Carbohydrates

Question 1

How are monosacchrides formed?

Answer 1

from the cleavage of larger sugars.

Question 2

how does glucose enter the cell?

Answer 2

via insulin, from there it is metabolized to ATP

Question 3

define glycogenolysis

Answer 3

conversion of glycogen (from the liver) to glucose (g-6-p) and can occur within minutes.

Question 4

what is gluconeogensis?

Answer 4

it is the transformation from non-carbohydrate sources (amino acids, lactate, and glycerol) to the formation of glucose. it takes HOURS.

Question 5

How do glucagon and insulin work with each other?

Answer 5

They work in opposition of each other. insulin stimulates sugar uptake from blood. glucagon stimulates the production of glucose via glycogenolysis and gluconeogenesis. this is minute to minute regulation.

Question 6

what other hormones act to increase liver glucose production?

Answer 6

epinephrine, growth hormone, cortisol, thyroxine, and somatostatin.

Question 7

when should glucose (ideally) be obtained?

Answer 7

after and 8-10 hour over night fast.

Question 8

What are the normal values for glucose?

Answer 8

fasting : 70-99
random plasma: less than 200
2 hour post meal: less than 140
critical values: less than 45 more than 450

Question 9

what is the renal threshold?

Answer 9

When the blood level starts to exceed 160-180, then sugar will start to spill into the urine.

Question 10

how is csf related to plasma glucose?

Answer 10

its approximately 60% of plasma glucose. and therefore should always be evaluated in relation to plasma glucose. plasma glucose > csf glucose.
bacterial = less than normal glucose, viral= normal

Question 11

Define hypoglycemia:

Answer 11

when blood sugar falls below 50.

Question 12

what gets used as the energy source when prolonged fasting occurs?

Answer 12

ketones

Question 13

what is the brain totally dependent on for energy production?

Answer 13

glucose

Question 14

what are some of the symptoms of someone who is hypoglycemic?

Answer 14

increased hunger, sweating, confusion, nausea and vomitting, slurring speech

Question 15

what are the lab findings for hypoglycemia?

Answer 15

decreased blood glucose, increased insulin (if insulinoma)

Question 16

What is Type I diabetes?

Answer 16

results from cell-mediated autoimmune destruction of the B-cells of the pancreas; linked to genetic susceptibility and environmental factors, rate of cellular destruction is variable. completely dependent on insulin. most severe, ketosis-prone

Question 17

What is type II diabetes?

Answer 17

caused by insulin secretion that is delayed or insufficient for the glucose load, or perish tissue insulin resistance. insulin levels will appear normal in early course, but then become deficient.

Question 18

What are the symptoms of diabetes?

Answer 18

polydypsia, polyuria, polyphagia

Question 19

what are the diagnostic criteria for diabetes?

Answer 19

1. symptoms (3 p’s) and a random 200mg/dL blood sugar. 2. fasting blood sugar greater than 126 3. HgbA1c value greater than 6.5 4. PP >200 blood sugar during OGTT

Question 20

What is an oral glucose tolerance test?

Answer 20

1. draw a sample 2. administer glucose 3. draw blood sugar at 30, 60, 120, 180 min

Question 21

What is keto-acid metabolism?

Answer 21

In type I diabetes mellitus, lack of insulin causes cells to mobilize FFA’s from triglycerides. Fatty Acid degradation becomes the main source of energy for the cell. this can cause lower blood pH and cause metabolic acidosis.

Question 22

What are three ketones?

Answer 22

acetoacetate, B-hydroxybuterate (current tests can’t identify this ketone), acetone

Question 23

What are the symptoms of ketoacidosis?

Answer 23

increased plasma, urine glucose. increased ketones in plasma and urine, decreased pH and bicarb, increased anion gap, increased potassium,

Question 24

T/F: Fasting plasma glucose only reflects acute changes

Answer 24

true

Question 25

What is glycosated hemoglobin?

Answer 25

Hgb A1c is occurs due to the non-enzymatic addition of glucose residue to terminal amino groups. It assesses diabetic control of the last 2-3 months. patient does not have to fast for this

Question 26

What are the normal ranges for HgbA1C?

Answer 26

non-diabetic is less than 4%
greater than 6.5% indicates diabetes.
GOAL FOR DIABETICS: 6-7%
one can roughly estimate the plasma glucose

Question 27

If patients need more accurate monitoring, you can measure..

Answer 27

glycosylated albumin, and can be measured over a period of 2-3 weeks.

Question 28

What is UAE?

Answer 28

Urinary albumin excretion. An increased UAE indicates that there may be some microvascular damage, and is highly predictive of diabetic neuropathy, end stage renal disease, and retinopathy.

Question 29

UAE can be effected by…

Answer 29

exertion, posture, fluid intake, acute surgery, etc

Question 30

who should perform self monitoring of blood glucose?

Answer 30

all patients with diabetes!!

Question 31

What are some of the variables that can affect glucose readings?

Answer 31

Fase decreases: polycythemia, dehydration

false increases: heamtocrit

Question 32

What is GDM associated with?

Answer 32

neonatal mortality, and the mothers are at an increased risk of developing DM down the road.

Question 33

what is a glycogen storage disorder?

Answer 33

It is a disorder in one of the 8 enzymes that break down glycogen leading to a buildup of glycogen. severe hypoglycemia can occur because glycogen cannot be converted back to glucose.

Question 34

What is the most common form of glycogen storage disorder?

Answer 34

TYPE I (von gierke’s disease). patient will have a massive liver due to accumulation of glycogen. may also see growth retardation.

Question 35

What are disorders of galactose metabolism?

Answer 35

genetic disorder resulting format he lack of enzyme needed to metabolize galactose to glucose resulting in galactose in the plasma.

Question 36

What are the symptoms of galactose metabolism?

Answer 36

after milk ingestion: vomit, diarrhea, FTT, liver disease cataracts. most common defiency is GALACTOSE-1-PHOSPHATE-URIDYL TRANSFERASE.