Carbohydrates Flashcards
In the fasting state, the level of blood glucose is maintained by drawing upon the glycogen stores in the _____
Liver
___ cannot directly contribute glucose to the blood due to it’s lack of glucose-6-phosphatase (enzyme)
Skeletal muscle
Storage form of carbohydrates (sugar)
Glycogen
The formation of glycogen
Glycogenesis
The ONLY hormone that can lower blood sugar
Insulin
Absorption of carbohydrates takes place where?
Intestine
Insulin is produced by the ___ cells in the pancreas, while glucagon is produced by the ___ cells
Beta (of the islets of Langerhans), Alpha
What two hormones from the anterior pituitary gland have an antagonistic action to insulin (tend to raise BG)
- Growth hormone
2. Adrenocorticotropic hormone (ACTH)
The formation of glucose (from non-carbohydrate substrates)
Gluconeogensis
The breakdown of glycogen
Glycogenolysis
___ increases the permeability of cells to glucose
Insulin
____ is produced in the adrenal medulla. It stimulates glycogenolysis.
Epinephrine
What hormone stimulates hepatic glycogenolysis?
Glucagon
Fasting blood glucose levels should be?
<100 mg/dl
Casual blood glucose levels should be?
<200 mg/dl
Diabetes mellitus is characterized by disturbances in ___, ___ and ___ metabolism.
Carbohydrate, lipid, protein
Type 1 makes up about __% of all diabetes mellitus diagnoses, while type 2 is about __%
10%, 80%
A metabolic state of the body where fat gets converted to ketones for energy use (usually due to low/no carbohydrates)
Ketosis
Small vessel disease
Microangiopathy
It is recommended that pregnant women get screened for possible gestational diabetes between the ___ and ___ weeks.
24th and 28th
Post challenge (2-hours after drinking heavy sugar beverage) blood glucose levels are > what is considered normal, but < what is required for diagnosis of diabetes. What designation would this person be given?
Impaired Glucose Tolerance (IGT)
In the 2-hour challenge, blood glucose should be less than ___ mg/dL. If BG is higher than ___ it is considered the patient has DM.
140, 200
A fasting glucose of >100mg/dl, but less than 126mg/dl (considered DM) is considered?
Prediabetes (impaired fasting glucose)
The earliest symptom of diabetes?
Polyuria (increased urination)
What are the “3 P’s” of DM?
Polyuria, polydipsia, polyphagia
Polydipsia
Increased thirst
Polyphagia
Increased hunger
Monilial vaginitis and itching are more common in type __ diabetes mellitus
2
Neuropathy is a common presentation in type __ DM
2
The gold standard for diagnosis of diabetes mellitus is the demonstration of ____
Hyperglycemia
Glycosuria associated with ____ is almost always pathognomonic of diabetes mellitus
Ketonuria
A HbA1C of >__% is diagnostic for DM
6.4%
Microvascular disease (common in diabetes) often leads to what two things?
- Renal failure
2. Visual loss
Hydrocortisone stimulates gluconeogenesis. It is produced in the _____
Adrenal cortex
Which test is more sensitive: fasting blood glucose or two hour post challenge blood glucose?
Two hour post challenge
In the 2 hour post challenge blood glucose test, the patient is given __ gm of carbohydrate or glucose load after an overnight fast, and then 1 tube of blood is drawn two hours later.
75 gm
Normal HbA1c?
<5.7%
The goal of therapy for a person with DM is a HbA1c of?
<7%
There is a greater risk of complication in a patient with a HbA1c level of >__%
8%
Name a few good management steps for patients with type 2 diabetes:
- Weight loss
- Exercise
- High complex carb, low-fat diet
- Eat foods in whole form
- 6 small, mixed meals/day
- Chromium supplementation
- Cinnamon
- ABC’s (A1c <7%, BP <130/80, Cholesterol)
What cells in the body are NOT insulin dependent for glucose penetration, and therefore during hyperglycemia these areas attain increased levels of intracellular glucose?
- Retina
- Lens
- Kidney
- Peripheral nerves
- Blood vessels
Blood glucose <50 mg/dl
Chemical hypoglycemia
Clinical hypoglycemia is divided into what two categories?
- Fasting hypoglycemia
2. Reactive/postprandial hypoglycemia
If hypoglycemia persists, CNS glucose deprivation occurs and symptoms resemble those of ________
Cerebral hypoxia
____ is the basic screening procedure for an insulinoma (tumor of pancreas)
Whipple’s triad
SSx of this type of hypoglycemia tend to be one or more of those associated with CNS neuroglycopenia (lethargy, headache, confusion, visual disturbances, odd behavior, etc.)
Fasting hypoglycemia
This most often occurs after gastric surgery and results from unusually swift or complete gastric emptying of ingested carbs into duodenum, leading to hyperglycemia and then hypoglycemia.
“Dumping syndrome” (Alimentary)
This type of hypoglycemia develops 3-4 hours after eating. In most cases the symptoms cannot be correlated with acceptably low blood glucose levels. The person tends to be adrenergic (nervous, sweating, flushed, tremors, shaking, hunger). No known cause.
Idiopathic postprandial syndrome (functional hypoglycemia)
This type of hypoglycemia is due to insulin abuse or oral hypoglycemic agents
Factitious hypoglycemia (fake)
This type of hypoglycemia is due to improper specimen preparation, Leukocytosis, Polycythemia Vera, or bacterial contamination of specimen.
Artifactual hypoglycemia
Management of reactive/postprandial hypoglycemia?
- Relieve emotional stress
2. Frequent small, mixed meals
What tumor is commonly found in those with fasting hypoglycemia?
Insulinoma (tumor of pancreas)
Of the two categories of clinical hypoglycemia, which one is more common?
Reactive/postprandial hypoglycemia
