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Case #2: 

1. What are the mechanisms of blurred vision which was part of his initial symptoms? 

Elevated blood glucose levels cause the water balance in the eyes to fluctuate which can cause blurred vision (McCance & Huether, 2019). 

2.  Are there correlations between his abnormal blood chemistries and his other symptoms? 

There are correlations between J.R.’s abnormal blood chemistries and his other symptoms. J.R.’s lab results meet diagnostic criteria for diabetes mellitus (DM). One diagnostic criterion for DM J.R. met was that he was a patient with classic symptoms of hyperglycemia and a random plasma glucose greater than 200mg/dL (McCance & Huether, 2019). J.R.’s random glucose test resulted with a blood glucose of 350 mg/dl and his admission non-fasting serum glucose was 268 mg/dl, which are both above the normal values for blood glucose. The second diagnostic criteria for DM that J.R. met was that his glycosylated hemoglobin (HbA1c) level was greater than 6.5%, at 9.6% (McCance & Huether, 2019). The diagnostic criteria for DM that J.R. met reflect his other symptoms. Polyuria, polydipsia, polyphagia, weight loss, fatigue, and blurred vision are all symptoms of DM (McCance & Huether, 2019). Water is osmotically attracted from body cells due to elevated blood glucose levels, which results in intracellular dehydration and hypothalamic stimulation of thirst, resulting in polydipsia (McCance & Huether, 2019). When someone has hyperglycemia, it acts as an osmotic diuretic in the body (McCance & Huether, 2019). The amount of glucose that is filtered by the glomeruli of the kidneys exceeds the amount that can be reabsorbed by the renal tubules, which results in glycosuria accompanied by large amounts of water lost in the urine, causing polyuria (McCance & Huether, 2019).  The effects of insulin deficiency lead to the fluid is lost in osmotic diuresis and the loss of body tissue as proteins and fat are utilized for energy, resulting in weight loss (McCance & Huether, 2019). Cellular starvation and a corresponding increase in hunger, also known as polyphagia, results from the depletion of cellular stores of carbohydrates, fats, and protein (McCance & Huether, 2019). Sleep loss from severe nocturia can contribute to fatigue as well as the metabolic changes that result in poor use of food products. The effects of insulin deficiency lead to the fluid is lost in osmotic diuresis and the loss of body tissue as proteins and fat are utilized for energy, resulting in weight loss (McCance & Huether, 2019). 

3. Identify the cardiovascular and microvascular risk factors in the history, physical examination, and laboratory data in this patient. 

Microvascular complications of diabetes depend on both the severity and duration of hyperglycemia (Fowler, 2008). Diabetic retinopathy may be the most common microvascular complication of diabetes (Fowler, 2008). In patients with type 2 D.M., the development of diabetic retinopathy may begin to develop as early as seven years before the diagnosis of diabetes (Fowler, 2008). J.R. has complaints of blurred vision that is more than likely due to his high blood glucose levels from the lab values. Additional microvascular complications that can exist are diabetic nephropathy and diabetic neuropathy (Fowler, 2008). J.R. does not complain of signs of neuropathy at this time, but this is common and may come in the future. To determine diabetic nephropathy in J.R., we would need additional lab results. Individuals with diabetes pose a cardiovascular risk factor and are twice as likely to have heart disease or a stroke, especially at a young age (McCance & Huether, 2019). Over time, hyperglycemia can damage blood vessels and the nerves that control your heart; therefore, individuals with diabetes are more likely to have other conditions that increase the risk for heart disease (Centers for Disease Control and Prevention [CDC], 2021). J.R. does exhibit cardiovascular risk factors, specifically obesity (CDC, 2021).