DrVirgo
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Polyuria, frequency, weight loss, HTN, FBS=280… FH of HTN and DM,
What is the DX? What is increased? B Glucagon or D Insulin?
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| khorshid
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Dx is DM, and in DM II, we have resistance to insulin, so insulin levels may be initially higher than nl, (unlike type I where we have destruction of cells and therefore decreased insulin). Why increased glucagon? I mean there is no other signs and symptoms of glucagonoma.
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| elitoki
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I remember that in HIGH Fasting glucose level in DM II is due to increase glucagon level, that activate glucogenolysis to produce glucose.  Increasing insuline should produce hypoglycemia and we use exogeneous insuline with SSN as treatment in Hyperosmolar diabetes... but in this case they said NONFASTING glucose level was high... so...
Now I'm confuse
But my answer is B
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| radonc
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My answer is insulin. Type 2 DM is insulin resistance.
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| dr_arc
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type 2 Dm= too much insulin, resistance to insulin action.
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| Justice
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Type 2 diabetes is characterized by peripheral insulin resistance with an insulin-secretory defect that varies in severity. For type 2 diabetes to develop, both defects must exist: All overweight individuals have insulin resistance, but only those with an inability to increase beta-cell production of insulin develop diabetes. This guy developed it, so his insulin isn't increased.
Increased glucagon contributes to raise of glucose via glycogen degradation...
I go with B
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| DrVirgo
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You guys are confusing me! 
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| hanwin
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This is type II DM.
Insulin resistance
Increased insulin
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| manolok
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i think this is B. this patient has hyperglycemia, the question is asking what would be increased? increased glucagon leads to increase glucose hence the hyperglycemia. You can't have an increased insulin and have hyperglycemia. correct me if im wrong
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| pearljam59
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So we agree he has diabetes, right? Well whats the pathophys? Basically this guy's fat secretes stuff (dont ask me what) that causes a resistance to insulin. It is this resistance that then leads to the liver creating glucose. Sooooo I would say Insulin since it happens FIRST and the hepatic glucose cant ever exist unless you have this resistance.
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| Justice
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pearljam59 wrote:
So we agree he has diabetes, right? Well whats the pathophys? Basically this guy's fat secretes stuff (dont ask me what) that causes a resistance to insulin. It is this resistance that then leads to the liver creating glucose. Sooooo I would say Insulin since it happens FIRST and the hepatic glucose cant ever exist unless you have this resistance.
Until the Pt has a capability to increase insulin, the glucose will not raise to the clinically apparent values...
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| dr in trouble
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manolok, in type 2 diabetes there is insulin but the receptors are resistant---the insulin is secreted in response to high plasma glucose--if the glucose is high it has +ve feedback on insulin secretion but --ve feedback on glucagon until it is glucagonoma which is usually present with characteristic rash.
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| DrVirgo
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manolok wrote:
i think this is B. this patient has hyperglycemia, the question is asking what would be increased? increased glucagon leads to increase glucose hence the hyperglycemia. You can't have an increased insulin and have hyperglycemia. correct me if im wrong
Yes, increased glucagon can lead to increased Glucose
Increased insulin would lead to decreased glucose.
BUT sometimes in Type II DM (OBESE patients), there is INSULIN RESISTANCE, so there may be a normal to even slightly higher level of insulin, but the body's cells are not responding to it.
So the question here is:
does he have Type II DM with insulin resistance and his INSULIN is slightly higher but not responding so glucose remains high
-Also, Insulin is an anabolic Hormone and this man is FAT!.... (D)
OR
does he have increased Glucagon (maybe due to GLUCAGONOMA), so it is the Glucagon increase which is responsible for the increase in Glucose.
Also glucagonoma causes weight loss, which this man had! (B)...
*Note: -from UW: Glucagonoma: TRIAD of hyperglycemia, Necrotizing Dermatitis, and Weight Loss...
(don't know if it helps for this question though).
 
Edited by DrVirgo on 08/13/07 - 06:05 AM
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| dr_arc
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i think the answer is insulin. insulin in most type 2 diabetics increases and keeps on increasing in an attempt to maintain normal glucose . eventually even the increased amt of insulin is not enough to hold down the glucose levels , the primary pathology being insulin resistance.the pt has features of DM2.
also in glucagonama there is always the trademark dermatological manifestation. i remeber pestana saying this in surgey that you are more likely to find the glucagonoma pts outside the dermats office. also it is i think just a touch of diabetes rather than a predom symptom.
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| DrVirgo
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I agree dr_arc,
and MY FINAL ANSWER is also D. Insulin increase
due to all the reasons you mentioned.
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| cirus
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I agree that INITIALLY in type II DM, the insulin level will be high, then normal then low (Never like Type I), BUT, for glucose to reach the level of 280!!, this means that the pancreas starting giving up & the glucose level will drop, More over, in this type (I recently discovered that there r 2 types of DMII, one with of the obese pts & another with the thin pts, i searched for this because of a q that I posted earlier stating that DMII m b an auto immune disease d t abs competing with insulin, & yes i found it in thin pts contracting type II DM) the pt would have been gaining weight rather than loosing
On the other hand the pt lost weight though no change in diet, meaning that even though he is not eating less there is something that is INDUCING lipolysis & so glucagon level should be assessed
So the answer is gluconoma
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| Korotkoff
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What the hell
Insulin could be either normal or increased in type 2 DM.
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| ozdoctor
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Yes, the answe may not be insulin increase. in type 2 diabetes, peripheral resistance to the actions of insulin is always combined with a pancreatic secretory deficiency of varying severity. Insulin resistance means the body is unable to take glucose up into cells. Normally, the body would compensate for this by producing increased amounts of insulin, but in type 2 diabetes mellitus the pancreas cannot respond. This means not enough insulin is produced, and excess sugar remains in the bloodstream, causing hyperglycemia.
There are not many new data on the role of endogenous glucagon in type 2 diabetes, although there is enormous interest in the potential therapeutic options with glucagon-like peptide. Basal glucagon secretion in type 2 diabetes is increased and this almost certainly contributes to fasting hyperglycemia by increasing fasting hepatic glucose output. Glucagon suppression by hyperglycemia or an amino acid infusion is blunted, and this phenomenon is more marked in severe insulinopenia. However, lack of insulin is not the only factor, as glucagon levels remain high even after starting insulin treatment, and it is likely that the alpha cells are also insulin-resistant in some way.
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| sandra
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insulin level high in type 2 DM??
i understand it would be either low or normal( insulin resistance)
mez with glucagon
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| DrVirgo
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Any other thoughts on this one?
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