The story revolves around a 46-year-old man named CJ, who after experiencing a series of tragic events, including the loss of his son and wife, became severely obese, depressed, and developed bad habits such as not brushing his teeth for 40 days. This led to an infected tooth, which further exacerbated his health issues. He ended up in the emergency room with symptoms of dehydration, excessive thirst, abdominal discomfort, and shortness of breath.
The diagnosis revealed that CJ was suffering from a hyperglycemic crisis, a condition characterized by extremely high blood sugar levels, which led to a hyperosmolar hyperglycemic state. This condition is caused by the body's inability to regulate glucose levels, leading to an accumulation of glucose in the blood, which in turn causes dehydration, kidney injury, and eventually, a coma.
The narrative explains the physiological consequences of CJ's condition, including the role of insulin, glucose metabolism, and the effect of dehydration on the kidneys. It also highlights the importance of proper medical care and the advancements in treating diabetes, including the use of genetically engineered human insulin.
Ultimately, CJ makes a full recovery after receiving proper treatment, including antibiotics, rehydration, and insulin therapy. The story serves as a cautionary tale about the importance of maintaining good health habits, monitoring one's health, and seeking medical attention when necessary.
Here are the key facts extracted from the text:
1. CJ is a 46-year-old man who presented to the emergency room with excessive thirst, abdominal discomfort, and shortness of breath.
2. CJ had lost 15 pounds over the last two weeks and had developed a pounding toothache.
3. CJ's blood glucose level was 800 milligrams per deciliter, more than 10 times the normal level.
4. CJ's estimated blood volume was about 9 liters.
5. CJ weighed over 400 pounds at admission.
6. CJ's diet consisted of high-sugar and high-fat foods, which led to his hyperglycemia.
7. CJ's body mass index (BMI) was defined as class III obesity.
8. CJ's hyperglycemia was caused by his diet, obesity, and lack of insulin sensitivity.
9. CJ's kidneys were overloaded with glucose, leading to kidney injury and failure.
10. CJ's hyperosmolar hyperglycemic state was caused by the high glucose levels in his blood.
11. CJ's infection was treated with antibiotics, and his abscessed tooth was removed.
12. CJ was given intravenous insulin to help regulate his blood sugar levels.
13. CJ was rehydrated with up to 20 liters of water over 48 hours to mitigate dehydration and reduce plasma osmolality.
14. CJ's acute kidney injury was alleviated, and his kidneys began to filter urine and remove wastes.
15. CJ was diagnosed with type 2 diabetes, a disorder where the body creates insulin but doesn't respond to it.
16. The concept of hyperglycemic crisis was first described in ancient Egyptian medical texts around 1500 BC.
17. The first description of diabetic coma in Western literature was by German physician August von Stosh in 1828.
18. Before 1921, a diabetes diagnosis was a death sentence without insulin.
19. Insulin was first extracted from cows in 1921 by Canadian physician Frederick Banting and his team.
20. Human insulin was first produced through genetic engineering in 1980.
21. Modern therapies and techniques have improved the treatment of diabetes, including short and long-acting insulin analogs.