9.6- Glucose Tests Flashcards
first line tests for glucose metabolism (3)
- glucose
- keytones
- plasma glycalated haemoglobin (HbA1c)
what are the 4 types of diabetes
type 1- Primary insulin dependednt
type 2- non insulin dependent
type 3- secondary diabetes (pancreatic autoimune, genetic, endocrine)
type 4- gestational
diagnosis of DM (any plasma, fasting, 2hrs post meal, borderline)
any glucose- >11.1mmol/L
fasting- >7mmol/L
2hrs post- >11.1mmol/l
borderline- 6.7-11.1mmol/l
need to repeat twice
What is the glucose tolerence test and when should it be normal
drink 50-100g glucose
2 hours should be <7.8mmol/l (DM will stay high)
-must be fasting
what antibodies can you test for for early type 1 (2)
- Serum islet cell antibodies
- Serum glutamic acid decarboxylase antibody
What antibodies can you test for for early type 2
serum insulin antibody
what can cause false pos on glucose dipstick
preg
high vit C
ketosis and insulin compared in type 1+2
type 1- common ketosis, low/absent insulin
type 2- in stress ketosis, present insulin
What is MODY- and what is the defect
in youth (5%) -looks like type 1
–Glucokinase def
What is NIDDM-Y- when is it found + def
in youth, looks like type II
- -Usually in obese/overweight females
- -absence of glutamic acid decarboxalase antibodies
What is LADA and test to find it
Looks like type II but needs insulin
–Serum glutamic acid decarboxylase antibodies usually present (100% specific)
diabetic ketosis lab work
- blood glucose
- Plasma glu/bicarbonate/potassium (pot will be high)
- Plama sod/choride (elevated = signs of dehydration)
3 tx of diabetic keto acidosis
- FLuids
- Insulin
- Potassium
3 tx of diabetic keto acidosis
- FLuids
- Insulin
- Potassium
What are the 3 types of diabetic comas
- diabetic ketoacidotic coma (DKA)
- Hyperosmolar non ketotic coma (HONK)
- Lactic acidodic coma (LA)
DKA vs HONK vs LA- glucose, keytones, acid, dehydration, hyperventilate
DKA- high glu, ketones, acid, dehydration, hyperventilated (type 1)
HONK- Very high glu, no keytones/acidosis/hyperventilate (type 2)
LA- variable byt very acidic
risk factors for type II
- overweight
- high blood pressue
- babies over 3.5kg
- gestationa diates
- impaired glu tolerence
what two tests are done to assess long term damage in type 2 DM
Glycalated Hb- every 2-4m
Urine albumin- yearly
What blood marker gives us a estimation on long term exposure to high glu
HbA1c
what is the test to determine if execise fructose causes type II
Serum fructosamine
what is type 3 diabetes due to and what to measure
obesity/pituitary causes
- Pituitary-measure GH, adrencorticotrophic hormine
Thyroid- TSH
Adrenal- cortisol
what do u need normal at preg to avoiid teratogenic probs
need normal glu at time of conception
Type 4 DM lab test and when is it abnormal
oral glu tolerence 24-28w
50g given, a plasma glu >8mmol at 1 hour is considered abnormal
Risk to neonate in type 4 diabetes
- born big
- hypoglucemia after birth
- jaundice, bilirubin increased
- low calc
- breathing probs
type 4 risks for offspring
Obesity as teen
Early onset of DM and diseases of aging
What is normal healthy glucose and hypoglucermia
healthy= 3.5-5mmol/l
hypo- plasma <2.5mmol/l
acute symptoms of hypoglycemia
- sweating
- slurred speech
- nausea
- impaired judgement
- confussion etc
Causes of fasting hypoglycaemia
- cancers such as insulinoma
- organ failures
- endocrine diseases
Causes of episodic/reactive hypoglycaemia
Gastrointestinal sugery
alcohol
med error
causes of hypoglycaemia in DM
- insufficient carbs
- excess insulin
- strenuous ex
- excess alcohol
what effect does ethanol metabolism have on DM
- primes pancrease to secrete insulin
- Inhibits gluconeogenesis
- Inhibits energy from alanine from mm
- inhibits counter hormones
- NADH/NAD ratio blocks metabolism
how is insulin made
-pre insulin is metabolized to proinsulin which is metabolized to insulin + C peptide
lab tests for hypoglucaemia
Blood glu
plasma ketones
plasma insulin
plasma proinsulin/c peptide
What % of neonates have hypoglycaemia
normal- about 10%%
small for gestational age- 25% have it
