Diabetes Case Study – Jason Bao

Directions: Read the following excerpts and then answer the associated questions with each part. You may work in your
small groups, but do NOT split up the assignment. It goes in order and this is actually information that is good for you to
know for life.

Questions
1. What are the three parts of the cell transduction pathway, in order?
The three parts of the cell transduction pathway are 1) Reception in which the receptor binds to the signal, 2) Transduction
in which signaling molecules transmit the message, and 3) Transduction in which the cell responds in the form of a short-
term or long-term cellular change.
2. Where are receptor proteins found within the cell?
The receptor proteins can be found on the cell membrane extracellularly or found in intracellularly in the cell’s cytoplasm.

Edited from National Center for Case Study Teaching by Kristy J. Wilson
Questions
3. What is doing the phosphorylating and what is being phosphorylated?
Kinase is doing the phosphorylating and amino acids like serine, threonine, and tyrosine are being phosphorylated.
4. What is the role of ATP in cellular signaling?
ATP is utilized by the proteins such as the kinase protein as energy to continuously add phosphate groups during
phosphorylation.

Edited from National Center for Case Study Teaching by Kristy J. Wilson
Questions
Edited from National Center for Case Study Teaching by Kristy J. Wilson
 5. What type of feedback is described on the previous page? How do you know? Is it reversible or irreversible?
Negative feedback is described on the previous page as the regulation is sparking a return back to homeostasis in which
feedback inhibition hinders an earlier step in signal transduction that can completely stop the response. The process is
reversible as an enzyme called phosphatase can remove a phosphate group from the kinase and reactivate the response
process again.
6. What is the counter protein to kinase? Why do we need a counter protein?
The counter protein is the enzyme phosphatase which turns a protein off. Counter proteins are necessary to ensure a return
back to homeostasis after a cell responds to an outside stimuli to maintain stability of the cell and overall organism.
7. Provide 3 examples of common secondary messengers.
Examples of common secondary messengers include cyclic-AMP, Ca2+ ions, phosphoinositides (PIP3, PIP2, etc.), and
diaclyglycerol (DAG).

Questions
8. Explain how signal amplification occurs within a cell.
Signal amplification occurs through a kinase cascade that exponentially activates additional kinases and through the use of
second messenger signaling that activates signaling proteins in various areas of the cell. Together, the sharp increase in
signaling molecules amplifies the signal throughout the cell which can lead to a faster cellular response and greater
cellular changes.
9. THINK! Why would there need to be multiple steps for inhibition within a cell signaling pathway.
There needs to be multiple steps to improve the effectiveness and range of inhibition. Just like signaling, feedback
inhibition can be exponentially amplified through the multiple steps which creates a greater inhibiting effect once the
inhibition signal activates a cellular response back to homeostasis and therefore increases the scope and effectiveness of
the inhibition.

Edited from National Center for Case Study Teaching by Kristy J. Wilson
Questions
10. How are diabetics interfering with their own cell signaling?
Diabetics interfere with their own cell signaling by not responding well to the insulin signal (disrupting the signal)
produced by the pancreas that would otherwise signal to your body to use glucose for energy.
11. What is the body response to increased blood glucose from eating?
A normal body response to the increased blood glucose would be to utilize and break down the glucose for the cell’s
energy needs. However, in diabetics, this response does not occur either due to the absence of insulin or insulin resistance
which causes the cell to break down proteins and fats for energy.
12. With a diet like keto, where proteins are one of the major sources of energy, what is the impact on the blood?
Explain.
With a keto diet, the blood’s pH level will decrease and become more acidic as the breakdown of proteins leads to a
buildup of ketoacids in the blood, therefore making the blood more acidic and moving it farther away from the
homeostatic pH of 7.
13. Why should diabetics check their feet?
They should check their feet for blisters as they often lose feeling in their feet. If diabetics don’t check, the blister may
become infected and combined with the poor wound healing of diabetics could lead to an amputation.
Edited from National Center for Case Study Teaching by Kristy J. Wilson
Questions

14. Quick Research! This article was written in 2007. How have the financial impact of diabetes changed from 2007
to now (2020)? Consider also that Type-1 is genetic, so an entire family will most likely have numerous members
with this condition.
The latest data from 2017 estimates that the annual cost of those diagnosed with diabetes has risen to $327 billion dollars,
much more than the $174 billion dollars of ten years ago, and the average medical expenditures for diabetics continues to
be about 2.3 times higher than in those without diabetes. More specifically, today, Type-1 usually costs a patient around
$4,699 dollars annually, which is much greater than the average cost of around $1,900 dollars for those with Type-2.
15. What are symptoms to look out for if you are concerned you could be developing Type-2 diabetes?
Symptoms that are often associated with the onset of Type-2 diabetes include an increase in thirst and hunger, weight loss,
fatigue, blurry vision, headaches, and the tingling of hands and feet. If one is concerned possibly developing Type-2, he or
she should pay attention to these symptoms.

Questions
16. Do what Dr. Kim is asking of Mia and circle/highlight the areas of Excerpt 3 that are involved with each of the 3
steps of the cell transduction pathway. Each player needs to be in one of the 3 categories.
*See Picture Below*
17. What is the role of GLUT4? By what process is it added to the cell membrane?
GLUT4 is a protein that enables the facilitated diffusion of glucose down its concentration gradient (a glucose transporter)
and plays an important role in regulating the body’s glucose homeostasis. It is added to the cell membrane through the
process of vesicle fusion.
Edited from National Center for Case Study Teaching by Kristy J. Wilson
Red Circle – Signal
Blue Circle – Reception
Yellow Circle – Transduction
Green Circle – Effects/Response

Edited from National Center for Case Study Teaching by Kristy J. Wilson
Questions
18. Predict which cells in the body might need a higher reactivity to insulin. Support your claim.
Cells in muscles, fat, and liver might need a higher reactivity to insulin. Cell muscles directly utilize glucose as fuel to
operate and take in glucose from the blood so they rely on insulin receptors to signal when to absorb the sugars to regulate
the blood sugar levels. Additionally, excess glucose in the bloodstream is converted into fatty acids and later fats with the
help of insulin so fat cells would need a higher reactivity to insulin to receive the signal to start converting glucose into
more fats. Finally, similar to fat cells, cells in the liver must have a higher reactivity or sensitivity to insulin with a greater
amount of receptors as insulin stimulates the liver to store glucose, which thereby regulates the blood sugar levels of the
blood.
19. What role does genetics play in diabetes?
Genetics plays a role as the development of diabetes is often linked to shared genetic factors from inheritance patterns.
For example, the more family members affected by diabetes, the increased likelihood of developing diabetes. Moreover,
certain gene mutations also lead to a higher risk of diabetes, which highlights the large role genetics play in diabetes.
20. THINK! If insulin is not the issue for some diabetics, then what else could be the cause of their condition?
Other causes of their condition could be a malfunction of the GLUT4 protein that prevents it from properly regulating the
body’s glucose homeostasis or malfunction of the pancreas in that it is unable to detect when blood glucose levels are too
high or low and therefore cannot release insulin when needed.

Edited from National Center for Case Study Teaching by Kristy J. Wilson