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Diagnostic Studies, Unit IV > Glucose/Hgb A1c > Flashcards

Glucose/Hgb A1c Flashcards

1
Q

WHO Diabetes Statisitics

A
  • > 220 million people worldwide
  • 26 million in US
  • 7 million (27%) unaware of condition
  • $245 billion in US healthcare costs/year
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2
Q

Carbohydrates

A
  • Major energy source
  • Blood concentration maintained c various influences
    • Lowered
      • Insulin - lowers blood glucose by promoting cellular updatke and glycogen synthesis
    • Raised - promote glycogenolysis
      • Glucagon
      • Cortisol
      • Epinephrine
      • Growth hormone
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3
Q

Diabetes Mellitus (DM)

A

Prolonged hyperglycemia due to one or both of the following:

  • Insulin secretion defect
  • Insulin action defect
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4
Q

Consiquences, untreated DM

(6)

A
  1. Retinopathy
  2. Vascular damage
  3. Renal failure
  4. Neropathy
  5. Cardiac disease
  6. CVA
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5
Q

Diabetes Classifications

(4)

A
  1. Type I
  2. Type II
  3. Gestational
  4. “Other” - group of varying dx
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6
Q

Type I DM Characteristics

(4)

A
  1. “Insulin dependent”
  2. 5-10% of cases
  3. Abrupt onset of s/sx
    • ​Polyuria
    • Polydipsia
    • Weight loss
  4. Insulinopenia - require insulin to sustain life
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7
Q

Type II DM Characteristics

(6)

A
  1. Non-insulin dependent
  2. ~90% cases
  3. Minimal s/sx - not prone to ketosis
  4. Insulin levels may be normal, decreased, or increased
  5. Impaired insulin action
  6. Obesity is common
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8
Q

Causes of Secondary DM

(5)

A
  1. Genetic defects in insulin secretion/action
  2. Pancreatic surgery/disease
  3. Endocrinopathies (Cushing’s, acromegaly)
  4. Drugs, steroids
  5. “Other syndromes”
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9
Q

Diagnostic Criteria, DM

(4 options)

A

Note - usually these tests are performed in progression

  1. S/Sx + casual/random plasma glu >200mg/dL
    • ​Casual = any time of day s regard to time since last meal
  2. FPG (fasting for at least 8 hrs) >126 mg/dL on multiple occasions
  3. 2 h post glucose load >200 mg/dL during OGTT (Glucose Tolerence Test)​
  4. Hemoglobin A1c >6.5%
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10
Q

“Increased Risk” For DM

(2)

A

Impaired glucose tolerence (IGT) - “Pre diabetes”

  • ​Fasting plasma glu 100-125 mg/dL
  • 2 hr OGTT 140-200 mg/DL
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11
Q

Fasting Glucose (FPG) Ranges

A

< 100 = normal

100-125 = “impaired”

>126 = provisional dx, DM

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12
Q

Oral Glucose Tolerance Test (OGTT) Values

A

< 140 2h post load = normal

140-199 post load = “impaired”

>200 = provisional dx, DM

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13
Q

Gestational DM

(def, explaination, incidence, prognosis)

A

Def: CHO intolerence onset during pregnancy

Explaination:

  • demands of pregnancy exceeds mother’s capacity to secrete insulin
  • fetus secretes more insulin
  • stimulate fetal growth, macrosomia

Icidence: ~3%

Prognosis:

  • usually asymptomatic and life threatening to mother but increases chances for DM II later
  • asst c inc neonatal hypocalcemia, hypoglycemia, macrosomia
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14
Q

Gestational DM Screening

(4 step procedure)

A

Protocol:

  1. Initial glu test on at risk women
  2. Repeat 24-28 weeks
  3. If elevated, repeat c modified 1 hr OGTT
  4. If still elevated, perform 3 hr OGTT

​Testing Type:

  • Initially, no fasting
  • If +, use 50 g oral loading dose and 1hr plasma glu
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15
Q

Diagnosis, Gestational DM

(4 qualifications)

A
  • Fasting venous plasma > 92 mg/dL
  • 1 hr venous plasma >180 mg/dL
  • 2 hr venous plasma >153 mg/dL
  • 3 hr venous plasma > 140 mg/dL

If 2 hr OGTT + one other value exceeds threshold, GDM present

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16
Q

Postpartum GDM

A

Since risk for Type II DM is high after developing GDM (30% within 5-10 years), women must undergo dx testing 6-12 weeks postpartum

17
Q

Hypogycemia

A

Blood glucose below fasting average

18
Q

Causes, Hypoglycemia in Diabetic Pts

(8)

A
  1. Oral hypoglycemic agents
  2. Insulinoma
  3. Islet hyperplasia
  4. Severe exercise
  5. Hypothyroidism
  6. Hypopituitarism
  7. Addison disease (cortisol deficiency)
  8. Liver disease
19
Q

Causes, Hypoglycemia in Non-diabetic Pts

(2 categories, 5/2 specifics)

A

Fasting

  1. Insulin
  2. EtOH abuse
  3. Severe hepatic/renal insufficiency
  4. Hypopituitarism
  5. Surreptitiuos insulin injection

Postprandial (symptoms develop 1-2 hrs post meal)

  1. Ailmentary hypoglycemia
  2. Functional hypoglycemia - pt has not undergone GI surgery
20
Q

Specimensd for Glucose Testing

(4)

A
  1. Blood glucose
    • ​Serum
    • Plasma (note - Na fluoride inhibits glycolysis)
  2. Urine
  3. CSF
  4. Whole blood

Draw blood in correct tube!

  • Gray tube if blood sample will not be tested w/i 1 hr to prevent glycolysis inhibition
  • Red top for blood sample that will be tested w/i 1 hr
21
Q

Diabetes Analytes

(9)

A
  1. Glucose
    • ​blood
    • urine
  2. Glycates proteins
    • ​Glycated hemoglobin - HbA1c
    • Gycated albumin - fructosamine
  3. Ketones
    • ​blood
    • urine
  4. Urine protein
    • ​urine albumin excretion
  5. Genetic markers
  6. Autoimmune markers (Ab)
    • ​ICA
    • IAA
    • GAD
    • IA-2
  7. Insulin + precursors
  8. Lipids
  9. “Others” - amylin, leptin, blood lactate, urinary albumin, fructosamine, ketone bodies, glucagon, Hgb A1c
22
Q

Blood Lactate (Lactic Acid)

(endogenous fctn, elevation - 2 categories 4/3 specifics, sample handling)

A

Fctn: intermediate in CHO metabolism

Elevation:

  • Hypoxia
    1. ​Shock
    2. Severe blood loss
    3. AMI and CHF
    4. Pulmonary edema
  • Metabolic
    1. ​DM
    2. Liver/renal disease
    3. Toxins - ethanol, methanol, salicylate poison

Handling:

  • Gray top tube
  • Keep cold
23
Q

Fructosamine

(endogenous fctn, clinical usefulness)

A

Endogenously: glycated serum PRO

Usefulness: monitor short-term glycemic changes (2-3 weeks)

24
Q

Ketone Tests (2)

A
  1. Acetest (tablet)
    • ​uses sodium nitroprusside
    • detects acetoacetic acid and acetone
    • does not detect beta-hydrobutyric acid (predominating ketone, requires a special test)
  2. Ketostix
25
Q

Glucagon

(engodenous fctn, clinical significance)

A

Endogenous: secreted by alpha cells @ Islets of Langerhans in response to low blood glucose

Clinical: diagnose glucagonoma (diabetic pt c pancreatic dysfunction)

26
Q

Hemoglobin A1c

(endogenous fctn, clinical use)

A

Endogenous: glycated hemoglobin c a glucose moiety attached to the large PRO structure, irreversible formation that depends on

  • RBC life span
  • blood glucose concetration

Clinical: useful in monitoring long term glucose ctrl in DM

27
Q

HbA1c Interpretation

A

Inc blood glucose = inc non-enzymatic glycosylation of PRO. Proportional to

  • ​Glucose level
  • Lifepan of circulating PRO

Constant lifespan of RBC allows this test to represent mean daily glucose concentrations and degree of CHO imbalance over preceding 3-4 mo

28
Q

False Decreases, Hgb A1c

(3)

A
  1. Hemolytic anemia
  2. Major blood loss
  3. Blood transfusions
29
Q

Calculation, Estimated Avg Glu Based on A1c

A

eAG = 28.7 x A1c - 46.7

30
Q

A1c Correlation to Estimated Avg Glucose (eAG)

A

Linear rlnshp based on calculation. Many clinicians keep this chart on hand

31
Q

do the case study

A

Diagnostic Studies, Unit IV (7 decks)

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