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CC1 LECTURE DEAN > GESTATIONAL DIABETES MELLITUS > Flashcards

GESTATIONAL DIABETES MELLITUS Flashcards

1
Q

– pregnancy-related hyoerglycemia

A

HUMAN PLACENTAL LACTOGEN

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2
Q

– similar to action of GH (inhibits insulin)

A

HUMAN CHORIONIC SOMAMOTROPIN

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3
Q

Glucose intolerance which develops in [?] of pregnancies

A

7%

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4
Q

Abnormal glucose concentration discovered for the 1st time during pregnancy

A

GESTATIONAL DIABETES MELLITUS

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5
Q

ONE-STEP STRATEGY

A

2011 Standards of Care – ADA

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6
Q

TWO-STEP STRATEGY

A

2013 – NIH

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7
Q

24 to 28 weeks of gestation

A

ONE-STEP STRATEGY
TWO-STEP STRATEGY

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8
Q

Step 1: Perform a 75-g OGTT (fasting, 1H, and 2H BGL)

A

ONE-STEP STRATEGY

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9
Q

Step 1: Perform a 50-g GLT (non-fasting)

A

TWO-STEP STRATEGY

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10
Q

1H PG measurements

A

TWO-STEP STRATEGY

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11
Q

If the 1H PG is [?], or [?], proceed to a [?]

A

> or = to 130 mg/dL
140 mg/dL
100-g OGTT

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12
Q

Step 2: The 100-g OGTT should be performed when the patient is fasting

A

TWO-STEP STRATEGY

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13
Q

ONE-STEP STRATEGY

Diagnosis of GDM is made when any or the PG values are = or > than any of the ff PG levels:

Fasting:

A

92 mg/dL (5.1 mmol/L)

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14
Q

ONE-STEP STRATEGY

Diagnosis of GDM is made when any or the PG values are = or > than any of the ff PG levels:

1 h:

A

180 mg/dL (10.0 mmol/L)

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15
Q

ONE-STEP STRATEGY

Diagnosis of GDM is made when any or the PG values are = or > than any of the ff PG levels:

2 h:

A

153 mg/dL (8.5 mmol/L)

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16
Q

TWO-STEP STRATEGY

Diagnosis of GDM is made if at least two values are = to or > than any of the ff PG levels:

Fasting:

A

105 mg/dL

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17
Q

TWO-STEP STRATEGY

Diagnosis of GDM is made if at least two values are = to or > than any of the ff PG levels:

1 h:

A

190 mg/dL

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18
Q

TWO-STEP STRATEGY

Diagnosis of GDM is made if at least two values are = to or > than any of the ff PG levels:

2 h:

A

165 mg/dL

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19
Q

TWO-STEP STRATEGY

Diagnosis of GDM is made if at least two values are = to or > than any of the ff PG levels:

3 h:

A

145 mg/dL

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20
Q

Results from an imbalance between glucose utilization and production

A

HYPOGLYCEMIA

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21
Q

Observable symptoms appear at about

A

50 to 55 mg/dL

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22
Q

ADRENALINE

A

EPINEPHRINE

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23
Q

 Triggered by the ANS

A

NEUROGENIC/ADRENERGIC

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24
Q

 Tremulousness, palpitations, anxiety

A

NEUROGENIC/ADRENERGIC

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25
Q

 Diaphoresis (cold sweat)

A

NEUROGENIC/ADRENERGIC

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26
Q

 Hunger

A

NEUROGENIC/ADRENERGIC

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27
Q

 Paresthesias (numbness)

A

NEUROGENIC/ADRENERGIC

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28
Q

 CNS hypoglycemia

A

NEUROGLYCOPENIC

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29
Q

 Dizziness, tingling, difficulty in concentrating, blurred vision

A

NEUROGLYCOPENIC

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30
Q

 Confusion, behavioral changes, seizure, coma

A

NEUROGLYCOPENIC

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31
Q

aka fast Hgb, glycosylated Hgb

A

Glycohemoglobin

32
Q

– major fraction; predominant form

A

HbA1c

33
Q

Non-enzymatic condensation between glucose and the N-terminal valine of each B-chain

A

HbA1c

34
Q

Occurs over the lifespan of the RBC (90 to 120 days)

A

HbA1c

35
Q

[?] ——– [N-terminal of B]

A

Glucose + Valine

36
Q

[?] (unstable aldimine) ——– [Amadori rearrangement]

A

SCHIFF BASE

37
Q

(stable)

A

KETOAMINE

38
Q

GHb testing provides an index of ave. BGL over the

A

past 2-4 months

39
Q

Values for [?] have a high degree of correlation

A

total HbA1 & HbA1c

40
Q

Labile fraction (Schiff base or pre-A1c): accounts for [?] of total HbA1

A

5 to 8%

41
Q

GHb testing Advantages:

  1. Provides objective means of
  2. Additional confirmation of the
A

reflecting control of DM
clinical impression of control

42
Q

 Cation-exchange resin or carboxymethyl cellulose resin

A

ION-EXCHANGE CHROMATOGRAPHY

43
Q

 HbA1 elutes from the column first

A

ION-EXCHANGE CHROMATOGRAPHY

44
Q

 False elevation: labile fractions, HbF

A

ION-EXCHANGE CHROMATOGRAPHY

45
Q

 Low values: Hb variants

A

ION-EXCHANGE CHROMATOGRAPHY

46
Q

 Reference method

A

HPLC

47
Q

 Separates and quantifies HbA1c and other haemoglobin types

A

HPLC

48
Q

 Hb A1c — acid — 5-HMF

A

COLORIMETRY

49
Q

 Specific for ketoaminelinked

A

COLORIMETRY

50
Q

 Unaffected by HbF, Hb variants and labile intermediate

A

COLORIMETRY

51
Q

 Routine

A

COLORIMETRY

52
Q

 Antibodies against Hb A1c (sheep antiserum)

A

RADIOIMMUNOASSAY (RIA)

53
Q

 Partial cross-reactivity w/ HbA1c

A

RADIOIMMUNOASSAY (RIA)

54
Q

 Antiserum not commercially available

A

RADIOIMMUNOASSAY (RIA)

55
Q

Citrate agar electrophoresis (pH 6.0-6.2)

  • Buffer:
A

Citrate agar buffer (acidic)

56
Q

Citrate agar electrophoresis (pH 6.0-6.2)

  • Solid support:
A

agarose gel

57
Q

HbF migrates to the same region as HbA1

A

Citrate agar electrophoresis

58
Q

Cellulose acetate electrophoresis (pH 8.0)

  • Buffer:
A

Tris EDTA boric acid (alkaline)

59
Q

Cellulose acetate electrophoresis (pH 8.0)

  • Solid support:
A

cellulose acetate

60
Q

 Good resolution of Hb A & Hb A1

A

ELECTROPHORESIS

61
Q

 No interference from Hb variants

A

ELECTROPHORESIS

62
Q

 HbF migrates to the same region as HbA1

A

ELECTROPHORESIS

63
Q

 Scanned on high-resolution microdensitometer

A

ISOELECTRIC FOCUSING

64
Q

 Hb A1c is adequately resolved from HbA1a, A1b, S and F

A

ISOELECTRIC FOCUSING

65
Q

ISOELECTRIC FOCUSING MEDIUM

A

Polyacrylamide gel

66
Q

 Use of affinity gel columns

A

AFFINITY CHROMATOGRAPHY

67
Q

AFFINITY CHROMATOGRAPHY ADVANTAGES:

A

o No interference from non-glycosylated Hb
o Negligible interference from the labile intermediate
o Minimal dependence on variations in ambient T

68
Q

Total Hb A1 MEAN %

A

6.5

69
Q

Total Hb A1 RANGE

A

5.0 – 8.0

70
Q

Hb A1c only RANGE

A

3.0 – 6.0

71
Q

Hb A1c only MEAN %

A

4.5

72
Q

HbA1c (%) =

Approximate Plasma Glucose
mg/dL
Mmol/L

A
73
Q

For patients with inaccurate HbA1c assays (hemglobinopathies and hemolytic anemias)

A

o Affinity chromatography
o Immunoassays

74
Q

Turnover time of serum proteins: (primary albumin) 14 to 20 days

A

o Reflects glycemic control over narrower period of time

75
Q

Most widely used to assess short-term (3 to 6 week) glycemic control

A

FRUCTOSAMINE ASSAYS

76
Q

FRUCTOSAMINE ASSAYS ADVANTAGE:

A

Use of serum samples and automated equipment (simple to perform and low in cost)

77
Q

More reliable than other glycosylated protein assays

A

FRUCTOSAMINE ASSAYS

CC1 LECTURE DEAN (14 decks)

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