1. _____ administration if person is alert. 2. _____ administration for unconscious patients.

1. Oral glucose 2. Intravenous glucose

Lec 12: Intro To Glucose Flashcards by Reyben Ki

• low blood glucose
• CNS symptoms
• Improvement of symptoms upon glucose administration

Whipple’s triad

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Type of hypoglycemia that occurs before eating.

Post absorptive or Fasting hypoglycemia

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Type of hypoglycemia usually seen occurring 2 hours after eating.

Reactive or Postprandial hypoglycemia

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Symptoms:
• increased hunger
• sweating
• nausea and vomiting
• dizziness
• nervous and shaking
• blurring of speech and sight
• mental confusion

Hypoglycemia

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Normal glucose concentration range

60–110 mg/dL

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<60 mg/dL

Hypoglycemia

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> 110 mg/dL

Hyperglycemia

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Describe insulinoma

Excess production of insulin

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Type ___ diabetic patient:
• rely on insulin from outside sources
• pancreas can’t produce insulin

Type 1 diabetic patient

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Type ___ diabetic patient:
• has insulin but deficient
• most common in seniors
- insulin ran out due to old age

Type 2 diabetic patient

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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

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What happens to the babies of diabetic mothers?

• develops hypoglycemia due to exposure to maternal hyperglycemia.

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Why do small for date babies have inadequate glycogen stores?

• due to Prematurity
- glycogen stores are laid in the last months of pregnancy.

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6 Endocrine Disorders associated with Hypoglycemia

• Hypothyroidism
• Hypopituitarism
• Hypocorticism
• Liver disorders
• glycogen storage disease
• heavy exercise

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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

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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

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_____ administration if person is alert.
_____ administration for unconscious patients.

Oral glucose
Intravenous glucose

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Symptoms:
• increased thirstiness
• dry skin
• blurring vision
• poor wound healing
• sleepiness
• increased appetite
• frequent urination

Hyperglycemia

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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

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Genetic predisposition + viral infection + environmental factor = ___

Diabetes Mellitus

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• 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

1. Describe Pancreatitis. 2. In what type of diabetes Mellitus does it occur?

1. Inflammation of the pancreas 2. 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

1. Defined as any degree of glucose intolerance with onset or first recognition during **pregnancy**. 2. The condition in #1 is identified through ___.

1. Gestational Diabetes Mellitus 2. 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**

1. In this pathway, glucose is broken down into _pyruvic acid_, then converted to _acetyl coenzyme A_ that can enter the **tricarboxylic acid cycle**. 2. The pathway in #1 requires oxygen. What kind of pathway is it?

1. Embden Meyerhof Parnas pathway / Glycolytic pathway 2. 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)

1. Inhibit insulin 2. Increase glucagon 3. Release of catecholamines, anterior pituitary hormones, ACTH 4. 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)