Richard Smith, who is 21 years old, has type 1 diabetes mellitus. He gives himself two injections per day, and each one is a combination of medium-acting insulin and regular, short-acting insulin. He takes one injection before breakfast and one before dinner, and he usually tests his blood glucose level before each meal and at bedtime. Richard is a college student who is usually active in athletics.
However, this is final examination week, and Richard’s schedule is irregular. He is putting in long hours of study, and he is under considerable stress. On the day before a particularly difficult examination, he is reviewing his study materials at home, and he forgets to check his blood glucose or eat lunch. During the middle of the afternoon, he begins to feel faint. He realizes that his blood glucose level is low and that an insulin reaction is imminent if he does not get a quick source of energy. He looks in the kitchen, but all he can find is orange juice, milk, a loaf of bread, and a jar of peanut butter.
1. Which of the foods should Richard eat immediately? Why?
2. Later, when he is feeling better, Richard makes a peanut butter sandwich, pours a glass of milk, and eats his snack while he continues studying. What carbohydrate food sources of energy are in his snack?
4. What is the complex form of carbohydrate in his snack? Why is this a valuable form of carbohydrate in his diet?
5. If Richard did not take his insulin to provide the necessary control agent for metabolizing the carbohydrate, what would happen to him as the result of improper handling of fat and the accumulation of ketones?