Diane could not remember whether she had taken her 6 pm insulin dose when, in fact, she had done so. unfortunately, she decided to give herself the evening dose (for the second time). when she did not respond to her alarm clock at 6 am the following morning, her roommate tried unsuccessfully to awaken her. the roommate called 911 and diane was rushed to the er in a coma. her skin was flushed and slightly moist. her respirations were slightly slow. her vitals were: heart rate -75 bpm, blood pressure - l12/87, respiratory rate: 10 rpm, oxygen saturation-100% at room air.
1. what is diane's diagnosis? what is the mechanism involved?
2. what clinical signs and symptoms to distinguish a coma caused by an excess of blood glucose and ketone bodies due to a deficiency of insulin (dka) from a coma caused by a sudden lowering of blood glucose (hyperglycemic coma) induced by the inadvertent injection of excessive insulin?
3. what is the pathophysiology leading to the elevation of blood glucose after a meal differs between patient with insulin-dependqt diabetes mellitus(iddm) and those with non-insulin-dependent diabetes mellitus (niddm)? explain both.
4. what are the types of treatment available to diane in the future?