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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
Amount of HbA1c (glycohemoglobin) present in directly proportional to:
-Blood glucose level -Length of time in circulation
26
Hemoglobin A1c: Normal
• Normal: <5.7%
27
Hemoglobin A1c: Abnormal
**Abnormal: • Prediabetes: 5.7-6.4% • Diabetes: >6.4%
28
Hemoglobin A1c: Goal for Treatment
• Goal for treatment: <7%
29
Hemoglobin A1c: Test Interference factors
-Increased HbF (Fetal Hemoglobin) -Hemolysis or bleeding -Splenectomy (increases HbA1c) -Pregnancy (increases HbA1c)
30
Carbohydrate: Additional Screening Tests
• Serum fructosamine assay (a glycated protein-similar to HbA1c) • Lipid panel: Triglycerides, HDL • Insulin
31
DM results from abnormality in production or utilization of:
Insulin
32
• Secondary complications of diabetes have become leading cause ofdeath in patients with DM
Retina, Lens, Kidney, Peripheral nerves, Blood vessels
33
DM: Signs/Symptoms
• 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
Type I (Insulin Dependent) DM: Characteristics
<25 yoa • Autoimmune • Antibodies against beta cells of pancreas (GAD Antibodies) • Onset: Abrupt • Lean • Ketosis prone w/o insulin • Insulinopenia • Microangiopathy
35
Type I (Insulin Dependent) DM: Management
• Refer to pediatric endocrinologist • Insulin – injectable • Blood glucose monitoring: HbA1c every 3 months • Support groups
36
Type II (Non-insulin dependent) DM: Characteristics
• Obese • Peripheral resistance to insulin cells* • Non-ketosis prone • Variable insulin levels • Atherosclerosis* • Hyperplasia of islet cells • Vascular changes
37
Type II (Non-insulin dependent) DM: HbA1c control levels
• Use HbA1c to monitor treatment effectiveness, adherence • 9-12% poor control • <8% to prevent complications • <7% is the goal
38
ABCs of Type II DM
• 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
Sometimes referred to as Type1.5 diabetes
Latent Autoimmune Diabetes in Adults (LADA)
40
What’s the differences between LADA and Type I DM?
• Autoimmune: Slower than type 1 – months or years to need insulin • Over age 30 • Frequently misdiagnosed with type 2 DM
41
LADA patients may report with
Unintentional weight loss
42
Diabetes associated w/ certain conditions and symptoms (Secondary DM)
• Pancreatitis • Endocrinopathies • Drug related • Infection related • Malnourishment
43
Gestational Diabetes: Characteristics
Pregnant women w/o history of impaired glucose tolerance
44
Screening for Gestational Diabetes
• 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
Gestational Diabetes: Management
• Referral to registered dietician • Physical activity • Blood glucose & Blood pressure monitoring • Increased frequency of check-ups • Insulin
46
Prediabetes leads to:
• Increased risk for diabetes mellitus and other conditions (cardiovascular)
47
Prediabetes: Measurements (Fasting Blood Glucose/Impaired Glucose-HbA1c)
-Fasting Blood Glucose: 100-125 -Impaired Glucose: 5.7-6.4%
48
Management of Prediabetes
• Begin recommendations similar to T2 DM recommendations • Follow-up testing
49
Hypoglycemia Symptoms (If HG persists)
-If HG persists: CNS glucose deprivation occurs, symptoms resemble those of cerebral hypoxia • Headache, blurred vision, weakness, tiredness, confusion, dizziness, seizures
50
Fasting Hypoglycemia: Causes (4)
• Insulinoma (tumors in pancreas) • Alcohol-induced • Chronic liver disease • Endocrine disorders
51
Fasting Hypoglycemia is relieved w/:
• Relieved w/ CHO, Higher LT hypoglycemia symptoms
52
Fasting Hypoglycemia is indicated if the measurement is:
• 10+ mg/dL below NL
53
Reactive/Postprandial Hypoglycemia: Causes
• Alimentary – Dumping Syndrome • Pre-diabetes/Type 2 diabetes mellitus • Idiopathic postprandial syndrome
54
Reactive/Postprandial Hypoglycemia: Signs/Symptoms
• Anxiety, shaking, palpitations, tremor, craving sweets (2-4 hours after meal)
55
Reactive/Postprandial Hypoglycemia: Management
• Mixed meals, stress management, smaller & more regular meals
56
Hypoglycemia Symptoms (Rapid decrease in BG)
Anxiety, nervousness, sweating, palpitations, irritability, nausea

Clinical Pathology II (10 decks)

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