Carbohydrates Lab Questions Flashcards
Is it Possible that somene has Glucosuria at a serum glucose concentration of 5 mM?
Yes - “Renal Glucosuria” by Fanconi Syndrome by multiple aqcuired or congenital causes the patient get Impaired reabsorption in proximal tubule.
Is it possible that somene doesnt have Glucosuria at the serum glucose concentration of 15mM?
Yes if there is a decreased GFR - Causes:
- Renal Artery Obstruction
- Diabetic Nephropathy
-at Normal (120ml/min) GFR the Glucose Reabsorption thershold is 10 mM.
GFR↓ → Glucose Reabsorption thershold↑
A 56 year-old man who used to be healthy complains of polyuria.
Laboratory findings:
fasting blood glucose: 7.3 mmol/l, fasting blood glucose a week later: 7.6 mmol/l.
What is your diagnosis, and what would you do with him?
- Diabetes Mellitus - Fasting Glucose Above 7mole/L
- Most Likly type 2 cause of age - LADA check
- Treatment: Diet, Excersize, Sulfonylureas
- Check for complications - Retino-, Neuro- and Nephro- pathy! as well as Atherosclerosis.
A 60 year-old woman, weighing 90 kg. Fasting blood glucose concentration: 6.9 mmol/l.
Neither glucose nor ketone bodies are found in her urine.
The results of oral glucose tolerance test:
fasting value: 6.4 mmol/l
2h value: 8.5 mmol/l
What is your diagnosis, and what would you advise to her?
- IGT → 2hr OGTT Between 7.8 to 11 mmole/L
- 25% of IGT/IFG deveop T2DM
- If shorter than 200cm , lose weight (90kg)
- Reduce Carbs, Excersize and regular blood glucose Check ups.
Laboratory findings of a person:
fasting blood glucose: 6.2 mmol/l
Oral glucose tolerance test was performed on another occasion:
fasting value: 6.3 mmol/l
2h value: 6.5 mmol/l.
What is the diagnosis, and what is the clinical significance of it?
- IFG → 2hr OGTT Between 6 to 7.8 mmole/L
- 25% of IGT/IFG deveop T2DM
What are your options to check the glucose metabolism of your diabetic patient, to decide if the current treatment needs to be changed or not?
- Home Glucose test Kit - Recording over time
- Fasting Blood Glucose - Short term check
- HbA1c - Every 3 months the HbA1c should be (for diabetic) 6-7%
- Yearly checkups for complications:Neuro-/ Retino-/ Nephropathy
- Fructosamine - Like Hb1Ac but for 2 weeks time
A diabetic patient treated with insulin has a fasting blood glucose concentration of 6.4 mmol/l. No glucose was detected on the morning of the examination (Urine).
The HbA1c level is 10 % (normal value: 3–6 %).
Do you think the control of glucose concentration was acceptable in the last 1–2 months?
- No → For treated diabetic HbAc1 is 6-7%
- Problem with Diet/Treatment
A type 1 diabetic man has been eating very little for the last couple of days, due to a febrile illness, so he decided to stop administering his insulin. He checked his blood glucose, because he felt worse and worse, and was suprised to see, that it was more than 20 mmol/l.
What is the explanation?
- T1DM with no Insulin adminstrition will have very low endogenous Insulin produced and GNG↑
- Inflammtion → Cortisol + Epinephrine → GNG↑
A diabetic man treated with insulin skipped his late evening meal before going to bed, without any change in his insulin administration. He has been sweating a lot during the night, and glucose has been detected in his urine in the morning.
What is the explanation for this?
- Paradox/Somogyi Effect - No meal + Insulin before bed → Hypoglycemia→Sympathetic activates Cortisol/Glucagon/GH/Catecholamines/T3/T4 → Gluconeogensis(GNG)↑→ Hyperglycemia with Glucosuria in Morning.
- Treatment: Eating regulary after that should eliminate the stress
man with type 1 diabetes, cooperating very well with his physician, keeps his diet and insulin administration very precisely. He is an employee of a bank, and currently attends a team building training, a several-day-long survival tour causing significant physical exertion. The man, who is known to be reserved, starts shouting and quarreling with his coworkers, then he begins to sweat, quiver and develops cramps.
What do you think is the explanation of his behaviour?
- Exercise → ↑GLUT4 Translocation↑ → ↑ Muscle Uptake → Hypoglycemia
- Hypoglycemia → Sympathetic → Polydipsia
- Hypoglycemia→ CNS→ Mood changes
A woman was admitted to the hospital with the complaint of recurring seizures. Her fasting blood glucose level is 2.7 mmol/l.
What can cause these symptoms?
What tests would you perform to establish the diagnosis?
1) [Alcohol]→ NAD+↓ →GNG↓
2) [TSH]↑ → Hypothyroidism
3) [C-peptide]↑ → Insulinoma
4) [C-peptide]↓ → DM Insulin Overdose
5) ACTH Stimulaion test → Adisson’s
6) CRP↑ / Leukocytosis → Sepsis
7) Imaging → Cirhosis/ Insulinoma
