Aaron is a male patient aged 63 who has type 2 diabetes mellitus, who has a height of 174cm,
weighs 145kg, and his waist circumference is 160 cm [Range: <94cm]. Although he was diagnosed
with hypertension approximately 5 years ago, this has been reasonably well controlled with
medications. He has not adhered to the dietary and lifestyle choices suggested for him by his
dietician, and most of his recent blood tests show persistent hyperglycaemia.
He presents with complications associated with his diabetes, which have resulted in him developing
a wound on the sole of his left foot which wasn’t treated until it was a substantial wound that
became severely infected and ulcerated. Unfortunately, complications from this severely injured
wound have resulted in the need to have his left foot amputated at the level of his ankle.

Question 1. Discuss the effects of his persistent hyperglycaemia on the neurons of his left foot,
including why his wound wasn’t treated earlier (focus your reasoning on pathophysiology, avoiding
personal choice issues such as him not wanting to go to the doctor). In your answer, include
discussion on neuronal requirements for glucose and oxygen. [4 marks]
Question 2. Discuss his risk for the development of stroke, ensuring that you relate this to relevant
processes discussed in question 1 above. In your answer, include which type of stroke he would be
most likely to suffer, and justification of why you have selected that type. [2 marks].
Question 3. After his amputation, discuss the pain which he may experience relating to that
procedure, including relevant brain involvement. In your answer, include an explanation of the
nociceptor injury (presuming that the affected nociceptors would be severed a long distance from
their cell bodies). [4 marks].