Carbohydrates Flashcards
-Methods -Hypoglycemia -Diabetes -DKA
Although C peptide and Insulin are produced in equimolar quantities, the ratio of C peptide:Insulin is ____.
5-15:1 (when both insulin and C-peptide are expressed in SI units [pmol/L])
What is the major clinical use of C-peptide?
Detection of exogenous insulin administration
When blood is left in an unseprated tuest tube, glycolysis will REDUCE the glucose by ___mg/dL/hr depending on the temperature and WBC count.
5-10 mg/dL/hr
What can be added to an unseperated test tube that will arrest glycolysis for 24 hours?
Sodium fluoride (NaF)
*The initial arrest of glycolysis takes 1-2 hours to take effect, so an initial decrement of 5-10 mg/dL can be expected
Uncalibrated whole blood glucose usually runs ____% lower than plasma glucose.
10-15%
How is glycosylated hemoglobin formed?
When hemoglobin undergoes nonenzymatic reaction with glucose.
What is a normal HgbA1c?
-What is it an indicator of?
<6%
-glucose concentrations over the preceeding 3 months
What is the equation for average blood glucose (AG) using he HgbA1c?
AG=(28.7xHbA1c)-46.7
Insulinomas are neoplasms of what?
Beta-islet cells
What is the clinical triad of Insulinomas?
Whipple triad:
- Hypoglycemic symptoms
- Plasma glucose <45 mg/dL
- Relief of sxs with Glucose
Type I Diabetes:
- Pathophysiology
- % of diabetics
Autoimmune islet Beta-cell destruction, causing a deficiency of insulin
-5-10% of diabetics (typically presents in childhood)
Type I Diabetes:
-Autoantibodies
- Islet cell Abs (ICA)
- Insulin autoantibodies (IAA)
- Glutamic Acid Decarboxylase Abs (GAD)
- IA2/ICA512 (Insulinoma Associated Protein)
Type I Diabetes:
-HLA association
HLA-DR/HLA-DQ loci
-particular alleles having either predisposing or protective effects
What are the 4 routes to diagnosis of DM?
- Fasting plasma glucose (FPG)
- 75g oral glucose tolerance (OGTT)
- Hemoglobin A1c
- Random plasma glucose (pts w/ classic sxs)
What is the recommended test for diagnosis of DM?
Fasting plasma glucose
Diagnostic Criteria for DM:
-HbA1cdfasfsd
> 6.5%
Diagnostic Criteria for DM:
- Fasting Plasma Glucose (FPG)
- Definition of fasting
> 125 mg/dL
*No caloric intake for >8 hours
Diagnostic Criteria for DM:
-75g at 2 hrs oral glucose tolerance (OGTT)
2 hour plasma glucose >200 mg/dL
Diagnostic Criteria for DM:
-Random plasma glucose
> 200 mg/dL
In pregnancy, the ADA recommendations:
-Women with risk factors
Tested for T2DM at 1st prenatal visit
standard criteria applied
In pregnancy, the ADA recommendations:
-Women without risk factors
24-28 weeks using OGTT (75mg/2hrs)
-After overnight fast of >8 hrs
Diagnostic Criteria for Gestational Diabetes, based on OGTT (75mg):
- Fasting
- 1 hour
- 2 hour
Plasma Glucose
- > 92 mg/dL - Fasting
- > 180 mg/dL - 1 hour
- > 153 mg/dL - 2 hour
Who does Diabetic Ketoacidosis occur in?
Insulin dependent diabetics
What is the triad (general) of DKA?
- Hyperglycemia
- Ketosis
- Metabolic acidosis
DKA:
- Glucose
- pH
- Bicarbonate
- Anion Gap
- Glucose: >200 mg/dL
- pH: <7.30
- Bicarbonate: 15 mmol/L
- Increased Anion Gap
P.smear findings in DKA.
Left-shifted neutrophilia
DKA:
-Potassium
Initially elevated
-Severe Hypokalemia following treatment
What are the major serum ketones in DKA? (3)
- Acetone
- Acetoacetic acid
- B-hydroxybutyrate
Nitroprusside technique is sensitive to which ketones?
Acetone and Acetoacetic acid
*Not B-hydroxybutyrate, which, in DKA, is often 80% of serum ketones
Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC):
-Who does it occur in?
Noninsulin dependent diabetics
Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC):
-Signs/Symptoms (5)
- Altered Mental Status
- Hyperglycemia (>1000 mg/dL)
- Hyperosmolarity (>330 mOsm/L)
- Dehydration
- Normal pH
Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC):
- Bicarbonate
- Ketones
Both are normal
