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Clinical Biochem > Glucose and Diabetes > Flashcards

Glucose and Diabetes Flashcards

1
Q

Fasting glucose serum/plasma reference range

A

3.3-6.0 mmol/L

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2
Q

Random glucose serum/plasma reference range

A

3.3-11.1 mmol/L

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3
Q

OGTT serum/plasma fasting reference range

A

2.2-6.0 mmol/L

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4
Q

OGTT serum/plasma 2hr reference range

A

</= 7.8 mmol/L

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5
Q

CSF glucose reference range

A

2.2-4.4 mmol/L

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6
Q

HbA1C reference range

A

4.3-6.1%

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7
Q

Lactic acid reference range

A

0.5-2.2 mmol/L
critical: >4.0 mmol/L

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8
Q

What is hypoglycemia

A

abnormally low blood glucose concentration

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9
Q

When is hypoglycemia most often seen

A

in patients with diabetes who are being treated with hypoglycemic drugs (insulin)

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10
Q

What is fasting hypoglycemia associated with

A

ethanol and salicylates

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11
Q

What is postprandial hypoglycemia associated with

A

insulin, antibodies to insulin or insulin receptors and inborn errors of metabolism

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12
Q

When is a hypoglycemia diagnosis made

A

when the criteria of the Whipple Triad is met

  • symptoms are known or likely to be caused by hypoglycemia
  • blood glucose is low when the symptoms occur
  • symptoms are relieved by administration of glucose
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13
Q

What is hyperglycemia

A

abnormally high blood pressure caused by hormonal imbalance

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14
Q

What is diabetes mellitus

A

a group of disorders characterized by underutilization of glucose as an energy store causing hyperglycemia

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15
Q

What is type 1 diabetes mellitus

A

insulin-dependent diabetes

the insulin producing cells of the pancreas are destroyed by the hosts immune system, usually develops in children or teens

prone to ketosis

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16
Q

What is the treatment for type 1 diabetes mellitus

A

insulin and meal planning

islet cell, pancreas, kidney transplants

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17
Q

What is type 2 diabetes mellitus

A

the result of insulin resistance with or without defective secretion of insulin

normal levels of blood insulin are seen but the action of the insulin cells is defective, most common in adults

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18
Q

What is the treatment for type 2 diabetes mellitus

A

lifestyle modifications such as diet and exercise or medications such as insulin

19
Q

What is gestational diabetes

A

a temporary condition characterized by glucose intolerance that begins or is first recognized during pregnancy

usually asymptomatic but is associated with increased morbidity and mortality as well as mother and child are at increased risk of developing diabetes

20
Q

What is prediabetes

A

individuals at high risk of developing type 2 diabetes and its complications

usually have abnormal fasting glucose, OGTT or HbA1C results but do not meet the criteria for diagnosis yet

21
Q

What is metabolic syndrome

A

individuals with type 2 diabetes and prediabetes can also present with additional symptoms of abdominal obesity, hypertension, dyslipidemia and elevated blood glucose

22
Q

What are complications of diabetes

A

retinopathy, neuropathy, angiopathy, nephropathy, infection, dyslipidemia and atherosclerosis

23
Q

When should patients start being screened for diabetes

A

around 40 years of age or older, every 3 years using fasting glucose or HbA1C

24
Q

What is the diagnosis criteria for diabetes

A

fasting blood glucose >7.0 mmol/L, OGTT >/= 11.1 mmol/L or Hba1C >6.5%

25
Q

What is the OGTT

A

a test to evaluate glucose clearance after loading with a defined dose under controlled conditions

26
Q

What is the procedure of the OGTT

A

ingest a minimum of 150g carbs per day for three days leading up to the procedure

the patient then fasts for 10-16 hours

the test should be performed between 7 and 9 am

a fasting specimen is drawn and then the patient drinks a 75g glucose drink within 5 minutes a second draw is done after 2 hours

27
Q

What are variables that affect the glucose tolerance

A

illness, oral contraceptives, thiazide, corticoid steroids, length of fast, age, activity, weight, smoking, caffeine, anxiety, stress, posture

28
Q

What is the preferred specimen for blood glucose

A

serum or plasma
immediately separated
stable for 8 hours at RT
leukocyte and bacterial contamination can falsely decrease
24 hour urine samples should be collected in containers with 5mL glacial acetic acid

29
Q

What is the hexokinase method of glucose testing used for

A

blood, urine and CSF

30
Q

What are interferences in the hexokinase method of glucose testing

A

hemolysis, icterus and lipemia

31
Q

What is the glucose oxidase method of glucose testing used for

A

blood and CSF

32
Q

What are the interferences in the glucose oxidase method of glucose testing

A

hemoglobin, bilirubin, ascorbic acid and uric acid

33
Q

When does glucose appear in the urine

A

when the blood levels exceed the renal threshold of 11.0 mmol/L

commonly associated with uncontrolled diabetes mellitus, advanced renal disease, pregnancy

34
Q

When is a CSF glucose test done

A

to differentiate between viral and bacterial (low glucose) meningitis

35
Q

What is hemoglobin A1C

A

a test that can be used to diagnose and monitor diabetes

HbA1C is proportional to the average plasma glucose concentration

it is reported as a percentage of the normal hemoglobin

in patients with unstable RBCs intra-individual results are compared rather than comparing to a reference range

36
Q

What is fructosamine

A

non-enzymatic attachment of glucose to amino groups of proteins other than hemoglobin

fructosamine levels can be measured at 2-3 week intervals

individuals with kidney or licer disease have decreased serum protein therefore fructosamine cannot be used

37
Q

How is fructosamine level determined

A

chromatography and photometric methods

38
Q

What is the urine albumin:creatinine ratio used to monitor

A

kidney function of people with diabetes

screens for early kidney damage by detecting albumin in the urine

an ACR of >/= 3mg/mmol is clinically significant

39
Q

Why do diabetics have increased ketones

A

a decreased use of carbs for energy causes the metabolization of fatty acids which produces ketones

40
Q

What is B-Hydroxybutyrate used for

A

to determine if a patient is in metabolic acidosis

it can be detected by a colorimetric or gc-ms spectrophotometry

41
Q

What is the reference range for B-Hydroxybutyrate

A

<0.4 mmol/L

42
Q

What causes lactic acidosis

A

severe tissue hypoxia and association with disease (diabetes mellitus, liver disease, drugs and inborn errors of metabolism)

43
Q

What is the reference range for lactic acid

A

0.5-2.2 mmol/L
critical: >4.0 mmol/L

Clinical Biochem (15 decks)

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