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House Clinical Pathology > Disorders of carbohydrate metabolism > Flashcards

Disorders of carbohydrate metabolism Flashcards

1
Q

Carbohydrates (CHO)

Source of energy for the body
Essential energy for some tissues like _____ and ______

A

brain and RBC

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2
Q

Carbohydrates (CHO)

Exist as
Polysaccharides – ____,_______

Disaccharides – _____,______

Monosaccharides – _______,________

A

Starch, Glycogen

Lactose, sucrose

Glucose, Fructose

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3
Q

Carbohydrates (CHO)

Complex CHO taken as food are digested to _______ which are then absorbed in the intestines

A

monosaccharides

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4
Q

_______ is the most used monosaccharide as metabolic fuel

A

Glucose

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5
Q

Many tissues are capable of ______ glucose completely to ______

A

Oxidizing

carbon dioxide

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6
Q

Others metabolize glucose only as far as _______, which can be converted back into glucose, principally in the _____ and also in the _______, by _________

A

lactate

liver

gluconeogenesis

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7
Q

Tissues capable of completely oxidizing glucose, ______ is produced if insufficient oxygen is available (_________ metabolism)

A

lactate

anaerobic

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8
Q

The body’s sources of glucose are _______ and endogenous production by _________ (release of glucose stored as _____) and ________ (glucose _______ from, for example, _______,______ and most _________).

A

dietary carbohydrate

glycogenolysis; glycogen

gluconeogenesis; synthesis

lactate, glycerol and most amino acids

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9
Q

Glycogen is stored in the ______ and ________ , but only the former contributes to blood glucose.

A

liver and skeletal muscle

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10
Q

Regulation of blood glucose

Blood glucose concentration depends on the _____________________

A

influx of glucose into circulation and use

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11
Q

Regulation of blood glucose

Homeostatic mechanisms maintains blood glucose around ____-____mg/dL.

A

50 -110 mg/dL.

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12
Q

Regulation of blood glucose

The _______ produces hormones that regulate blood glucose concentration

A

pancreas

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13
Q

Pancreatic hormones that affects glucose

List 3

A

Glucagon

Insulin

Somatostatin

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14
Q

Pancreatic hormones

Glucagon – from _____ cells; ____eases blood glucose concentration

Insulin – from _______ cells; ____eases blood glucose concentration

Somatostatin - synthesized by ____ cells); it _______________________ , resulting in ____ease in plasma glucose level

A

alpha; incr

beta; Decr

delta; Inhibits both insulin, glucagon and growth hormone release

incr

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15
Q

Pancreatic hormones

Other hormones – (Aid or Counter?) insulin action: _____,______hormones, _______,________ hormone, _____

A

Counter Epinephrine

thyroid

Cortisol

Growth; ACTH

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16
Q

Pancreatic hormones

Two most important hormones in glucose homoeostasis are ______ and _____

A

insulin and glucagon.

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17
Q

Insulin is a ____ amino acid polypeptide, secreted by the ____-cells of the pancreatic islets of Langerhans in response to a (rise or fall?) in blood glucose concentration.

A

51; β ; rise

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18
Q

Insulin

It is synthesized as a _______,________.

This molecule undergoes ______ prior to secretion to form insulin and _______

A

prohormone, proinsulin

cleavage

C-peptide.

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19
Q

Insulin secretion is also stimulated by gut hormones collectively known as _____, particularly _________ and _______________(_____ formerly known as ___________ ).

A

incretins

glucagon-like peptide-1 (GLP-1)

glucose- dependent insulinotropic peptide (GIP

gastric inhibitory polypeptide

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20
Q

Incretin release is stimulated by ______, so that _______ begins to increase before blood ________

A

food

insulin secretion

glucose concentration.

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21
Q

Biosynthesis of insulin

The cleavage of ________ produces insulin, consisting of two polypeptide chains linked by ________, and _________

A

proinsulin

disulphide bridges

C-peptide.

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22
Q

Biosynthesis of insulin

Insulin promotes the ______ of glucose from the ______ through stimulating the relocation of the insulin-sensitive _______ glucose transporter from the _____ to __________, particularly in ______ and ________.

A

removal; blood

GLUT-4 ; cytoplasm ; cell membranes

adipose tissue ; skeletal muscle.

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23
Q

Biosynthesis of insulin

Insulin also stimulates glucose uptake in the liver, but by a different mechanism: it induces the enzyme ______, which ___________ to form ________, a substrate for _______ synthesis.

This process maintains a (low or high?) intracellular glucose concentration and thus a ___________ that facilitates glucose uptake.

A

glucokinase ; phosphorylates glucose

glucose 6- phosphate

glycogen ; low

concentration gradient

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24
Q

Insulin stimulates glycogen _______ (and inhibits glycoge______)

A

synthesis

nolysis

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25
Q

Binding of insulin to its receptor leads to activation of the _______ pathway and phosphorylation of various _______.

These include _________, which dephosphorylates both ________ (thereby activating it and promoting ________ ) and _________ (rendering it inactive and thus preventing the activation of ________ , the key enzyme of _________).

A

postreceptor pathway

effector proteins

phosphoprotein phosphatase ; glycogen synthase

glycogen synthesis; phosphorylase kinase ; glycogen phosphorylase

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26
Q

As a result of insulin’s actions in the liver , in the fasting state, when insulin secretion is ________, hepatic ________ is stimulated and glucose is ________ into the blood.

A

inhibited

hepatic glycogenolysis is stimulated

liberated

27
Q

Insulin also exerts control over glycolysis and gluconeogenesis, stimulating the former and reciprocally inhibiting the latter, by stimulating the expression of ______________, ______________ and the enzyme responsible for the synthesis of the key allosteric modifier, ______________

A

phosphofructokinase

pyruvate kinase

fructose 2,6-bisphosphate

28
Q

Disorders of CHO metabolism
1. HYPOGLYCAEMIA

Blood glucose less than ____ mg/dl (____ mmol/L)

A

50 mg/dl (2.8 mmol/L)

29
Q

Disorders of CHO metabolism
1. HYPOGLYCAEMIA

Causes include __________, __________ insulin release (eg, due to _________, _______ or ————- , excess __________ without food intake inhibiting __________

A

starvation

excess ; insulinoma

excess insulin or hypoglycaemic drug administration

alcohol ; gluconeogenesis

30
Q

Disorders of CHO metabolism
1. HYPOGLYCAEMIA

Features – increase release of anti insulin hormones causing _____,___________,__________ , impaired _________, confusion, seizures, coma

A

anxiety

dizziness

perspiration

nerve function

31
Q

Disorders of CHO metabolism
1. HYPOGLYCAEMIA

Diagnosis

There are ____ stages in the diagnosis of hypoglycaemia: ___________ and ________

A

Two

confirmation of the low blood glucose concentration and elucidation of the cause

32
Q

Disorders of CHO metabolism
1. HYPOGLYCAEMIA

Diagnosis

Symptoms will usually be present only with a concentration of less than ____ mmol/L.

Neonates, however, often develop features only when the blood glucose is <____ mmol/L.

A

2.2 mmol/L.

<1.5 mmol/L.

33
Q

Disorders of CHO metabolism
1. HYPOGLYCAEMIA

Diagnosis

Glucose meters :

can be used to note clinical suspicion of hypoglycaemia

they are sufficiently accurate at low blood glucose concentrations to provide a definitive diagnosis

formal laboratory measurements should not be used

Blood must be collected into a container with ______, to inhibit ______.

T/F

A

T

F. they are insufficiently accurate at low blood glucose concentrations to provide a definitive diagnosis

F . formal laboratory measurements should be used.

fluoride; glycolysis.

34
Q

Disorders of CHO metabolism
1. HYPOGLYCAEMIA

MANAGEMENT

Give glucose either by _______ or ______

The presence of a low blood glucose concentration, symptoms of hypoglycaemia and their abolition by giving glucose constitute ‘______________’.

A

mouth or parenterally

‘Whipple’s triad’.

35
Q

Disorders of CHO metabolism
1. HYPOGLYCAEMIA

MGT

The cause of the hypoglycaemia may be obvious from the patient’s history, particularly in _______ hypoglycaemia. With _____ hypoglycaemia, many possible causes can be eliminated by simple tests.

A

reactive

fasting

36
Q

Disorders of CHO metabolism
2. LACTOSE INTOLERANCE

Inability to _____________________ which is present in human and cow milk

A

digest to digest milk sugar (Lactose)

37
Q

Disorders of CHO metabolism
2. LACTOSE INTOLERANCE

________ or ________ ———— in the small intestine

A

Deficiency or abnormal lactase enzyme

38
Q

Disorders of CHO metabolism
2. LACTOSE INTOLERANCE

Symptoms – mild to severe – ————-,———-,_______,_______,_______

Usually starts _______ to _______ after food ingestion

A

abdominal pain, bloating, gas, diarhoea, nausea.

30 mins to 2 hrs

39
Q

Diagnosis of Lactose intolerance

________ test

_______[[ test

A

Hydrogen breath

Stool acidity

40
Q

Diagnosis of Lactose intolerance

Hydrogen breath test – Patient drinks ___________ drink and the ______ is analysed at intervals to check ________.

___________ will cause ________ in breath

A

lactose laden drink

breath ; Hydrogen level.

Undigested lactose

elevated hydrogen in breath

41
Q

Diagnosis of lactose intolerance

Stool acidity test – Good for ______;

Undigested lactose causes ___________ in stool due to _________

A

infants

increased acidity (lactate)

bacterial action

42
Q

Diabetes mellitus

Diabetes mellitus is a condition characterized by ____________ with a tendency to _____glycaemia and is due to a relative or absolute _________

A

abnormal glucose tolerance

hyper

deficiency of insulin.

43
Q

Diabetes mellitus

It can occur secondarily to other __________ but the majority of cases are __________.

A

pancreatic disease

idiopathic

44
Q

Diabetes mellitus

Type 1 typically affects (younger or older?) patients.
It is an _______ disease and usually has an (acute or chronic?) onset.

Type 2 typically affects _____-aged and _____ people (although it is increasingly being diagnosed in ——- _____ people) and has a more _______ onset. Genetic and environmental factors are important in its pathogenesis.

A

Younger ; autoimmune; acute

middle; elderly; obese young; gradual

45
Q

Diabetes mellitus

The prevalence of both types of diabetes, but particularly of type ___, is increasing.

Hyperglycaemia leads to _____ and causes an _______, producing the classic clinical features of _______ and ________

A

type 2

glycosuria ; osmotic diuresis

polyuria and polydypsia.

46
Q

Diabetes mellitus

Patients with type 1 DM may develop diabetic ______ in which hyperglycaemia, together with increased _____,_______,_________ , leads to severe dehydration.

A

diabetic ketoacidosis

lipolysis, proteolysis and ketogenesis

47
Q

DIABETES MELLITUS

Pre-renal uraemia and a profound metabolic respiratory acidosis.

Patients with type 2 DM appear to have (sufficient or insufficient?) insulin secretion to prevent the excessive _______ and ________ that are essential to the production of ________.

Instead, inadequate treatment may lead to the development of very severe ______ and _________, producing a (ketotic or non-ketotic?) , _______ state.

A

sufficient

lipolysis and ketogenesis

ketoacidosis.

hyperglycaemia and dehydration

non-ketotic, hyperosmolar state.

48
Q

DIABETES MELLITUS

Pre-renal uraemia and a profound metabolic respiratory acidosis.

In type 2DM

Both ketoacidosis and non-ketotic hyperosmolar coma are medical emergencies; their management involves _________ and _________ , with general supportive measures and treatment of any specific pre-existing or complicating factors

A

provision of fluid and insulin

49
Q

DIAGNOSIS DIABETES MELLITUS

Normal : Fasting= < _____ mmol/L

Impaired fasting:
fasting venous plasma=____-____ mmol/L
2 hr PP= <_____ mmol/L

A

6.1

6.1 – 7.0

7.8

50
Q

DIAGNOSIS DIABETES MELLITUS

Impaired glucose tolerance

fasting venous plasma= <____ mmol/L
2hr PP =_____ -_____ mmol/L

A

7.0

7.8 – 11.1

51
Q

DIAGNOSIS DIABETES MELLITUS

DM

fasting venous plasma = or > _____ mmol/L

2hr PP = or > ____ mmol/L

A

7.0

11.1

52
Q

2 hr post standard glucose load can stand for OGTT

T/F

A

T

53
Q

Complications of DM

Microvascular complications - ____pathy, _____pathy and ____pathy and _________.

A

Retino

Neuro

Nephro

atherosclerosis

54
Q

Complications of DM

The presence of microalbuminuria may indicate _________ and ___________ ————.

Diabetes is associated with ______ that predispose to ________

A

early (and potentially treatable) nephropathy

dyslipidaemia; atherosclerosis

55
Q

Complications of DM

The treatment of diabetes is aimed at relieving symptoms and preventing both short- and long-term complications.

T/F

A

atherosclerosis

56
Q

Complications of DM

The efficacy of treatment, whether with _____, ____________________ drugs or _____________ alone, can be assessed clinically and by measurements of blood glucose concentration, both in the clinic and by patients.

A

insulin

oral hypoglycaemic

dietary modification

57
Q

Complications of DM

Measurements of ____________(HbA1c) provide a valuable index of ___________ over a period of _______

A

glycated haemoglobin (HbA1c)

glycaemic control

three months

58
Q

Gestationnal DM

Maternal diabetes increases the risk of ___________ and unexplained fetal death.

This risk can be greatly reduced by ensuring ________ at conception and during ________

A

congenital malformations

good glycaemic control

early pregnancy

59
Q

Gestationnal DM

Maternal hyperglycaemia increases ______ secretion and can cause fetal ________, predisposing to difficult ____ and neonatal _________.

A

fetal insulin

macrosomia

delivery; hypoglycaemia

60
Q

Gestationnal DM

Pregnancy causes ————- especially in the _______________ trimesters of pregnancy

A

insulin resistance

2nd and 3rd

61
Q

Gestationnal DM

Risks factors

_______ ;_______
Advanced ______
Past _________
____uria

High risk patients require testing – age > ____yrs, PCOS, obesity

A

Family history ; Obesity

macrosomic baby ; Glycos

25

62
Q

Testing

One step approach –____ of glucose given irrespective of initial fast or not

A

100g

63
Q

Testing

2 step approach –_____ glucose given irrespective of initial fast or not

if serum glucose concentration is > _____ mg/dl, then proceed to the 2nd stage of testing whish is the _______ with _____ or _____ glucose:

1hr – _____ mg/dl
2hr – ____ mg/dL
3hr – ____ mg/dL

A

50g; 140

OGTT test

75g or 100g

180; 155; 140

House Clinical Pathology (45 decks)

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