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MLSCI360 > GLUCOSE AND DIABETES > Flashcards

GLUCOSE AND DIABETES Flashcards

1
Q

Define hypoglycemia

A
  • abnormally low blood glucose
    ie. diabetic patients being treated with insulin
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2
Q

Define and describe hyperglycemia

A
  • abnormally high blood glucose
  • due to hormonal imbalance
  • defects in insulin secretion or action (insulin is supposed to decrease glucose levels)
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3
Q

Describe the OGTT procedure

A
  • evaluates glucose clearance

PROCEDURE:
- patient ingests min 150g carbs/ day for three days
- fasting 10 to 16 hours prior to test while ambulatory
- since glucose is diurnal, test is done in the morning
- fasting glucose blood specimen is drawn
- a second sample is drawn after patient ingests 75g glucose within 5 minutes

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4
Q

Type I vs Type II diabetes mellitus

A

Type I:
- insulin-dependent AND immune-mediated
- beta cells in pancreas are destroyed by autoantibodies
- usually develops in children/ teens
- prone to ketosis

Type II (90%):
- insulin-resistance; normal levels of insulin but defective action
- beta cells produces more insulin to compensate
- more common in adults

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5
Q

Ref: fasting glucose serum/plasma

A

3.3 - 6.0 mmol/L

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6
Q

Ref: CRITICAL for fasting and random glucose

A

<2.6 OR >24.9 mmol/L

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7
Q

Ref: random glucose serum/ plasma

A

3.3 - 11.1 mmol/L

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8
Q

Ref: fasting OGTT serum/plasma

A

3.3 - 6.0 mmol/L

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9
Q

Ref: 2h OGTT serum/ plasma

A

≤ 7.8 mmol/L

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10
Q

Ref: CSF glucose

A

2.2 - 4.4 mmol/L

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11
Q

Ref: HbA1c

A

4.3 - 6.1%

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12
Q

Ref: lactic acid

A

0.5 - 2.2 mmol/L

CRITICAL: >4.0 mmol/L

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13
Q

Hypoglycemia in diabetic patients can be a result of what 2 things ?

A
  1. defective glucagon secretion
    - glucagon is supposed to increase glucose levels
  2. decreased epinephrine response to hypoglycemia
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14
Q

How is hypoglycemia differentiated in people without diabetes ?

A

FASTING hypoglycemia:
- starvation
- drugs ie. ethanol, salicylates

POSTPRANDIAL hypoglycemia:
- drugs ie. insulin
- antibodies to insulin (receptors)
- inborn errors of metabolism

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15
Q

What is the whipple triad ?

A
  • used to diagnose hypoglycemia:
    1. trembling, sweating, nausea, rapid pulse, lightheaded symptoms
    2. low blood glucose
    3. symptoms are relieved by glucose administration
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16
Q

__ is a group of diseases associated with hyperglycemia

A

DIABETES MELLITUS is a group of diseases associated with hyperglycemia

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17
Q

Describe gestational diabetes mellitus

A
  • a temporary condition onset of pregnancy
  • associated with increased morbidity
  • mother and child are at an increased risk of developing diabetes
  • fetal macrosomia
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18
Q

Define prediabetes

A
  • individuals at high risk of developing type II diabetes
  • abnormal fasting glucose, OGTT, or hA1c but do not meet criteria of diagnosis yet
  • can revert to normal glycemia but at risk for cardiovascular disease
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19
Q

How is diabetes diagnosed ?

A
  • same testing used to screen for disease:

a). fasting blood glucose > 7.0 mmol/L
b). HbA1c ≥ 6.5%
c). 2hr OGTT ≥ 11.1 mmol/L

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20
Q

Why must the patient be ambulatory when performing the OGTT ?

A

Inactivity decreases glucose tolerance

21
Q

T or F: the OGTT has good reproducibility

A

FALSE; the OGTT has POOR REPRODUCIBILITY
- variables such as fasting, age, activity, illness, oral contraceptives, corticoid steroids, weight, smoking, caffeine, stress, and posture all affect the OGTT

22
Q

When is prediabetes diagnosed after an OGTT ?

A

a). fasting glucose (<6.1 mmol/L) and 2h OGTT glucose (7.8 mmol/L) are both within range
b). fasting glucose is higher (6.1 - 6.9 mmol/L) but 2h OGTT glucose is within range (7.8 mmol/L)
c). fasting glucose (6.1 - 6.9 mmol/L) and 2h OGTT glucose are both higher (7.8 - 11.0 mmol/L)

RECALL: diabetes diagnosis requires fasting glucose ≥ 7.0 mmol/L and 2hr OGTT glucose ≥ 11.1 mmol/L

23
Q

Glucose samples collected in the morning have a higher glucose concentration because of __

A

Glucose samples collected in the morning have a higher glucose concentration because of DIURNAL VARIATION

24
Q

Specimen type for blood glucose testing

A

Serum* or plasma:
- should immediately be spun down to prevent glycolysis = stable for 8 hours at RT
- NaF anticoagulants can temporarily inhibit glycolysis (bacterial contamination decreases glucose)

24-hour urine:
- collected with 5 mL acetic acid to inhibit bacterial contamination

Urine:
- referigerated

CSF:
- STAT; bacteria may be present

25
Q

What is the reference method for blood glucose testing ? Why ?

A

Glucose Hexokinase method; suitable for blood, urine and CSF !

26
Q

Interferences for Glucose Hexokinase method

A

severe HIL = falsely decreased blood glucose levels

27
Q

Specimen types for Glucose oxidase method

A

Blood and CSF ONLY
- NOT URINE

28
Q

Interferences of Glucose Oxidase method

A
  • Hemolysis (hemoglobin)
  • Icterus (bilirubin)
  • Ascorbic acid/ vitamin C
  • Uric acid

ALL INHIBIT REACTION

29
Q

POCT devices typically use which 2 glucose methods for quantitative results ?

A
  1. Glucose oxidase
  2. Glucose dehydrogenase
30
Q

Specimen types for POCT devices

A

Whole blood; has lower glucose levels than plasma/ serum

31
Q

Interferences for POCT devices

A
  • incorrect specimen application
  • temperature
  • humidity
32
Q

Why is CSF glucose tested ?

A

Differentiates between viral vs bacterial meningitis:

Bacterial/ carcinomatous = LOW glucose
Viral = normal glucose

33
Q

T or F: A positive urine test is NOT diagnostic for diabetes mellitus

A

TRUE; a urine test is ONLY used as a SCREENING tool to MONITOR diabetes

34
Q

Is glucose normally found in urine ?

A

NO; GLUCOSE IS NOT NORMALLY FOUND IN URINE

35
Q

Define glycosuria

A
  • glucose in urine
  • associated with uncontrolled diabetes mellitus, advanced renal disease, and pregnancy
  • glucose exceeds renal threshold >11.0 mmol/L
36
Q

What test is used for management of diabetes ?

A

HbA1C:
- determined using HPLC or immunoassays
- used to diagnose or monitor diabetes mellitus
- hemoglobin A becomes irreversibly bound to glucose = glycated
- proportional (%) to average glucose over an RBC’s lifespan (120 days)
- measured every 3-4 months EXCEPT for pregnant women

37
Q

What is the urine albumin: creatinine ratio (ACR) used for ?

A
  • used to monitor kidney function of people with diabetes AND screen for early kidney damage
  • ACR > 3 mg/mmol is clinically significant
38
Q

Why is urine albumin:creatinine ratio (ACR) used instead of a 24-hour urine collection ?

A
  • 24-hour urine specimens fluctuate depending on hydration status; ACR accounts for variation
  • first-morning void specimens are ideal for ACR
39
Q

What are ketones ?

A
  • fatty acids are metabolized during prolonged starvation = excess acetyl-coA
  • also seen in impaired carbohydrate metabolism ie. diabetes mellitus
40
Q

If metabolic acidosis is suspected, a quantitative test for __ is ordered.

A

If metabolic acidosis is suspected, a quantitative test for β-HYDROXYBUTYRATE is ordered

41
Q

Specimen type and stability for β-hydroxybutyrate

A

Unspun whole blood (lithium heparin or EDTA)
- stable for 2 hours at RT or 48 hours refrigerated

42
Q

How is β-hydroxybutyrate detected ?

A
  1. Colorimetric method
  2. GC-MS
43
Q

T or F: ketones are NOT normally found in urine

A

TRUE; KETONES ARE NOT NORMALLY FOUND IN URINE

44
Q

Fatty acid metabolism in the liver produce ketone bodies. Identify the 3 types. Which is the ONLY one detected by urine reagent strips ?

A
  1. Acetoacetic acid* IS THE ONLY ONE DETECTED BY URINE REAGENT STRIPS
  2. β-hydroxybutyric acid
  3. Acetone
45
Q

Describe the principle behind lactic acidosis

A
  • lactic acid is mainly produced in muscle, the medulla of the kidney, and RBCs
  • oxygen deprivation leads to blockage of aerobic oxidation of glucose; pyruvate is reduced to lactate, instead of acetyl CoA
  • lactate: pyruvate ratio increases and blood lactate levels rise
46
Q

Differentiate the 2 types of lactic acidosis

A

Type A*:
- respiratory; severe tissue hypoxia (more common)
ie. anemia, shock, pulmonary insufficiency, cardiac failure

Type B:
- metabolic
ie. diabetes mellitus, liver disease, drugs (ethanol, methanol, salicylates), inborn errors of metabolism

47
Q

Ref: lactic acid

A

0.5 - 2.2 mmol/L

CRITICAL: >4.0 mmol/L

48
Q

Specimen type for lactic acid testing

A
  • potassium oxalate OR heparin ON ICE
  • DO NOT USE TOURNIQUET
  • specimen is immediately cooled and spun to prevent glycolysis (false increase)
49
Q

What method is used to test for lactic acid ?

A

Lactate dehydrogenase; oxidizes lactate back to pyruvate = increase in absorption

MLSCI360 (22 decks)

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