Labs of Endocrine- Schoenwald Flashcards
What is DM Type 1?
- Autoimmune destruction of pancreatic islet B cells
- Insulin DEPENDENT
What is DM Type 2?
- Tissue insensitivity to insulin
- Obesity and adult onset
What is the MC endocrine disorder in the US?
DM Type 2
Do patients with gestational diabetes have a higher chance of developing type 1 or type 2 diabetes?
-30-50% chance of developing type 2 diabetes later
What test is used to screen for diabetes?
- Glucose
- Usually measured fasting and 2 hour post prandial
PEARL: What test should you perform if glucose is abnormal?
-assess if fasting vs nonfasting
What is a normal fasting glucose level?
< 110 mg/dl
What fasting glucose result would indicate dx for diabetes?
Fasting glucose >126 on 2 separate occasions diagnostic for diabetes
What is a post prandial glucose?
Measures glucose 2 hours after a meal
If post prandial glucose level remains elevated at 2 hours what does this indicate?
Diabetes
A glucose level of > ____ mg/dl confirms dx of diabetes?
200
If a glucose level is 140 to 200 mg/dl what test should you do?
Glucose tolerance test
When do you order a glucose tolerance test (two most common reasons)?
- Pregnancy/women with hx of large birth weights or stillbirths
- Abnormal 2 hour post prandial glucose not diagnostic of diabetes (140mg/dl-200 mg/dl)
What are the normal glucose tolerance test results (fasting, 1 hr, 2 hr, 3 hr)?
- fasting <110 mg/dl
- 1 hour <200 mg/dl
- 2 hour <140 mg/dl
- 3 hour 70-115 mg/dl
What is the glucose tolerance test criteria for dx diabetes?
- Fasting glucose >126 mg/dl
- 2 hour glucose >200 mg/dl
What are 6 things that can cause elevated glucose?
- Stress
- Caffeine
- IV fluids containing dextrose (should not be given to diabetic pts)
- Pregnancy
- Drugs (prednisone, estrogen)
- Smoking
What are 3 things to remind patients before a glucose tolerance test?
- Fast for 8-12 hours
- Don’t smoke during the test
- No exercise 24 hours prior to test
HbA1c allows for a ____ month measurement of glucose levels
3
What is a normal HbA1c %?
4-5.7% roughly
What is a HbA1c % that indicates poor glucose control?
> 6.5% roughly
Is fasting required for an HbA1c?
No
What HbA1c % is prediabetic?
5.7% to 6.4%
What three tests diagnose diabetes?
- HgbA1c>6.5% or
- Fasting glucose >126 mg/dl or
- OGTT with 2 hour level at 200 mg/dl or higher.
Is ketoacidosis more common in Type 1 or Type 2 diabetes?
Type 1
What causes ketoacidosis?
Insulin deficiency resulting in protein breakdown and increased hepatic glucose production
In ketoacidosis, lipolysis ocurrs and causes free fatty acid conversion to what two ketone bodies?
beta-hydroxybutyric acid & acetoacetic acid
What are 4 symptoms of ketoacidosis?
- Dehydration
- Lethargy
- Acetone smelling breath
- Occasionally coma
A glucose level of > 300 mg/dl is indicative of what medical condition?
Ketoacidosis
Are bicarbonate and pH levels in ketoacidosis low or high?
Low
PEARL: What is the initial treatment of ketoacidosis?
insulin administration with K+
We need K+ to bring insulin into the cells (K+ is like a carrier for insulin)
How is ketoacidosis detected? (what test)
Urinalysis (urine ketone test)
A urine ketone test is able to dect _______________ & unable to detect _____________
Acetoacetatic acid, beta-hydrohybutyrate
What does a microalbumin test indicate?
glomerular damage, predictive of nephropathy
What is a microalbumin test?
A urinemicroalbumintest is a test to detect very small levels of a blood protein (albumin) in your urine.
A microalbumin test is used to detect early signs of what?
Amicroalbumintest is used to detect early signs of kidney damage in people who are at risk of developing kidney disease.
Why do we check urine albumin annually in diabetics?
- to look for any kidney damage
- diabetes causes glomerular permeability to exceed reabsorption
Microalbumin can be affected by ________________
hydration status
What calculation corrects for hydration status?
Correct for hydration status by utilizing:
(urine microalbumin/urine creatinine) x 1000
TSH is secreted by the __________
__________
Anterior pituitary
What regulates the release of T3 and T4?
TSH from the anterior pituitary
Hypothyroidism causes _______ TSH and _______ T4
Elevated, decreased (deficiency)
Hyperthyroidism causes _______ TSH and _______ T4
Low, Excessive
What lab test would you order to test for Hypo/Hyperthyroidism?
TSH
What does a low T4 indicate?
Hypothyroidism
What does a high T4 indicate?
Hyperthyroidism
What is the most accurate measure of thyroid status?
Free T4 (measures unbound T4) -determines how well T4 is working
What does a high T3 indicate?
hyperthyroidism
What does a low T3 indicate?
hypothyroidism
What does a T3 measure?
Indirectly estimates number of binding sites on thyroid bound by T3
Hyper or Hypothyroidism is a major contributor to new onset AFib?
Hyperthyroidism
If someone has new onset AFib, what lab test should you order?
TSH
The parathyroid is responsible for ________ _________
calcium metabolism
What is the mc cause of primary hyperparathyroidism?
Adenoma of the parathyroid gland. Results in hypercalcemia.
______ & calcium are directly related
Albumin
What is the calculation that is used to determine calcium levels?
Serum calcium + (0.8 x (4-albumin))
