Lecture 10: "Brownies are only good for the soul"

Question 1

Which hemoglobin binds most readily with glucose?

Answer 1

hemoglobin A1C

Question 2

At what value of hemoglobin A1C does diagnosis of diabetes occur?

Answer 2

> 6.5% of total hemoglobin

Question 3

What is the goal HgbA1C value for patients with diabetes?

Answer 3

under 7%

Question 4

What is the average lifespan of a RBC?

Answer 4

approx. 100-120 days

Question 5

What are the % risk reductions that coincide with a 1% reduction in mean HgbA1C?

Answer 5

37% microvascular
21% any endpoint related to diabetes
21% death related to diabetes
14% fatal and nonfatal MI
43% amputation or death from PVD

Question 6

Where is insulin produced?

Answer 6

in pancreatic beta-cells

Question 7

Why is measuring insulin levels in the blood not always reflective of pancreatic beta-cell function?

Answer 7

because insulin undergoes first past metabolism by the liver

Question 8

What is the function of insulin?

Answer 8

insulin’s release facilitates the movement of glucose from the circulatory system to the cell which in turn then lowers blood glucose levels

Question 9

What factors can increase insulin levels?

Answer 9

insulinoma ( insulin secreting tumor, fairly uncommon), obesity, fructose of galactose intolerance, Cushing syndrome, acromegaly, early type 2 diabetes

Question 10

What factors decrease insulin levels?

Answer 10

insulin dependent diabetes (typically type 1), hypopituitarism, chronic pancreatectomy

Question 11

What is C-Peptide?

Answer 11

it is Connecting peptide- connects the alpha and beta chains of pro-insulin, which is the precursor of insulin

Question 12

Why is a C-peptide test useful?

Answer 12

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

Question 13

What is the correlation between C-peptide and type 1 or 2 diabetes?

Answer 13

Type 1 = low C peptide

Type 2 = normal or high c-peptide

Question 14

What is the normal level for amylase?

Answer 14

27-130 U/L

Question 15

What can pancreatitis result from?

Answer 15

long-term alcohol use or binge drinking, gallstones, trauma to pancreas, drug-induced

Question 16

What is the normal level for lipase?

Answer 16

0-160 U/L

Question 17

How is amylase secreted?

Answer 17

secreted from acinar cells of the pancreas to the pancreatic duct to the duodenum

Question 18

What happens when damage occurs to the acinar cells?

Answer 18

amylase pours out into lymphatic system, free peritoneum and circulatory system

Question 19

What is the normal level for uric acid?

Answer 19

4.0-8.5 mg/dL

Question 20

When can uric acid be elevated?

Answer 20

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

Question 21

What test is frequently ordered to evaluate abdominal pain and specifically to detect pancreatitis?

Answer 21

amylase

Question 22

Where is amylase cleared?

Answer 22

rapidly cleared by the kidneys

Question 23

what is amylase increased in?

Answer 23

acute pancreatitis, chronic pancreatitis, pancreatic cancer, obstruction by gallstone, renal failure

Question 24

What is lipase used to detect?

Answer 24

abdominal pain and pancreatitis

Question 25

What is uric acid the end byproduct of?

Answer 25

purine nucleotide catabolism

Question 26

How is uric acid secreted?

Answer 26

kidneys but also by the intestinal tract

Question 27

at what level can uric acid be deposited into joint tissue in the form of monosodium urate crystals?

Answer 27

greater than 6.9