Carbohydrates Flashcards
What happens to glycogen stores during the fasting state?
Glycogen stores in the liver release glucose into circulation
What occurs when blood glucose levels increase?
Leads to increased storage as glycogen in the liver
What are the main functions of insulin?
-Promotes glycogenesis & lipogenesis
-Increases the permeability of cells to glucose
What pathologies are associated with insulin?
-Islet cell tumor (increased insulin = decreased blood glucose)
-Diabetes mellitus
How do GH and ACTH affect blood glucose levels?
GH and ACTH have an antagonistic action to insulin and tend to raise blood glucose levels.
In glucose regulation, hydrocortisone stimulates________
Glucogenesis (glucose formation)
What are the effects of Cushing’s syndrome on blood glucose?
Hyperadrenal corticism (Cushing’s disease) leads to:
-Increased hydrocortisone
-Increased blood glucose
What happens in Addison’s disease in terms of blood glucose?
Hypoadrenal corticism (Addison’s Disease) leads to:
-Decreased hydrocortisone
-Decreased blood glucose
How does epinephrine affect blood glucose & what process does it stimulate
-Epinephrine stimulates glycogenolysis, increasing blood glucose levels
What pathologies is associated with increased epinephrine levels?
-Pheochromocytoma (tumor of the adrenal medulla)
-Stress
-Lead to increased breakdown of glycogen and increased blood glucose
In glucose regulation, glucagon stimulates _________
Glycogenolysis (breakdown of glycogen)
How does Thyroxine (T4) affect blood glucose levels?
-Stimulates glycogenolysis (breakdown of glycogen)
-Increases the rate of absorption of glucose from the intestine
When do we typically start screening for DM for healthy adults?
-Begin at age 45
-Repeat every 3 years
When do we typically start screening children for DM?
-Screen at age 8
-Annually thereafter if risk factors (obesity ie.)
When should we be testing earlier for DM?
• BMI >25 (overweight)
• Immediate family member w/ diabetes
• Members of high-risk population
• Previous abnormal glucose measurement
• Decreased exercise
• Altered blood lipid levels
Random (Casual) Blood Glucose is measured:
Any time throughout day, regardless of if individual has recently consumed food
Random (Casual) Blood Glucose: Abnormal Findings
• Abnormal:**200mg/dL
Fasting blood glucose is measured:
After fasting (typically 8-12 hours)
Normal Fasting Blood Glucose
<100mg/dL (85-99)
Abnormal Fasting Blood Glucose
**Abnormal:
• Impaired fasting glucose (prediabetes): 100-125
• Diabetes mellitus: >125
Two-Hour Post Prandial Test: Process
• Fast for 8-12 hours, initial blood glucose measured (fasting BG)
• Ingest 75g carbohydrate drink or appropriate meal
• Blood glucose measured 2 hours later
Two-Hour Post-Prandial Test: Normal
<140mg/dL
Two-Hour Post Prandial Test: Abnormal
• **Abnormal: 140-199 (Impaired glucose tolerance-prediabetes)/>200 (DM)
Glucose reacts with amino acids in hemoglobin to form
Glycohemoglobin
Amount of HbA1c (glycohemoglobin) present in directly proportional to:
-Blood glucose level
-Length of time in circulation
Hemoglobin A1c: Normal
• Normal: <5.7%
Hemoglobin A1c: Abnormal
**Abnormal:
• Prediabetes: 5.7-6.4%
• Diabetes: >6.4%
Hemoglobin A1c: Goal for Treatment
• Goal for treatment: <7%
Hemoglobin A1c: Test Interference factors
-Increased HbF (Fetal Hemoglobin)
-Hemolysis or bleeding
-Splenectomy (increases HbA1c)
-Pregnancy (increases HbA1c)
Carbohydrate: Additional Screening Tests
• Serum fructosamine assay (a glycated protein-similar to HbA1c)
• Lipid panel: Triglycerides, HDL
• Insulin
DM results from abnormality in production or utilization of:
Insulin
• Secondary complications of diabetes have become leading cause ofdeath in patients with DM
Retina, Lens, Kidney, Peripheral nerves, Blood vessels
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
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
Type I (Insulin Dependent) DM: Management
• Refer to pediatric endocrinologist
• Insulin – injectable
• Blood glucose monitoring: HbA1c every 3 months
• Support groups
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
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
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
Sometimes referred to as Type1.5 diabetes
Latent Autoimmune Diabetes in Adults (LADA)
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
LADA patients may report with
Unintentional weight loss
Diabetes associated w/ certain conditions and symptoms (Secondary DM)
• Pancreatitis
• Endocrinopathies
• Drug related
• Infection related
• Malnourishment
Gestational Diabetes: Characteristics
Pregnant women w/o history of impaired glucose tolerance
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
Gestational Diabetes: Management
• Referral to registered dietician
• Physical activity
• Blood glucose & Blood pressure monitoring
• Increased frequency of check-ups
• Insulin
Prediabetes leads to:
• Increased risk for diabetes mellitus and other conditions (cardiovascular)
Prediabetes: Measurements (Fasting Blood Glucose/Impaired Glucose-HbA1c)
-Fasting Blood Glucose: 100-125
-Impaired Glucose: 5.7-6.4%
Management of Prediabetes
• Begin recommendations similar to T2 DM recommendations
• Follow-up testing
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
Fasting Hypoglycemia: Causes (4)
• Insulinoma (tumors in pancreas)
• Alcohol-induced
• Chronic liver disease
• Endocrine disorders
Fasting Hypoglycemia is relieved w/:
• Relieved w/ CHO, Higher LT hypoglycemia symptoms
Fasting Hypoglycemia is indicated if the measurement is:
• 10+ mg/dL below NL
Reactive/Postprandial Hypoglycemia: Causes
• Alimentary – Dumping Syndrome
• Pre-diabetes/Type 2 diabetes mellitus
• Idiopathic postprandial syndrome
Reactive/Postprandial Hypoglycemia: Signs/Symptoms
• Anxiety, shaking, palpitations, tremor, craving sweets
(2-4 hours after meal)
Reactive/Postprandial Hypoglycemia: Management
• Mixed meals, stress management, smaller & more regular meals
Hypoglycemia Symptoms (Rapid decrease in BG)
Anxiety, nervousness, sweating, palpitations, irritability, nausea
