Lec 12: Intro To Glucose Flashcards
• low blood glucose
• CNS symptoms
• Improvement of symptoms upon glucose administration
Whipple’s triad
Type of hypoglycemia that occurs before eating.
Post absorptive or Fasting hypoglycemia
Type of hypoglycemia usually seen occurring 2 hours after eating.
Reactive or Postprandial hypoglycemia
Symptoms:
• increased hunger
• sweating
• nausea and vomiting
• dizziness
• nervous and shaking
• blurring of speech and sight
• mental confusion
Hypoglycemia
Normal glucose concentration range
60–110 mg/dL
<60 mg/dL
Hypoglycemia
> 110 mg/dL
Hyperglycemia
Describe insulinoma
Excess production of insulin
Type ___ diabetic patient:
• rely on insulin from outside sources
• pancreas can’t produce insulin
Type 1 diabetic patient
Type ___ diabetic patient:
• has insulin but deficient
• most common in seniors
- insulin ran out due to old age
Type 2 diabetic patient
Alcohol-induced Hypoglycemia
Effects of alcohol
• increase NADH/NAD ratio
- more NADH instead of NAD
• decrease gluconeogenesis
• increase glycolysis
• increase conversion of pyruvate to lactate
• decrease fat breakdown
• increase fat synthesis
What happens to the babies of diabetic mothers?
• develops hypoglycemia due to exposure to maternal hyperglycemia.
Why do small for date babies have inadequate glycogen stores?
• due to Prematurity
- glycogen stores are laid in the last months of pregnancy.
6 Endocrine Disorders associated with Hypoglycemia
• Hypothyroidism
• Hypopituitarism
• Hypocorticism
• Liver disorders
• glycogen storage disease
• heavy exercise
Clinical Manifestations of Hypoglycemia
1. Neuroglycopenic
• deprivation of glucose to brain cells.
—> confusion, headache, convulsion, syncopal attacks, coma & death.
2. Adrenergic
• release of catecholamines, especially adrenaline.
—> palpitations, tremors, excessive sweating
Healthy males maintain plasma glucose of _____ for several days.
Healthy females permit plasma glucose to decrease to ____.
• 55–60 mg/dL (3.1–3.3 mmol/L)
• 40 mg/dL (2.2 mmol/L) or lower
- _____ administration if person is alert.
- _____ administration for unconscious patients.
- Oral glucose
- Intravenous glucose
Symptoms:
• increased thirstiness
• dry skin
• blurring vision
• poor wound healing
• sleepiness
• increased appetite
• frequent urination
Hyperglycemia
It is characterized by deficiency of insulin secretion or action resulting in hyperglycemia. The presence of insulin is usually deficient in the patients.
Diabetes Mellitus
Genetic predisposition + viral infection + environmental factor = ___
Diabetes Mellitus
• causes immune destruction of the b-cells of pancreas —> decrease insulin production
• abrupt onset
• insulin dependence
• genetically-related
Type 1 Diabetes Mellitus
Symptoms:
• Polydipsia
• Polyphagia
• Polyuria
• Rapid weight loss
• Mental confusion
• possible loss of consciousness
Type 1 Diabetes Mellitus
Complications included in Type 1 Diabetes Mellitus.
- Cardiovascular/Heart disease
- Microvascular problems
• Nephropathy: kidney problems
• Neuropathy: affects small blood vessels in brain
• Retinopathy: affects blood vessels in eyes
• strongly inherited
• no b-cell autoimmunity
• no known etiology
• no visible autoantibodies present
• doesn’t rely on insulin
Idiopathic Type 1 Diabetes
• result of an individual’s resistance to insulin with an insulin secretory defect.
• results in a relative insulin deficiency.
- no absolute absence of insulin
• associated with strong genetic predisposition.
• patients are more likely to go into a hyperosmolar coma
• increased risk of developing macrovascular & microvascular complications.
- involving bigger blood vessels
Type 2 Diabetes Mellitus
- Describe Pancreatitis.
- In what type of diabetes Mellitus does it occur?
- Inflammation of the pancreas
- Type 2 Diabetes Mellitus
Rare form of diabetes that is inherited in an autosomal dominant fashion.
Maturity-onset Diabetes
Drugs that increase blood glucose.
• corticosteroid
• thiazide diuretic
• niacin & phenytoin (high dose)
• rubella
- Defined as any degree of glucose intolerance with onset or first recognition during pregnancy.
- The condition in #1 is identified through ___.
- Gestational Diabetes Mellitus
- Oral Glucose Tolerance Test
Presence of glucose in the urine due to glucose concentration of plasma exceeding 180 mg/dL.
Glucosuria
The process of oxidizing glucose to make carbon dioxide, water, and energy.
Glycolysis
Blood glucose converted to fats
Lipogenesis
Storage form of glucose
Glycogen
Glucose to glycogen
Glycogenesis
The primary source of energy for humans.
Glucose
Three pathways of glucose
1. Hexose Monophosphate Pathway
- glycolysis
- produces ribose 5 PO4 & NADPH
2. Glycolytic pathway / Embden Meyerhof Parnas pathway
- pyruvate —> acetyl coenzyme A
- production of ATP & NADH
3. Glycogenesis pathway
- In this pathway, glucose is broken down into pyruvic acid, then converted to acetyl coenzyme A that can enter the tricarboxylic acid cycle.
- The pathway in #1 requires oxygen. What kind of pathway is it?
- Embden Meyerhof Parnas pathway / Glycolytic pathway
- Aerobic pathway
The conversion of amino acids into substrates that can be converted to glucose.
Gluconeogenesis
Breakdown of glycogen to glucose
Glycogenolysis
• inhibits pouring of glucose into blood
• promotes utilization of glucose
• primary hormone responsible for entry of glucose into the muscle and adipose
Insulin
• released during stress & fasting states
• main hyperglycemic agent
• primary hormone responsible for increasing glucose levels
• promotes glycogenolysis & gluconeogenesis
Glucagon
In cases of Hypoglycemia:
(Enumerate the 4 lines of defense in order)
- Inhibit insulin
- Increase glucagon
- Release of catecholamines, anterior pituitary hormones, ACTH
- Thyroid & GH (carbohydrate metabolism)
6 hormones that affect carbohydrate metabolism and increase glucose levels.
Epinephrine
- promotes glycogenolysis & lipolysis
- inhibits insulin
- released when stress
Glucocorticoids
- promotes glycogenolysis & lipolysis
Growth hormone
- decreases cell entry of glucose
ACTH
- triggers adrenal cortex to produce glucocorticoids
Thyroxine & Somatostatin
Laboratory findings
Plasma glucose: >1000 mg/dL
Plasma sodium & potassium: Normal or Elevated
Bicarbonate: slightly decreased
BUN & Creatinine: Elevated
Osmolality: Elevated
Nonketotic Hyperosmolar State
Diagnostic of Gestational Diabetes Mellitus
Fasting plasma glucose:
1 hour value:
2 hour value:
Fasting plasma glucose: 92 mg/dL or more
1 hour value: 180 mg/dL or more
2 hour value: 153 mg/dL or more
Oral Glucose Tolerance Test
Normal:
Impaired:
Provisional diabetes diagnosis:
(2 hours)
Normal: 140 mg/dL or less
Impaired: 140–199 mg/dL
Provisional diabetes diagnosis: 200 or more
Diabetes Mellitus Treatment
Insulin supplementation, oral hypoglycemic drugs
- preferred method for diagnosis of diabetes
- 8-10 hour fasting without any caloric intake
- more than 126 mg/dL = diagnosis DM
- serum: 70 to 100
- WB: 60 to 100
Fasting Blood Sugar
- a screening test for diabetes (not diagnostic)
- check response of glucose level post meals
- 200 mg/dL = Diabetes
- normal: 85 to 125
Random blood sugar
Criteria for Diagnosing Diabetes using OGTT
- Diabetes: ___mg/dL
- Impaired glucose tolerance: __mg/dL for 2 hours, and other value of ___ mg/dL
Diabetes: more than 140
Impaired: 140 to 200, more than 200
The following are procedures of what method of glucose tolerance test?
- 2 to 3 days CHO diet
- 12 hours fasting
- after 12 hours fasting, blood sample collected.
- high CHO meal
- 2 hours rest
- then, venous blood collected
✓ normal: 120 mg/dL
Exton Rose / Divided Dose method (2 hour postprandial)
