NAME: CHAMA KABASO

COMPUTER NO#: 201912010459

COURSE: CLINICAL BIOCHEMISTRY

LECTURER: MS NKOLE

ASSIGNMENT NO#: 1

TASK: CASE STUDY 2

DUE DATE; 20TH OCTOBER 2022

Case 2

A 65-year-old diabetic, reported to the Doctor’s office for a routine visit to monitor his
treatment. His doctor drew blood for an HbA1c determination. The laboratory reported values of
8.7%

a) What is the normal range for HbA1c.

HbA1c is the average blood glucose levels for the last two to three months. Normal HbA1c for
non-diabetics is less than 36mmol/L (5.5%)

For people with diabetes, the ideal HbA1c levels is 48mmol/L(6.5%) or below. The high the
hemoglobin A1c, the higher the risk of having complications related to diabetes.

b) What is the significance of HbA1c measurement.

HbA1c is an important indicator of long term glycemic control with the ability to reflect the
cumulative glycemic history of the preceding two to three months. HbA1c not only provides a
reliable measure of the chronic hyperglycemia but also correlates well with the risk of long term
diabetes complications

c) Give a note on diabetic neuropathy.

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood
sugar (glucose) can injure nerves throughout the body. Diabetic neuropathy most often damages
nerves in the legs and feet.

Depending on the affected nerves, diabetic neuropathy symptoms include pain and numbness in
the legs, feet and hands. It can also cause problems with the digestive system, urinary tract, blood
vessels and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be
quite painful and disabling.

Diabetic neuropathy is a serious diabetes complication that may affect as many as 50% of people
with diabetes. But you can often prevent diabetic neuropathy or slow its progress with consistent
blood sugar management and a healthy lifestyle

Symptoms
There are four main types of diabetic neuropathy. You can have one type or more than one type
of neuropathy.

Your symptoms depend on the type you have and which nerves are affected. Usually, symptoms
develop gradually. You may not notice anything is wrong until considerable nerve damage has
occurred.

Peripheral neuropathy

This type of neuropathy may also be called distal symmetric peripheral neuropathy. It's the most
common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and
arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:

 Numbness or reduced ability to feel pain or temperature changes

 Tingling or burning feeling

 Sharp pains or cramps

 Muscle weakness

 Extreme sensitivity to touch — for some people, even a bedsheet's weight can be painful

 Serious foot problems, such as ulcers, infections, and bone and joint damage

Autonomic neuropathy

The autonomic nervous system controls blood pressure, heart rate, sweating, eyes, bladder,
digestive system and sex organs. Diabetes can affect nerves in any of these areas, possibly
causing signs and symptoms including:

 A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)

 Drops in blood pressure when rising from sitting or lying down that may cause dizziness
or fainting (orthostatic hypotension)

 Bladder or bowel problems

 Slow stomach emptying (gastroparesis), causing nausea, vomiting, sensation of fullness

and loss of appetite
  Difficulty swallowing

 Changes in the way the eyes adjust from light to dark or far to near

 Increased or decreased sweating

 Problems with sexual response, such as vaginal dryness in women and erectile
dysfunction in men

Proximal neuropathy (diabetic polyradiculopathy)

This type of neuropathy often affects nerves in the thighs, hips, buttocks or legs. It can also affect
the abdominal and chest area. Symptoms are usually on one side of the body, but may spread to
the other side. Proximal neuropathy may include:

 Severe pain in the buttock, hip or thigh

 Weak and shrinking thigh muscles

 Difficulty rising from a sitting position

 Chest or abdominal wall pain

Mononeuropathy (focal neuropathy)

Mononeuropathy refers to damage to a single, specific nerve. The nerve may be in the face,
torso, arm or leg. Mononeuropathy may lead to:

 Difficulty focusing or double vision

 Paralysis on one side of the face

 Numbness or tingling in the hand or fingers

 Weakness in the hand that may result in dropping things

 Pain in the shin or foot

 Weakness causing difficulty lifting the front part of the foot (foot drop)

 Pain in the front of the thigh

References

1. Hamm LL, DuBose TD. Disorders of acid-base balance. In: Yu ASL, Chertow GM,
Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney.
11th ed. Philadelphia, PA: Elsevier; 2020:chap 16.
2. Palmer BF. Metabolic acidosis. In: Feehally J, Floege J, Tonelli M, Johnson RJ,
eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap
12.
3. Seifter JL. Acid-base disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil
Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 11
4. Cohen, R. M., Feldman, G. M. & Fernandez, P. C. The balance of acid base and charge in
health and disease. Kidney Int. 52, 287–293 (1997).
5. Petrovic, S., Wang, Z. H., Ma, L. Y. & Soleimani, M. Regulation of the apical
Cl−/HCO3− exchanger pendrin in rat cortical collecting duct in metabolic acidosis. Am. J.
Physiol. 284, F103–F112 (2003)
6. Kraut, J. A. & Madias, N. E. Approach to patients with acid-base disorders. Respir.
Care 46, 392–403 (2001).
7. Albert, M. S., Dell, R. B. & Winters, R. W. Quantitative displacement of acid-base
equilibrium in metabolic acidosis. Ann. Intern. Med. 66, 312–322 (1967)
8. Kraut, J. A. & Madias, N. E. Serum anion gap: its uses and limitations in clinical
medicine. Clin. J. Am. Soc. Nephrol. 2, 162–174 (2007)