Clinical Conditions: Hypo and Hyperglycemia Flashcards
- Decreased serum glucose concentration (≤ 60 mg/dL)
- A life-threatening condition (due to impairment of brain function)
Hypoglycemia
Diagnostic criteria for Hypoglycemia
Whipple’s triad
Content of Whipple’s triad
- Low Plasma glucose
- Symptoms consistent with hypoglycemia (in CNS)
- Relief of those symptoms if plasma glucose is raised
- Adrenergic (also affects the autonomous
nervous system) - Predominantly found in px with reactive/ alimentary hypoglycemia
Neurogenic
Hypoglycemia that occurs 4 hours after meal
Neurogenic
Symptoms of Neurogenic Hypoglycemia
Tremors, Palpitations, Anxiety, & Diaphoresis
- Decreased glucose supply in the brain
- Occurs if the glucose level is < 40 mg/dL
- Predominantly found in px under fasting hypoglycemia
Neuroglycopenic
Occurs after 10 hours without food intake
Neuroglycopenic
Symptoms of neuroglypenic
Blurred vision, Behavioral changes, Confusion,
Dizziness, & Tingling Sensation
Causes of Hypoglycemia
- Alcohol consumption
- Severe sepsis
- End-stage renal disease (ESDR)
- Cortisol and/or Growth Hormone deficiencies
- Alimentary/Hypoglycemia/ Reactive hypoglycemia
Normal FBG/ Fasting Blood Sugar value
70-99 mg/dL
Glucagon & other hyperglycemic hormones are released into the circulation value
65-70 mg/dL
Strongly suggests hypoglycemia
(if result is found in series/ multiple glucose testing)
≤ 60 mg/dL
Observable symptoms of hypoglycemia appear
55 mg/dL
Impairment of cerebral function begins
50 mg/dL
- Increased serum glucose concentration (> 90 mg/dL)
- Toxic to beta-cell function (beta-cell functions to produce insulin)
Hyperglycemia
General Lab findings in hyperglycemia
○ Increased urine and serum glucose
○ Increased urine specific gravity
○ Ketones in urine and serum (DM Type I)
○ Decreased blood and urine pH (acidosis)
○ Electrolyte imbalance (↓Na+, ↑K+, ↓HCO3)
A group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin receptors or both
Diabetes Mellitus
FBS result for DM
≥ 126 mg/dL on more than one testing
Glucose in urine due to reaching the
maximum renal threshold for glucose (160-180 mg/dL) making kidney to no longer reabsorb the excess glucose
Glucosuria
compensation of the body that occurs if a
non-carbohydrate source is utilized such as LIPID to form energy; which in turn produces a byproduct of ketones
Ketosis
Normal ratio of Ketones (Β-hydroxybutyrate to Acetoacetate)
1:1
Β-hydroxybutyrate to Acetoacetate ratio in Severe DM
6:1
T/F: The 6:1 ration is reversible by insulin administration
TRUE
General Signs & Symptoms of DM
- 3Ps (Polyuria, polydipsia, Polyphagia)
- Rapid weight loss
- Hyperventilation
- Mental confusion and possible loss of consciousness
↑ Blood Glucose = ↑ Osmolality = Promotion of
thirst
Polydipsia
Type 1 DM is also known as
- Insulin Dependent DM/
- Juvenile Onset DM/
- Brittle Diabetes/
- Ketosis-Prone Diabetes
- Occurs only if 80-90% of beta-cell is destroyed
- Insulinopenia Absolute insulin deficiency
Type 1 DM
Most common to childhood/teens
Type 1 DM
Risk factor: Autoimmunity (autoimmune disorder)
Type 1 DM
Pre-diabetes stage: (+) autoantibodies
Type 1 DM
Symptoms develop ABRUPTLY
Type 1 DM
Decreased or Undetectable C-peptide
Type 1 DM
Pancreas’ beta-cells produces PRO-INSULIN which is composed of
Insulin + C-peptide
Is an INACTIVE form and must be cleaved first
Proinsulin
Common, poorly controlled ketosis
Type 1 DM
Insulin is one of the medication
Type 1 DM
Autoantibodies found on pre-diabetes stage in Type 1 DM
- Glutamic Acid Decarboxylase (adults)
- Insulin Autoantibodies (children)
- Islet Cells
- Tyrosine Phosphatase (IA-2 and IA-2b)
- Insulinoma assoc. Protein 2 Autoantibody
- Zinc Transporter 8 Autoantibodies
Other names for Type 2 DM
- Non-Insulin Dependent
- Adult Type/ Mature Onset
- Stable Diabetes
- Ketosis-Resistant
- Receptor-Deficient DM
- Geneticist’s Nightmare
Insulin Resistance (due to alteration/ absence
of insulin receptors)
Type 2 DM
most common among adult
Type 2 Dm
Risk factors are
Genetics, Race, Obesity, Sedentary Lifestyle, Ethnicity, Polycystic Ovarian Syndrome, Hypertension, Dyslipidemia
Type 2 DM
(-) Autoantibodies
(have normal BS, but still at
risk for DM)
Type 2 DM
Symptoms develop
GRADUALLY (milder symptoms, some asymptomatic) If not controlled, it can be
converted to Type I DM
Type 2 DM
Detectable C -peptide
Type 2 DM
Ketosis is rare
Type 2 DM
The medication for Type 2 DM
Oral Agents (Metformin – increases
sensitivity of cells to insulin)
- Cause of DM is UNKNOWN
- It does not have β-cell autoantibodies and have episodic requirements for insulin replacement
Idiopathic Type 1 DM
Occurs only among PREGNANT women (if diabetic already prior to pregnancy, it’s not classified as GDM)
Gestational Diabetes Mellitus (GDM)
Disorder characterized by impaired ability to metabolize
carbohydrates usually caused by a deficiency of insulin, metabolic or hormonal changes
GDM
How many percentage converts to Type 2 DM within 10 years
30-40%
Should evaluated 6-12 weeks after birth
GDM
GDM screenign should be performed between __ weeks of gestation
24-28 weeks of gestation
Normal FBS value
70-99 mg/dL
Normal 2hr GTT value
60-140 mg/dL
Normal HbA1c value
3-6%
(ADA: <5.7%)
Normal RBS
<160 mg/dL
Value for FBS (DM)
≥ 126 mg/dL
Value for 2hr GTT (DM)
≥ 200 mg/dL
Value for HbA1c (DM)
≥ 6.5%
Value for RBS (DM)
≥ 200 mg/dL (w/ DM symptoms)
Value for FBS (Impaired Fasting Glucose)
100-125 mg/dL
Value for 2hr GTT impaired glucose tolerance
140-199
mg/dL
Hypoglycemia value
≤ 60 mg/dL (Whipple’s Triad)
