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DS Unit 4 > Glucose > Flashcards

Glucose Flashcards

1
Q

How does insulin regulate blood glucose?

A

Insulin lowers blood glucose by promoting cellular uptake of glucose and synthesis of glycogen.

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2
Q

what hormones have opposite effects of insulin? What do they do?

A
  1. glucagon, cortisol, epinephrine and growth hormone

2. Raise blood glucose by promoting glycogenolysis and promoting efflux of glucose from cells to blood

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3
Q

What is the hallmark sign of DM?

A
  1. hyperglycemia resulting from
    A. Defects in insulin secretion
    B. Insulin action
    C. Or both
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4
Q

What are complications from untreated DM?

A 
retinopathy 
vascular damage 
kidney failure 
nerve damage 
heart disease and stroke
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5
Q

What are the types of DM?

A

Type I DM
Type II DM
Other specific types of DM
Gestational DM (GDM)

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6
Q

Define ketoacidosis

A

: ketone production is high due to fat breakdown( bc cannot breakdown carbs) and causes a decrease in pH

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7
Q

What are the sxs of type 1 DM?

A
  1. Abrupt onset of symptoms (e.g., polyuria, polydipsia and rapid weight loss)
  2. Insulinopenia (deficiency of insulin)
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8
Q

How is type 1 DM treated?

A

Dependent on insulin to sustain life and prevent ketoacidosis

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9
Q

What % of DM is type 1?

A

5 - 10% of all cases of D. mellitus are IDDM

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10
Q

What is another name for Type II DM?

A

Non-insulin-dependent (NIDDM) Type 2 (formerly adult onset)

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11
Q

What is another name for type I DM?

A

IDDM (insulin dependent diabetes mellitus) Type 1(formerly Juv Onset)

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12
Q

What % of DM is Type II?

A

90%

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13
Q

What are the sxs of type II DM?

A

Minimal symptoms, are not prone to ketosis and not dependent on insulin to prevent ketoacidosis

Obesity is common

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14
Q

What are the normal insulin levels in type II DM?

A

Insulin levels may be normal, decreased, or increased

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15
Q

What process is impaired in type II DM?

A

Impaired insulin action

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16
Q

What are the causes of secondary DM?

A
  1. Genetic defects in insulin secretion or action
  2. Pancreatic surgery or disease
  3. Endocrinopathies (e.g., Cushing’s syndrome, acromegaly)
  4. Drugs
  5. Diabetes associated with other syndromes
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17
Q

What are the diagnostic criteria for DM in casual/random glucose testing?

A

plasma glucose > 200mg/dl

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18
Q

What are the diagnostic criteria for DM in fasting glucose testing?

A

FPG > 126mg/dl on more than one occasion

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19
Q

What are the diagnostic criteria for DM in A1c testing?

A

> 6.5%

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20
Q

What are risk factors for DM?

A
  1. Impaired Glucose Tolerance (IGT)
    A. Fasting plasma glucose  100 but < 200 mg/dL(75g loading dose)
    C. Termed pre diabetes
  2. Impaired fasting glucose
    A. Fasting glucose between 100 – 125 3. mg/dL
    Progression of IGT/IFG to DM (2 - 22%)
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21
Q

What are the categories of fasting plasma glucose?

A
  1. FPG <100 mg/dL is a normal fasting glucose
  2. FPG 100 – 125 mg/dL is IFG
  3. FPG  126 mg/dL is provisional diagnosis of diabetes
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22
Q

What are the categories of (oral glucose tolerance test) OGTT?

A
  1. 2-h post load glucose <140 mg/dL is normal glucose tolerance
  2. 2-h post load glucose 140 – 199 mg/dL is IGT
  3. 2-h post load glucose  200 mg/dL is provisional diagnosis
    of diabetes
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23
Q

Define gestational DM

A

Carbohydrate intolerance of variable severity with onset during the present pregnancy.
A type of diabetes that occurs when the demands of pregnancy exceed the women’s capacity to secrete insulin.

Renal threshold for glucose decreases

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24
Q

What is the incidence of gestational DM?

A

3%

25
Q

What are the sxs of gestational DM?

A

Usually asymptomatic and not life threatening to the mother.

26
Q

What are the effects of gestational DM on the baby?

A
  1. Is associated with increased neonatal mortality and morbidity, including hypocalcaemia, hypoglycemia and macrosomia (large baby).
  2. The maternal hyperglycemia causes the fetus to secrete more insulin, resulting in stimulation of fetal growth and macrosomia.
27
Q

How is gestational DM screened for?

A
  1. Perform initial glucose test on at risk women and if within RI then repeat at 24 to 28 weeks gestation.
  2. Unnecessary for patient to fast for initial random glucose measurement. If elevated then retest using:
    Use 50g oral glucose load
    1-hr plasma glucose ≥ 140 mg/dL indicates the need for a full diagnostic 100g, 3 hr OGTT
28
Q

What are the diagnostic criteria for gestational diabetes?

A
  1. 2 hour OGTT and if one or more values exceed threshold the patient is identified as having GDM.
  2. Fasting venous plasma ≥ 92 mg/dL
  3. 1-hr “ “ ≥ 180 mg/dL
  4. 2-hr “ “ ≥ 153 mg/dL
  5. 3-hr “ “ ≥ 140 mg/dL
29
Q

True/False: gestational DM increases risk for type II DM?

A

Most women diagnosed with GDM will go on to develop Type II DM in the ensuring 5 – 10 years and all will remain at increased risk for the development of type II later in life.

30
Q

When should pts with gestational DM be testes for type II DM?

A

6 – 12 weeks postpartum

31
Q

Define hypoglycemia

A

Blood glucose values below fasting range.

May see values as low as 50 mg/dL post prandial

32
Q

What are general causes of hypoglycemia?

A
  1. Oral hypoglycemic agents: Very common
  2. Insulinoma
  3. Islet hyperplasia
  4. Severe exercise
  5. Hypothyroidism
  6. Hypopituitarism
  7. Addison disease: Cortisol deficiency
  8. Liver disease
33
Q

What are non-diabetic fasting causes of hypoglycemia?

A
  1. Insulin
  2. Alcohol abuse
  3. Severe hepatic or renal insufficiency
  4. Hypopituitarism
  5. Surreptitious injection of insulin
34
Q

What are non-diabetic postprandial causes of hypoglycemia? (sxs develop 1-2 hrs after meal)

A 
Alimentary hypoglycemia
Functional hypoglycemia (patient has not undergone GI surgery)
35
Q

What specimens can be used for testing glucose?

A
  1. BLood glucose: serum, plasma
  2. Urine
  3. CSF
  4. Whole blood
36
Q

What additional lab tests may be beneficial?

A
  1. Blood lactate
  2. Urinary albumin
  3. Fructosamine
  4. Ketone bodies
    A. acetoacetate
    B. acetone
    C. Betahydroxbutyrate
  5. Glucagon
  6. Hemoglobin A1c
37
Q

What is blood lactate/lactic acid?

A

An intermediary in carbohydrate metabolism

38
Q

What conditions cause elevated blood lactic acid?

A 
1. hypoxic
A. shock
B. Severe blood loss
C. AMI and CHF
D. Pulmonary edema
2. Metabolic
A. D. mellitus
B. liver or renal disease
C. Toxins
-Ethanol, methanol or salicylate poisoning
39
Q

What does increased urinary albumin indicate?

A

Increase urinary albumin excretion (UAE) indicates an increase in the transcapillary escape rate of albumin and is a marker of microvascular disease

40
Q

What are the diagnostic criteria for urinary albumin in overt diabetic nephropathy?

A

> 200ug/min

41
Q

What is fructosamine?

A

a glycated serum protein

glucose + ε-amino group of lysine residue of albumin

42
Q

How long is the half life of albumin?

A

20 days

43
Q

What is fructosamine used for?

A

A. Monitors short term glycemic changes
2 to 3 weeks
B. RI = 205 285 µmol/L

44
Q

How are ketones tested?

A
  1. Acetest (tablet)
    A. uses sodium nitroprusside
    B. detects acetoacetic acid and to a lesser extent acetone
    C. does not detect β-hydroxybutyric acid
  2. Ketostix: only detect acetone and sodium nitroprusside
45
Q

What is glucagon used for?

A

Used to diagnose a glucagonoma, diabetic patient and pancreatic dysfunction

46
Q

Where is glucagon made and secreted?

A

Secreted by the alpha cells of the islets of Langerhans in response to low blood glucose

47
Q

When is glucagon increased? decreased?

A
  1. Increased in glucagonoma (may be >1000 ng/L)
  2. Decreased in extensive pancreatic resection
  3. RI = 70 -180 ng/L
48
Q

What is hemoglobin A1c?

A
  1. Glycated Hemoglobin (also glycosylated or hemoglobin A1c)

2. Formation of glycated hemoglobin is irreversible,

49
Q

What does hemoglobin A1c depend on?

A

the life span of the red blood cell (120 days) and the blood glucose concentration

50
Q

What happens to the level of non-enzymatic glycosylation proteins as blood glucose levels rise?

A

As blood glucose levels rise, the increase in non-enzymatic glycosylation of proteins is proportional to both the level of glucose and the life span of the protein in circulation

51
Q

What is HbA1c an accepted measurement of?

A

HbA1c has been accepted as a measurement which reflects the mean daily glucose concentrations and the degree of carbohydrate imbalance over the preceding 3-4 months.

52
Q

When is HbA1c falsely low?

A

patients with hemolytic anemias, major blood loss, or blood transfusions

53
Q

At what HbA1c level do microvascular changes in eyes start to appear?

A

Above 8%

54
Q

What is the normal HbA1c level?

A

Normal is below 6% (120 mg/dL)

55
Q

What HbA1c is considered good control of diabetes?

A

under 7%

56
Q

How often should pts at high risk of DM be screened with an A1c test?

A

Every 3 years

57
Q

What is an HbA1c level that indicates a high risk for developing DM?

A

6.0-6.4%

58
Q

What is the relationship between HbA1c and estimated average glucose?

A 
Linear
6% = 126
6.5% = 140
7% = 154
7.5% = 169
8% = 183

DS Unit 4 (9 decks)

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