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CC 1 > 4.1 CARBOHYDRATES CLINICAL SIGNIFICANCE > Flashcards

4.1 CARBOHYDRATES CLINICAL SIGNIFICANCE Flashcards

1
Q

elevated blood glucose level

A

Hyperglycemia

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2
Q

low blood glucose level

A

Hypoglycemia

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3
Q

HYPERGLYCEMIA dxs

A

DIABETES MELLITUS

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4
Q

A group of metabolic diseases characterized by
hyperglycemia resulting from defects in insulin secretion, insulin action or both

A

DIABETES MELLITUS

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5
Q

DIABETES MELLITUS types

New categories of Diabetes (American Diabetes
Association (ADA) and World Health Organization (WHO))

A

Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Gestational Diabetes
Other specific types of diabetes

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6
Q

Other Specific Types of Diabetes

A

o Pancreatic disease (pancreatitis)
o Endocrine disease (growth hormone and cortisol)
o Drug or chemical induced
o Insulin receptor abnormalities
o Other genetic syndromes

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7
Q

Old Classification of diabetes mellitus by National Diabetes Group, 1979

A

 Type 1, insulin-dependent diabetes mellitus
(IDDM)
 Type 2, non-insulin-dependent diabetes mellitus (NIDDM)

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8
Q

What are the alternative names for Type 1 Diabetes Mellitus?

A

Insulin-dependent DM,
Juvenile Onset DM,
Brittle Diabetes,
Ketosis-Prone Diabetes.

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9
Q

In which age groups is Type 1 Diabetes usually diagnosed?

A

Children, teens, and young adults.

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10
Q

A form of diabetes characterized by unpredictable swings in blood glucose levels.

A

Brittle diabetes

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11
Q

production of ketone bodies coming from fat bodies

A

Ketosis-prone diabetes

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12
Q

Type 1 diabetes is the result of

A

cellular-mediated autoimmune destruction of the beta cells of the pancreas

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13
Q

Type 1 diabetes will cause what deficiency

A

absolute insulin deficiency

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14
Q

the antibodies that would destroy the beta cells of the pancreas

A

 Islet cell autoantibodies
 Insulin autoantibodies
 Glutamic acid decarboxylase autoantibodies
 Tyrosine phosphatase IA-2 and IA-2B
autoantibodies
 Remember that Type 1 DM is autoimmune in
nature because of the presence of autoantibodies, the B cells in particular

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15
Q

What percentage of all diabetes cases does Type 1 Diabetes constitute?

A

10% to 20%

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16
Q

Risk factors of T1DM

A

genetic, autoimmune, environmental

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17
Q

T1DM Characteristics

A

abrupt onset, insulin dependence, and
ketosis tendency

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18
Q

T1DM Signs and Symptoms

A

polydipsia,
polyphagia,
polyuria,
rapid weight loss hyperventilation,
mental confusion, and
possible loss of consciousness

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19
Q

excessive thirst

A

Polydipsia

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20
Q

increased food intake

A

Polyphagia

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21
Q

excessive urine output

A

Polyuria

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22
Q

What are the microvascular complications of Type 1 Diabetes?

A

 Nephropathy
 Neuropathy
 Retinopathy

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23
Q

kidney damage

A

Nephropathy

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24
Q

nerve damage

A

Neuropathy

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25
Q

retina of the eyes

A

Retinopathy

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26
Q

How is insulin administered in Type 1 Diabetes?

A

Via parenteral (injection) administration.

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27
Q

has no known etiology; is strongly inherited; does not have beta cell autoimmunity; requires insulin replacement

A

Idiopathic type 1 diabetes

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28
Q

A result of an individual’s resistance to insulin with an insulin secretory defect

A

Type 2 Diabetes Mellitus

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29
Q

What are alternative names for Type 2 Diabetes Mellitus?

A

Non-insulin Dependent DM,
Maturity Onset or Adult Type DM,
Stable Diabetes,
Ketosis-resistant Diabetes,
Receptor-Deficient DM.

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30
Q

What percentage of diabetes cases does Type 2 Diabetes constitute?

A

The majority of diabetes cases.

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31
Q

What are common characteristics of Type 2 Diabetes Mellitus?

A

Adult onset, milder symptoms than Type 1, and ketoacidosis is rare.

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32
Q

What are the risk factors for Type 2 Diabetes?

A

Genetic predisposition,
obesity,
sedentary lifestyle,
race/ethnicity,
PCOS,
dyslipidemia, and
hypertension

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33
Q

involves cystic structures in one or both ovaries and includes symptoms such as irregular menstruation, hirsutism, oily skin, and acne, which are risk factors for Type 2 Diabetes.

A

Polycystic Ovarian Syndrome (PCOS)

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34
Q

What are the macrovascular complications of Type 2 Diabetes?

A

Coronary artery disease,
stroke, and
heart attack.

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35
Q

What are the microvascular complications of Type 2 Diabetes?

A

Neuropathy,
nephropathy, and
retinopathy.

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36
Q

How is blood sugar managed in patients with Type 2 Diabetes?

A

oral agents or hypoglycemic agents

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37
Q

oral agents or hypoglycemic agents example

A

metformin

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38
Q

Any degree of glucose intolerance with onset or first recognition during pregnancy.

A

gestational diabetes

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39
Q

What are the risks for infants born to mothers with gestational diabetes?

A

Respiratory distress syndrome,
hypocalcemia, and
hyperbilirubinemia.

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40
Q

It is difficulty in breathing due to immature lungs, potentially caused by delayed lung development in infants of mothers with high glucose levels during pregnancy.

A

respiratory distress syndrome

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41
Q

It is an increase in bilirubin levels, often associated with prematurity and polycythemia (increased RBC count) in infants.

A

hyperbilirubinemia

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42
Q

How does polycythemia lead to hyperbilirubinemia?

A

Increased RBC count leads to increased degradation of hemoglobin, producing more bilirubin.

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43
Q

When should screening for gestational diabetes be performed?

A

Between 24 and 48 weeks of gestation.

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44
Q

A decrease in blood calcium levels due to reduced parathyroid hormone levels in the infant.

A

hypocalcemia in infants of mothers with gestational diabetes

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45
Q

What is a key characteristic of other specific types of diabetes?

A

associated with secondary conditions

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46
Q

What genetic defect can lead to other specific types of diabetes?

A

Genetic defects of beta cell function.

47
Q

What pancreatic disease is associated with other specific types of diabetes?

A

Pancreatitis

48
Q

What endocrine diseases are associated with other specific types of diabetes?

A

Acromegaly and Cushing’s syndrome (Hypercortisolism).

49
Q

causes increased production of growth hormone, a hyperglycemic agent that raises blood glucose levels, leading to diabetes.

A

acromegaly

50
Q

How does Cushing’s syndrome (hypercortisolism) contribute to diabetes?

A

It increases the production of cortisol, a hyperglycemic agent, which can lead to diabetes.

51
Q

How can drugs or chemicals induce diabetes?

A

By causing insulin resistance or damaging the beta cells of the pancreas.

52
Q

What abnormalities can lead to insulin resistance and contribute to diabetes?

A

Insulin receptor abnormalities.

53
Q

Individuals with this syndrome have an increased risk of diabetes due to autoimmunity or the production of antibodies against the beta cells of the islets of Langerhans.

A

Down syndrome

54
Q

What are the main laboratory findings in hyperglycemia related to glucose levels?

A

Increased glucose in plasma and urine

55
Q

presence of glucose in urine

A

glucosuria

56
Q

What happens to urine specific gravity in hyperglycemia?

A

Urine specific gravity is increased.

57
Q

What ketone-related findings are seen in hyperglycemia?

A

Presence of ketones in serum (ketonemia) and urine (ketonuria).

58
Q

How does hyperglycemia affect blood and urine pH?

A

Both blood and urine pH are decreased, leading to acidosis.

59
Q

What electrolyte imbalances are commonly found in hyperglycemia?

A

Low sodium concentration (due to polyuria and glucose shift into cells) and

high potassium concentration.

60
Q

According to ADA recommendations, at what age should all adults begin testing for diabetes, and how often?

A

All adults should begin testing at age 45 and be tested every 3 years.

61
Q

What tests are recommended by the ADA for diabetes screening in adults?

A

Hemoglobin A1c (HbA1c),
fasting plasma glucose, or a
2-hour 75g oral glucose tolerance test (OGTT).

62
Q

In which individuals should diabetes testing be done earlier than 45 years of age?

A

In individuals who are overweight and have additional risk factors.

63
Q

What is a lifestyle-related risk factor for diabetes?

A

Being habitually physically inactive.

64
Q

How does family history contribute to diabetes risk?

A

Having a family history of diabetes in a first-degree relative increases the risk.

65
Q

Which high-risk minority populations are at greater risk for diabetes?

A

African American, Latino, Native American, Asian American, and Pacific Islander populations.

66
Q

How does a history of gestational diabetes mellitus (GDM) or delivering a large baby impact diabetes risk?

A

It increases the risk, especially if the baby weighed more than 9 lbs (4.1 kg).

67
Q

How does hypertension relate to diabetes risk?

A

Blood pressure ≥ 140/90 mm Hg is a risk factor for diabetes.

68
Q

What level of HDL cholesterol is considered a risk factor for diabetes?

A

HDL cholesterol concentrations < 35 mg/dL (0.90 mmol/L).

69
Q

What triglyceride level is a risk factor for diabetes?

A

Elevated triglyceride concentrations > 250 mg/dL (2.82 mmol/L).

70
Q

How does a history of impaired fasting glucose or impaired glucose tolerance affect diabetes risk?

A

It increases the risk of developing diabetes.

71
Q

Why are women with polycystic ovarian syndrome (PCOS) at higher risk for diabetes?

A

PCOS is associated with insulin resistance, increasing the risk of diabetes.

72
Q

What other clinical conditions are associated with insulin resistance and increase the risk for diabetes?

A

Severe obesity and acanthosis nigricans.

73
Q

How does a history of cardiovascular disease relate to diabetes risk?

A

It is a significant risk factor for developing diabetes.

74
Q

o Hyperpigmentation of the skin, dark areas in the armpits or groins
o Get tested for diabetes

A

Acanthosis nigricans

75
Q

At what age should testing for Type 2 diabetes begin in asymptomatic children, and how often should it be repeated?

A

Testing should begin at age 10 or at the onset of puberty, with follow-up testing every 2 years.

76
Q

What are the criteria for testing Type 2 diabetes in overweight children?

A

Family history of Type 2 diabetes in first- or second-degree relatives

Race/ethnicity

Signs of insulin resistance

Maternal history of diabetes or GDM.

77
Q

Signs of insulin resistance

A

acanthosis nigricans,
hypertension,
dyslipidemia,
PCOS

78
Q

What HbA1c level is considered diagnostic of diabetes in children?

A

≥ 6.5%

79
Q

What fasting blood glucose level is diagnostic of diabetes?

A

≥ 126 mg/dL

80
Q

What 2-hour OGTT result is diagnostic of diabetes in children?

A

≥ 200 mg/dL

81
Q

What random plasma glucose level, along with symptoms of diabetes, is diagnostic of diabetes?

A

≥ 200 mg/dL plus symptoms

82
Q

Who should be screened for gestational diabetes according to the International Association of the Diabetes and Pregnancy Study Groups?

A

All nondiabetic pregnant women should be screened for GDM.

83
Q

What test is used to screen for GDM in pregnant women?

A

A 2-hour oral glucose tolerance test (OGTT) with measurements of fasting plasma glucose, 1-hour plasma glucose, and 2-hour plasma glucose levels.

84
Q

What are the fasting instructions for a pregnant woman before the 2-hour OGTT?

A

The patient should fast for 8-10 hours but not longer than 16 hours.

85
Q

What happens during the 2-hour OGTT for GDM testing?

A

After fasting, a blood sample is taken for fasting plasma glucose, then the patient is given a 75g glucose load dissolved in 300mL water. Blood samples are taken 1 hour and 2 hours later.

86
Q

At what stage of pregnancy is the 2-hour OGTT for GDM typically performed?

A

The test is usually done between 24 and 28 weeks of gestation.

87
Q

What is a challenge associated with the 2-hour OGTT for pregnant women?

A

The test requires multiple blood draws over several hours, which can be inconvenient for the patient.

88
Q

According to the revised ADA guidelines, what type of glucose test is used for diagnosing diabetes in non-pregnant individuals?

A

A fasting plasma glucose test and a 2-hour plasma glucose test using a 75g glucose load.

89
Q

According to the revised ADA guidelines, what type of glucose test is recommended for pregnant women?

A

Pregnant women should undergo the 3-step oral glucose tolerance test (OGTT) involving fasting, 1-hour, and 2-hour plasma glucose measurements.

90
Q

What is the fasting plasma glucose level diagnostic of gestational diabetes?

A

≥ 92 mg/dL (5.1 mmol/L).

91
Q

What is the one-hour plasma glucose level diagnostic of gestational diabetes?

A

≥ 180 mg/dL (10 mmol/L).

92
Q

What is the two-hour plasma glucose level diagnostic of gestational diabetes?

A

≥ 153 mg/dL (8.5 mmol/L).

93
Q

At what plasma glucose level do glucagon and other glycemic factors get released in response to hypoglycemia?

A

65 to 70 mg/dL (3.6 to 3.9 mmol/L).

94
Q

At what plasma glucose level do observable symptoms of hypoglycemia typically appear?

A

50 to 55 mg/dL (2.8 to 3.1 mmol/L).

95
Q

What are common symptoms of hypoglycemia?

A

Increased hunger,
sweating,
nausea and vomiting,
dizziness,
nervousness and shaking,
blurring of sight, and
mental confusion.

96
Q

What are the typical laboratory findings in hypoglycemia?

A

Decreased plasma glucose levels and extremely elevated insulin levels in patients with pancreatic β-cell tumors

97
Q

pancreatic β-cell tumors

A

insulinoma

98
Q

What condition is associated with extremely elevated insulin levels in hypoglycemia?

A

Pancreatic β-cell tumor (insulinoma), which produces excess insulin.

99
Q

Deficiency of a specific enzyme that alters glycogen metabolism.

A

glycogen storage diseases

100
Q

What is the most common form of glycogen storage disease?

A

Von Gierke disease (glucose-6-phosphatase deficiency).

101
Q

How does liver transplantation affect Von Gierke disease?

A

Liver transplantation can correct the disease.

102
Q

What are the key characteristics of Von Gierke disease (Type 1A Glycogen Storage Disease)?

A

Severe hypoglycemia due to the inability of glycogen to be converted into glucose units.

103
Q

What are the characteristics of liver forms (types I, III, IV, VI, IX, and 0) of glycogen storage diseases?

A

Marked by hepatomegaly and hypoglycemia.

104
Q

Types of glycogen storage diseases which are marked by hepatomegaly and hypoglycemia

A

types I, III, IV, VI, IX, and 0

105
Q

Types of glycogen storage diseases characterized by muscle cramps, exercise intolerance, fatigue, and weakness

A

types V and VII

106
Q

A cause of failure to thrive syndrome in infants, diarrhea, and vomiting.

A

Galactosemia

107
Q

What is the primary result of Galactosemia?

A

Increased levels of galactose in plasma.

108
Q

What is the most common enzyme deficiency in Galactosemia?

A

Galactose-1-phosphate uridyltransferase.

109
Q

Name two other enzymes related to Galactosemia.

A

Galactokinase and Uridine diphosphate galactose-4-epimerase.

110
Q

What laboratory test is used for diagnosing Galactosemia?

A

Erythrocyte galactose-1-phosphate uridyltransferase activity.

111
Q

What laboratory findings are associated with Galactosemia?

A

Hypoglycemia, hyperbilirubinemia, and galactose accumulation in the blood, tissue, and urine following milk ingestion.

112
Q

What is the enzyme deficiency in Essential Fructosuria?

A

Fructokinase deficiency.

113
Q

What condition is characterized by a defect in fructose-1,6-bisphosphate aldolase B activity?

A

Hereditary Fructose Intolerance.

114
Q

What is the defect associated with Fructose-1,6-Bisphosphatase Deficiency?

A

Defect in fructose-1,6-bisphosphatase.

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