Lecture 10: "Brownies are only good for the soul" Flashcards
Which hemoglobin binds most readily with glucose?
hemoglobin A1C
At what value of hemoglobin A1C does diagnosis of diabetes occur?
> 6.5% of total hemoglobin
What is the goal HgbA1C value for patients with diabetes?
under 7%
What is the average lifespan of a RBC?
approx. 100-120 days
What are the % risk reductions that coincide with a 1% reduction in mean HgbA1C?
37% microvascular 21% any endpoint related to diabetes 21% death related to diabetes 14% fatal and nonfatal MI 43% amputation or death from PVD
Where is insulin produced?
in pancreatic beta-cells
Why is measuring insulin levels in the blood not always reflective of pancreatic beta-cell function?
because insulin undergoes first past metabolism by the liver
What is the function of insulin?
insulin’s release facilitates the movement of glucose from the circulatory system to the cell which in turn then lowers blood glucose levels
What factors can increase insulin levels?
insulinoma ( insulin secreting tumor, fairly uncommon), obesity, fructose of galactose intolerance, Cushing syndrome, acromegaly, early type 2 diabetes
What factors decrease insulin levels?
insulin dependent diabetes (typically type 1), hypopituitarism, chronic pancreatectomy
What is C-Peptide?
it is Connecting peptide- connects the alpha and beta chains of pro-insulin, which is the precursor of insulin
Why is a C-peptide test useful?
useful to determine the functioning of the patient’s pancreas and ability to produce insulin… can be useful to determine type 1 from type 2
What is the correlation between C-peptide and type 1 or 2 diabetes?
Type 1 = low C peptide
Type 2 = normal or high c-peptide
What is the normal level for amylase?
27-130 U/L
What can pancreatitis result from?
long-term alcohol use or binge drinking, gallstones, trauma to pancreas, drug-induced
What is the normal level for lipase?
0-160 U/L
How is amylase secreted?
secreted from acinar cells of the pancreas to the pancreatic duct to the duodenum
What happens when damage occurs to the acinar cells?
amylase pours out into lymphatic system, free peritoneum and circulatory system
What is the normal level for uric acid?
4.0-8.5 mg/dL
When can uric acid be elevated?
high purine diets (animal proteins), alcohol abuse (alcohol metabolism increases uric acid production), cancer (increased metabolism of purines), renal failure, dehydration caused by diuretics… frequently elevated in gout
What test is frequently ordered to evaluate abdominal pain and specifically to detect pancreatitis?
amylase
Where is amylase cleared?
rapidly cleared by the kidneys
what is amylase increased in?
acute pancreatitis, chronic pancreatitis, pancreatic cancer, obstruction by gallstone, renal failure
What is lipase used to detect?
abdominal pain and pancreatitis
What is uric acid the end byproduct of?
purine nucleotide catabolism
How is uric acid secreted?
kidneys but also by the intestinal tract
at what level can uric acid be deposited into joint tissue in the form of monosodium urate crystals?
greater than 6.9
