Hyperglycemia

Question 1

1. give at least 3 lab findings in hyperglycemia
2. 3 important ketone bodies

Answer 1

1. give at least 3 lab findings in hyperglycemia
   - electrolyte imbalance
   - increase glucose level in plasma & urine
   - increased urine specific gravity
2. 3 important ketone bodies
   - beta-hydroxybutyrate
   - acetoaceticacid
   - acetone

Question 2

Classification of Diabetes Mellitus by American Diabetes Association
1. due to autoimmune β-cell destruction, usually leading to absolute insulin deficiency
2. due to progressive loss of β-cell insulin secretion frequently on the background of insulin resistance
3. diabetes diagnosed in the 2nd or 3rd trimester of pregnancy that was not clearly overt diabetes prior to gestation
4. other causes
- 2 monogenetic diabetes syndromes
- disease of exocrine pancreas
- _____ use

Answer 2

1. TYPE 1
2. TYPE 2
3. Gestational
4. other causes
   - neonatal diabetes mellitus & maturity onset diabetes or young
   - cystic fibrosis
   - glucocorticoid use

Question 3

CRITERIA FOR DIAGNOSING DIABETES

______: fasting is defined as no caloric
intake for at least 8hrs
1. non diabetic
2. impaired plasma glucose
3. DM
- mmol/L

____: 2hrs after glucose load
1. glucose load of ________
2. normal pre diabetes
3. impaired glucose tolerance
4. DM
- mmol/L
5. 2 exceptions
- diagnosis of ______
- diagnosis of ____55

Answer 3

Fasting Plasma Glucose
1. 70-99mg/dL
2. 100-125mg/dL
3. >126mg/dL
- 7.0mmol/L

2-H Plasma Glucose level
1. 75g glucose load
2. <140mg/dL
3. 140-199mg/dL
4. >200mg/dL
- 11.1mmol/L
5.
- diagnosis of cystic fibrosis-related diabetes
- diagnosis of diabetes during pregnancy

Question 4

CRITERIA FOR DIAGNOSING DIABETES

______: test should be performed in a
laboratory using a method that is NGSP certified and standardized to the DCCT assay
1. aka
2. normal
3. pre diabetes
4. DM

____: patient w/ classic symptom of
hyperglycemia or hyperglycemic crisis
1. reference
- mmol/L

Answer 4

HbA1C
1. glycosylated hemoglobin
2. <5.7%
3. 5.7-6.4%
4. >6.5%

Random Plasma Glucose
1. >200mg/dL
- 11.1mmol/L

Question 5

TYPE 1

1. risk factors
   - genetic (____ aka MHC on chr 6)
   - MHA meaning
2. C peptide
3. autoantibodies present
   - highest sensitivity as single screening marker; more common in adults
   - common in young
   - older assay
   - insulinoma associated antigen:
4. medication therapy
5. therapy to prevent

Answer 5

. risk factors
- Human Leukocyte Antigen
- Major Histocompatibility Complex
2. very low or undetectable
3. autoantibodies present
- glutamic acid decarboxylase 65
- insulin autoantibodies
- islet cell antigen 512
- IA-2A & IA-2B
4. insulin therapy
5. none known

Question 6

TYPE 2

1. medication therapy
2. therapy to prevent

Answer 6

1. oral hypoglycemic agents
2. lifestyle change

Question 7

Secondary Hyperglycemia
1. Due to pancreatic disorders (2)
2. Endocrine disorders (3)
3. Drugs
4. Miscellaneous cause
- increased hormone

Answer 7

1. Due to pancreatic disorders (2)
   - pancreatitis
   - cystic fibrosis-related diabetes
2. Endocrine disorders (3)
   - acromegaly
   - pheochromocytoma
   - Cushing syndrome
3. Drugs
   - steroids
4. Miscellaneous cause
   - pregnancy
   - human chorionic gonadotropin

Question 8

Patient Preparation (6)

Answer 8

1. 3 days of unrestricted diet (at least 150g CHO/day)
2. avoid medications that will interfere w/ the test (salicylates, diuretics, anticonvulsants)
3. no beverages
4. no alcohol/ no cigarettes
5. overnight (8-14hr) fas

Question 9

Oral Glucose Tolerance Test
1. 2-hour Postprandial
- dose
- normal
- peak value
2. 5-hour Postprandial Test:
- dose
- normal
- back to norml

Answer 9

1. 2-hour Postprandial
   - a gram / kg body wt.
   - ~150mgs%
   - 30mins
2. 5-hour Postprandial Test:
   - 75 grams
   - 140-160mgs%
   - 5hrs