Carbohydrates Flashcards
Normal blood glucose?
3,5-5,5 mmol/l
Name 4 hormones that increase blood glucose
• Glucagon
• catecholamines (adrenaline)
• growth hormone
• cortisol
Name 3 factors that stimulate insulin release
•increased blood glucose
• incretin gut hormones during food intake:
-Glucagon like peptide 1 GLP 1
- glucose dependent insulinotropic peptide GIP
Name 2 electrolyte changes in insulin deficiency
Hyperkalaemia
Hyper P
Name 3 electrolyte changes in insulin therapy
(Increased cellular uptake)
• hypo K
• hypo p
• hypo mg
Name 4 causes diabetes mellitis
• Chronic pancreatitis
•Haemochromatosis ( excess iron)
• endocrine conditions with increased cortisol eg Cushing
• endocrine conditions with increased gh eg acromegaly
Define normal fasting glucose
<6,1
Define dm glucose
Fasting ≥7
2h post glucose ≥11,1
Diabetic hba1c?
> 6,5% (48 mmol/mol)
Repeat within 2. weeks to confirm
(If <6,5%, reassess in 6 months because high diabetes and cv risk)
Define intermediate HbA1C values and appropriate action
6-6.4% (42-47 mmol/mol)
Increased risk diabetes and cv risk, reassess in 1 year
Name 6 contraindications to using hba1c
• Rapidly changing glucose levels eg acute illness, new onset dm, drugs
• abnormal RBC lifespan: liver and kidney disease, hemolytic anemia, fe deficiency, b12/folate deficiency, hypersplenism, splenectomy
• pregnancy
• severe anaemia hb <6,5
• no HbA ( homozygous variant: S,C,D, E)
. Method specific interferences from certain hb variants
First line diagnosis for gestational diabetes?
2h ogtt > 7,8 mmol/ L
When should gestational diabetes be tested for
24-28 Weeks
Best method of measuring ketones in diabetes?
Plasma 3-oh-buturate (3-0h-b) with ketone meter
(Urine detect acetoacetate and acetone, which can underestimate DkA severity)
Which tests should be used to monitor nephropathy in diabetes (4)
• Creatinine
• eGFR
• screen for microalbuminaria (3-30 mg / mmol) with urine albumin: creatinine ratio
• once clinical proteinuria (acr>30), monitor with urine protein: creatinine ratio
Electrolyte derangements in DkA? (3)
• Hypo Na
• hyper K
• hyper p
Treatment DKA? (5)
• Insulin for hyperglycaemia
• iv saline for hyponatraemia
• k, p, Mg supplements (insulin cause hypo)
• check uce, blood glucose every 6 hours
• monitor water balance with CvP and input output chart
Define hyperosmolar hyperglycaemic state (3)
• DM 2 severe hyperglycaemia > 50 mmol /l without DkA
• extreme dehydration, very high serum osmolality >320 mosm/kg
• no or minimal metabolic acidosis, no/mild ketones (unlike dka)
Treatment hyperosmolar hyperglycaemic state
• Rehydration
• low dose iv insulin
• thrombosis prophylaxis
Define Whipple’s triad of hypoglycaemia
• Hypoglycaemic symptoms: neuroglycopaenia
• low glucose <3
• symptoms resolve after glucose load
How determine cause of fasting hypoglycaemia? (3)
Measure insulin and C peptide while hypoglycaemic
• both increase: endogenous hyperinsulinism eg islet cell tumours, drug induced, anti-insulin antibodies
• both decrease: suppressed endogenous insulin secretion: liver diseases , CkD, non-islet cell tumours, endocrine deficiencies, drug, alcohol, severe starvation
•. increase insulin, decrease C peptide: exogenous insulin, anti-insulin receptor antibodies
How calculate expected pCO2 for metabolic acidosis?
1.5 x HCO3 + 8
(Range +/- 2. Max compensation may take 12-24h to reach)
Name 9 causes neonatal hypoglycaemia
• Fasting
• decreased liver glycogen ; muscle protein; fat in premature and iugr
• increased consumption in birth stress, RDS, infections, hypothermia
•Persistent hyperinsulinaemic hypoglycaemia of infancy
• decreased growth hormone, cortisol
• inborn errors of intermediary metabolism
-Galactosaemia
- organic acidemias
- Fatty acid oxidation disorders
- Glycogen storage diseases, hereditary fructose intolerance
Which test can be done on newborns to confirm presence of mono or disaccharide that can’t be metabolised
Screen for urine reducing sugars with copper reduction test (urine change colour)
