Case example 1:
Joan is a 74 year-old woman who lives at home alone. She reports having difficulty
seeing objects clearly, reports feeling ‘out of breath’ when ascending the stairway in
her home (more so than a month or so ago), and says that she is having difficulty
feeling sensations in her feet when they touch things. She has a lifetime history of
type I diabetes and uses insulin preparations for blood glucose control. Joan also
suffers from chronic peripheral vascular disease and diabetic neuropathy.
Joan attends the diabetic clinical regularly and on her visit two weeks ago weighed
48.2 kg; her height is 165 cm. For the past four months Joan has been visited by
community health nurses three days a week who are dressing and treating a
neurotrophic ulcer on her left foot. Today the attending nurse has noted that the
great toe of Joan’s left foot is reddened at the interphalangeal joint and necrotic at the
tip.
Discuss this case describing the mechanisms for chronic and acute pathophysiological
changes affecting the function of Joan’s organs and nervous and circulatory systems as
a result of her life long type 1 diabetes. Also include the acute on chronic mechanisms
that are responsible for the inflammatory changes observed in her toe. In your answer
you should demonstrate an understanding of the tissue and cellular mechanisms
responsible for Joan’s clinical signs and observations.
