produces insulin
that lowers blood glucose levels by increases cellular uptake of glucose. The pancreas is
involved in the increase of blood glucose levels by the production of glucagon, in response to
low blood glucose levels. “The glucagon stimulates the liver to convert glycogen into glucose.

DIABETES 4
Glucagon, besides, stimulates the liver to covert amino acids and fatty acids into glucose (Hoqua
& Mehal, 2015).”
The kidneys, the adrenal glands, the brain and blood vessels are affected since they
participate in the control of the blood fluid volume. The patient presents with complaints of
excessive urination, constant thirst, and elevated blood pressure, components that are influenced
by the amount of blood fluid volume. In the events of low blood fluid volume, the amount of
blood reaching the kidneys reduces, and the juxtaglomerular cells of kidney s are stimulated
secrete renin, which converts angiotensinogen into angiotensin I (Rahman, 2016). “Angiotensin
converting enzyme converts angiotensin I into angiotensin II, which, in turn, stimulates the
adrenal cortex to secrete aldosterone.” Angiotensin II and aldosterone cause vasoconstriction of
blood vessels, thus, increasing the peripheral vascular pressure, generally increasing blood
pressure. The baroreceptors activate the sympathetic nervous system. The epinephrine produced
and the aldosterone secreted activates calcium channels, thus increasing the amount of
intracellular calcium. Increased intracellular calcium causes contraction of vascular smooth
muscles. Additionally, aldosterone promotes the renal tubules to increase sodium and water
retention and secretion of potassium ions, thus increasing the amount of blood fluid volume in
the body. When the blood pressure reduces, the baroreceptors on the walls of the blood vessels
initiate impulse to the brain, and the brain sends impulses through the sympathetic nervous
system to cause vasoconstriction. The blood vessels, besides, are involved in the storage of body
lipids, specifically, cholesterols. Cholesterol is deposited on the walls of the blood vessels,
reducing the diameter of the blood vessels, thus, increasing the peripheral vascular pressure and
eventual raising the blood pressure (Bloch, 2015).
The Normal Structure of Organs Involved

DIABETES 5
Grossly, the pancreas is composed of a head, the body, and the tail. The head of the
pancreas that makes half of the total mass of the pancreas lies in the loop of the duodenum. The
uncinate process in an extension of the lower part of the head, on the left. The body and the tail
make the other half of the mass of the pancreas. The next lens anterior to the splenic and the
mesenteric veins. The tail of the pancreas is anterior to the left kidney and the aorta. The
increase derives blood supply from the superior mesenteric vein and the drains blood into the
portal vein and the superior mesenteric vein. The nerve supply originates from thoracic nerves
T6 to T 10 through the celiac and thoracic branches for the parasympathetic supply and from the
celiac branch of the dorsal trunk of the sympathetic branch (Calderon, Carrero, Ferris, Sojka,
Moore, Epelman, & Unanue, 2015). Microscopically, the pancreas is composed of acini glands
that are made up of zymogen cells aligned around a ductile. Several ducts combine to form an
intralobar ductile and several drains into the interlobar ducts. The interlobar ductules combine
and to drain into the pancreatic duct. Besides, the pancreas is made up of the islets of
Langerhans, which are composed of beta, alpha and delta cells that secrete insulin, glucagon and
somatostatin respectively (Cesmebasi, Malefant, Patel, Plessis, Renna, Tubbs, & Loukas, 2015).
The adrenal glands are located on top of both the kidneys. “Adrenal glands are composed
of the outer covering, the capsule, and the outer region, the adrenal cortex and the inner part, the
adrenal medulla (Moawad & Randa, 2017).” The adrenal cortex is made up of zona glomerulosa,
zona facility and zona reticularis, which produce mineralocorticoids, mainly the aldosterone, the
glucorticoids, mainly the cortisol and gonandocorticoids, the majority of the androgens
respectively. The adrenal medulla is composed closely packaged cells responsible for the
secretion of epinephrine and norepinephrine after the activation by the sympathetic peripheral
nervous system (Shahzad, Clausing, Prakash, Dennedy, & O’halloran, 2017).

DIABETES 6
The liver is located in the upper left quadrant of the abdomen. Inferiorly, the liver is
related to the stomach, duodenum, transverse colon and the hepatic fissure. Additionally,
inferiorly, there is H shaped fissure. The right arm of the fissure is made up of gallbladder
anteriorly and inferior vena c posteriorly. The left arm is made up of ligamentum teres anteriorly
and ligamentum venosum posteriorly. The arm between the two arms is made up of the common
hepatic vein to the right and the proper artery to the left. A “fissure into right and left lobes
grossly divides the liver. The right lobe is further divided into inferior and superior segments
while the left lobe is divided into medial and lateral portions. Microscopically, the liver is made
up of hepatic cells, known as the hepatocytes.” Canaliculi are located between the hepatocytes.
The canaliculi drain into the bile ductules. Several bile ductules join and form the intrahepatic
ductules, and the intrahepatic ductules are combined to form the intrahepatic ducts. The lobules
of the liver are made up of hepatic lobules. Each of the lobules is made up of a central duct that
is composed of the bile duct, portal vein, and hepatic arteries. The bile duct drains into the
common bile duct (Demetris, Bellamy, Gandhi, Prost, Nakanuma, & Stolz, 2016).
The kidneys are bean-shaped, located on both the left upper abdominal quadrants. The
kidneys are related to several organs around them. Superior, are the adrenal glands, medially, the
kidneys are bordered by the curvature of the stomach and the duodenum. On the anterior aspect
of the stomach, the kidneys are related to the spleen and colon. The kidneys on the inferior
aspect of the kidney rest on the psoas muscle and the quadratus lumborum muscles.
Microscopically, kidneys are covered by the Gerose Capsule and made up of the renal cortex and
renal medulla. The proximal convoluted tubule, the descending loop of Henle, the ascending
tubule and the distal convoluted tubule and the collecting duct (Zarins, Gifford, Deem, Sutton,
Levin, & Gelfand, 2017).

DIABETES 7
Blood vessels are made up of three layers on their walls. The outermost layer is known as
the tunica adventitia and is made up of connective tissue only. The layer is also composed of
nerve endings, majorly of the autonomic nervous system; the parasympathetic and sympathetic
components of the nervous system. The middle layer, the thickened in arteries, is made up of
connective tissues, elastic tissues a smooth polysaccharide substance. The innermost layer is
made up of polysaccharide component, squamous epithelial cells, and smooth muscle cells
(Serlin, Shelef, Knyazer, & Friedman, 2015).

Part B

Electrolyte homeostasis
Due to the high levels of glucose levels in the blood, the osmotic pressure of the
extracellular extravascular fluids increases. Therefore, fluid moves from the cells in the
extracellular and intravascular space. Eventually, the amount of blood volume increases and the
amount of glucose in the blood is high. The kidneys reduce the amount of glucose and the
amount of water through renal excretion. The kidneys excrete the excess amount of water and
glucose increases the amount of urine produced. The increased amount of water is lost together
with sodium ions. The sodium ions are excreted; potassium ions are retained through re-
absorption into the renal filtrate. Therefore, as a result, the amount of intracellular sodium
reduces and the number of potassium increases (Palmer & Clegg, 2015).
Effect on Nerve Conduction
The abnormally high levels of glucose affect the functioning of nerve fibers. Nerve cells,
like any other body cells, require nourishment with nutrients to carry out metabolic functions.
Increased blood sugar is converted into lipids. The lipids are deposited into several organs. One

DIABETES 8
the organs onto which the increased amounts of fats are deposited are in the inner layer of blood
vessels all through the body. The deposition of lipids in the inside of the blood vessels increases
the thicknesses of blood vessel walls. Therefore the diameter of the blood vessels lumen reduces
also. The eventual result of the fat deposition reduction in the amount of blood reaching the
respective organs supplied by the affected blood vessels. Also, the due to the insufficient blood
supply to the nervous tissue, leads to the death of the nervous tissue through the process of
hypoxemia, followed by interaction and finally, complete cell death. The most affected organs by
dysfunction of the nervous tissue are the eyes, the legs, and the brain. Pain, tingling, and loss of
sensation on the affected side characterize diabetic neuropathy. Additionally, an imbalance in the
amount of blood glucose levels affects the functioning of the central nervous system including all
the parts of the brain. An imbalance in the concentration of the blood sugar levels leads to the
inability of the brain to perform functions as on normal blood sugar concentrations. The
increased amount of fat deposited in the blood vessels also affects the blood vessels giving
supply to blood vessels to the brain. The brain, therefore, has reduced amount of the blood
flowing to the brain. Consequently, the nerve fibers in the brain cannot effectively conduct nerve
impulses to the various targets of the body. The disturbance in the electrolyte balance affects
nerve impulse conduction by the nerve fibers (Weiner & Verlander, 2016).
Increase in Urination
Increased urination as a complication of diabetes is a result of the kidneys response to the
increased concentration of glucose in the blood. The lack of insulin further worsens the situation
without the lack of a control mechanism to ensure the blood glucose is maintained within the
normal range. The kidneys reduce the amount of glucose in the body by increasing the excretion
of glucose through the kidney into the urine. Glucose is excreted together with sodium ions, and

DIABETES 9
sodium ions are excreted together with water. The baroreceptor along the walls of the blood
vessels sends impulses to the brain that interprets the homeostatic disturbance as thirst (Finan,
Yang, Ottaway, Smiley, Clemmensen, & Campbell, 2015).
Obesity and type 2 diabetes
Obesity increases the risk of diabetes type 2. In obese individual, the excess deposition of
fat takes place in several types of cells. Fat is deposited around organs and tissues. The overall
effect is increased amount of fat surrounding the cells in the. Therefore the insulin receptors on
the surface of the cells cannot function effectively. As a result, the insulin cannot initiate the
physiological changes in the cells that result in a reduction in the amount of glucose in the blood.
For instance, the insulin receptors cannot stimulate the entry of glucose into the cells, conversion
of glucose into glycogen and amino acids (Serlin et al., 2015).
In conclusion, there are several organs and organ systems affected in the case scenario
presented. The structure of the organs involved is adapted in facilitating their functioning at is to
maintain blood glucose levels within normal range. Impairment in the control of blood glucose
concentrations affects several other organs and body systems.

DIABETES 10

References

Bloch, M. J. (2015). Vasoconstrictive inhibitory factor (VIF), a novel modulator of the
RAAS. Journal of the American Society of Hypertension, 9(7), 503.
Calderon, B., Carrero, J. A., Ferris, S. T., Sojka, D. K., Moore, L., Epelman, S., … &
Unanue, E. R. (2015). The pancreas anatomy conditions the origin and properties
of resident macrophages. Journal of Experimental Medicine, jem-20150496.

DIABETES 11
Cesmebasi, A., Malefant, J., Patel, S. D., Plessis, M. D., Renna, S., Tubbs, R. S., &
Loukas, M. (2015). The surgical anatomy of the lymphatic system of the
pancreas. Clinical Anatomy, 28(4), 527-537.
Demetris, A. J., Bellamy, C. O. C., Gandhi, C. R., Prost, S., Nakanuma, Y., & Stolz, D.
B. (2016). Functional immune anatomy of the liver—as an allograft. American
Journal of Transplantation, 16(6), 1653-1680.
Dupont, G., Falcke, M., Kirk, V., & Sneyd, J. (2016). Some Background Physiology. In
Models of Calcium Signalling (pp. 3-27). Springer, Cham.
Finan, B., Yang, B., Ottaway, N., Smiley, D. L., Ma, T., Clemmensen, C., … &
Campbell, J. E. (2015). A rationally designed monomeric peptide triagonist
corrects obesity and diabetes in rodents. Nature medicine, 21(1), 27.
Hoque, R., & Mehal, W. Z. (2015). Inflammasomes in pancreatic physiology and disease.
American Journal of Physiology-Gastrointestinal and Liver Physiology, 308(8),
G643-G651.
Luan, B., & Sun, C. (2015). Protective effects of dimedone pyrone on podocytes in rats
with diabetic nephropathy. Tropical Journal of Pharmaceutical Research, 14(9),
1643-1649.
Moawad, U. K., & Randa, M. H. (2017). Histocytological and histochemical features of
the adrenal gland of Adult Egyptian native breeds of chicken (Gallus Gallus
domesticus). Beni-Suef University journal of basic and applied sciences, 6(2),
199-208.
Palmer, B. F., & Clegg, D. J. (2015). Electrolyte and Acid-Base Disturbances in Diabetes
Mellitus. The New England journal of medicine, 373(25), 2482.

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