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Clinical Pathology II > Carbohydrates > Flashcards

Carbohydrates Flashcards

1
Q

What happens to glycogen stores during the fasting state?

A

Glycogen stores in the liver release glucose into circulation

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2
Q

What occurs when blood glucose levels increase?

A

Leads to increased storage as glycogen in the liver

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3
Q

What are the main functions of insulin?

A

-Promotes glycogenesis & lipogenesis
-Increases the permeability of cells to glucose

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4
Q

What pathologies are associated with insulin?

A

-Islet cell tumor (increased insulin = decreased blood glucose)
-Diabetes mellitus

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5
Q

How do GH and ACTH affect blood glucose levels?

A

GH and ACTH have an antagonistic action to insulin and tend to raise blood glucose levels.

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6
Q

In glucose regulation, hydrocortisone stimulates________

A

Glucogenesis (glucose formation)

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7
Q

What are the effects of Cushing’s syndrome on blood glucose?

A

Hyperadrenal corticism (Cushing’s disease) leads to:
-Increased hydrocortisone
-Increased blood glucose

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8
Q

What happens in Addison’s disease in terms of blood glucose?

A

Hypoadrenal corticism (Addison’s Disease) leads to:
-Decreased hydrocortisone
-Decreased blood glucose

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9
Q

How does epinephrine affect blood glucose & what process does it stimulate

A

-Epinephrine stimulates glycogenolysis, increasing blood glucose levels

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10
Q

What pathologies is associated with increased epinephrine levels?

A

-Pheochromocytoma (tumor of the adrenal medulla)
-Stress
-Lead to increased breakdown of glycogen and increased blood glucose

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11
Q

In glucose regulation, glucagon stimulates _________

A

Glycogenolysis (breakdown of glycogen)

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12
Q

How does Thyroxine (T4) affect blood glucose levels?

A

-Stimulates glycogenolysis (breakdown of glycogen)
-Increases the rate of absorption of glucose from the intestine

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13
Q

When do we typically start screening for DM for healthy adults?

A

-Begin at age 45
-Repeat every 3 years

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14
Q

When do we typically start screening children for DM?

A

-Screen at age 8
-Annually thereafter if risk factors (obesity ie.)

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15
Q

When should we be testing earlier for DM?

A

• BMI >25 (overweight)
• Immediate family member w/ diabetes
• Members of high-risk population
• Previous abnormal glucose measurement
• Decreased exercise
• Altered blood lipid levels

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16
Q

Random (Casual) Blood Glucose is measured:

A

Any time throughout day, regardless of if individual has recently consumed food

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17
Q

Random (Casual) Blood Glucose: Abnormal Findings

A

• Abnormal:**200mg/dL

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18
Q

Fasting blood glucose is measured:

A

After fasting (typically 8-12 hours)

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19
Q

Normal Fasting Blood Glucose

A

<100mg/dL (85-99)

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20
Q

Abnormal Fasting Blood Glucose

A

**Abnormal:
• Impaired fasting glucose (prediabetes): 100-125
• Diabetes mellitus: >125

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21
Q

Two-Hour Post Prandial Test: Process

A

• Fast for 8-12 hours, initial blood glucose measured (fasting BG)
• Ingest 75g carbohydrate drink or appropriate meal
• Blood glucose measured 2 hours later

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22
Q

Two-Hour Post-Prandial Test: Normal

A

<140mg/dL

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23
Q

Two-Hour Post Prandial Test: Abnormal

A

• **Abnormal: 140-199 (Impaired glucose tolerance-prediabetes)/>200 (DM)

24
Q

Glucose reacts with amino acids in hemoglobin to form

A

Glycohemoglobin

25
Q

Amount of HbA1c (glycohemoglobin) present in directly proportional to:

A

-Blood glucose level
-Length of time in circulation

26
Q

Hemoglobin A1c: Normal

A

• Normal: <5.7%

27
Q

Hemoglobin A1c: Abnormal

A

**Abnormal:
• Prediabetes: 5.7-6.4%
• Diabetes: >6.4%

28
Q

Hemoglobin A1c: Goal for Treatment

A

• Goal for treatment: <7%

29
Q

Hemoglobin A1c: Test Interference factors

A

-Increased HbF (Fetal Hemoglobin)
-Hemolysis or bleeding
-Splenectomy (increases HbA1c)
-Pregnancy (increases HbA1c)

30
Q

Carbohydrate: Additional Screening Tests

A

• Serum fructosamine assay (a glycated protein-similar to HbA1c)
• Lipid panel: Triglycerides, HDL
• Insulin

31
Q

DM results from abnormality in production or utilization of:

A

Insulin

32
Q

• Secondary complications of diabetes have become leading cause ofdeath in patients with DM

A

Retina, Lens, Kidney, Peripheral nerves, Blood vessels

33
Q

DM: Signs/Symptoms

A

• Microvascular disease: Renal failure, Visual loss

• Neuropathy
• Bilateral, symmetrical distal polyneuropathy* (malfunction of peripheral nerves)
• Loss of position and vibration sense
• Decreased deep tendon reflexes
• Cranial nerves 3 and 6 most commonly affected
• Bilateral carpal tunnel syndrome: DM, hypothyroid*
• Sexual impotence

34
Q

Type I (Insulin Dependent) DM: Characteristics

A

<25 yoa
• Autoimmune
• Antibodies against beta cells of pancreas (GAD Antibodies)
• Onset: Abrupt
• Lean
• Ketosis prone w/o insulin
• Insulinopenia
• Microangiopathy

35
Q

Type I (Insulin Dependent) DM: Management

A

• Refer to pediatric endocrinologist
• Insulin – injectable
• Blood glucose monitoring: HbA1c every 3 months
• Support groups

36
Q

Type II (Non-insulin dependent) DM: Characteristics

A

• Obese
• Peripheral resistance to insulin cells*
• Non-ketosis prone
• Variable insulin levels
• Atherosclerosis*
• Hyperplasia of islet cells
• Vascular changes

37
Q

Type II (Non-insulin dependent) DM: HbA1c control levels

A

• Use HbA1c to monitor treatment effectiveness, adherence
• 9-12% poor control
• <8% to prevent complications
• <7% is the goal

38
Q

ABCs of Type II DM

A

• A – A1c below 7%
• B – Blood pressure <130/80
C – Cholesterol
• HDL >50 mg/dL women, >40 mg/dL men
• Triglycerides <150 mg/dL

39
Q

Sometimes referred to as Type1.5 diabetes

A

Latent Autoimmune Diabetes in Adults (LADA)

40
Q

What’s the differences between LADA and Type I DM?

A

• Autoimmune: Slower than type 1 – months or years to need insulin
• Over age 30
• Frequently misdiagnosed with type 2 DM

41
Q

LADA patients may report with

A

Unintentional weight loss

42
Q

Diabetes associated w/ certain conditions and symptoms (Secondary DM)

A

• Pancreatitis
• Endocrinopathies
• Drug related
• Infection related
• Malnourishment

43
Q

Gestational Diabetes: Characteristics

A

Pregnant women w/o history of impaired glucose tolerance

44
Q

Screening for Gestational Diabetes

A

• Screening between 24th and 28th week
• 50 g glucose dose, plasma glucose measure at 1 hour
• If 140mg/dL or higher; 3-hour glucose tolerance test performed

45
Q

Gestational Diabetes: Management

A

• Referral to registered dietician
• Physical activity
• Blood glucose & Blood pressure monitoring
• Increased frequency of check-ups
• Insulin

46
Q

Prediabetes leads to:

A

• Increased risk for diabetes mellitus and other conditions (cardiovascular)

47
Q

Prediabetes: Measurements (Fasting Blood Glucose/Impaired Glucose-HbA1c)

A

-Fasting Blood Glucose: 100-125
-Impaired Glucose: 5.7-6.4%

48
Q

Management of Prediabetes

A

• Begin recommendations similar to T2 DM recommendations
• Follow-up testing

49
Q

Hypoglycemia Symptoms (If HG persists)

A

-If HG persists: CNS glucose deprivation occurs, symptoms resemble those of cerebral hypoxia
• Headache, blurred vision, weakness, tiredness, confusion, dizziness, seizures

50
Q

Fasting Hypoglycemia: Causes (4)

A

• Insulinoma (tumors in pancreas)
• Alcohol-induced
• Chronic liver disease
• Endocrine disorders

51
Q

Fasting Hypoglycemia is relieved w/:

A

• Relieved w/ CHO, Higher LT hypoglycemia symptoms

52
Q

Fasting Hypoglycemia is indicated if the measurement is:

A

• 10+ mg/dL below NL

53
Q

Reactive/Postprandial Hypoglycemia: Causes

A

• Alimentary – Dumping Syndrome
• Pre-diabetes/Type 2 diabetes mellitus
• Idiopathic postprandial syndrome

54
Q

Reactive/Postprandial Hypoglycemia: Signs/Symptoms

A

• Anxiety, shaking, palpitations, tremor, craving sweets

(2-4 hours after meal)

55
Q

Reactive/Postprandial Hypoglycemia: Management

A

• Mixed meals, stress management, smaller & more regular meals

56
Q

Hypoglycemia Symptoms (Rapid decrease in BG)

A

Anxiety, nervousness, sweating, palpitations, irritability, nausea

Clinical Pathology II (10 decks)

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