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MT6317 CLIN CHEM 1 > U3 LEC: CARBOHYDRATES (PT. 3) > Flashcards

U3 LEC: CARBOHYDRATES (PT. 3) Flashcards

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1
Q

Condition in which levels of blood glucose are decreased

A

Hypoglycemia

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2
Q

Glucagon is released if blood glucose level is?

A

65-70 mg/dL

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3
Q

Symptoms of hypoglycemia appear if blood glucose level is?

A

50-55 mg/dL

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4
Q

Symptoms of Hypoglycemia are related to?

A

CNS

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5
Q

Hypoglycemia symptoms include:

A
  • shaking
  • fast heartbeat
  • shivering
  • dizziness
  • anxiety
  • irritable
  • headache
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6
Q

This causes brain fuel deprivation

A

Hypoglycemia

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7
Q

Hypoglycemia results to?

A
  • impaired judgement and behavior
  • seizures
  • coma
  • functional brain failure
  • death
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8
Q

This is the imbalance in the rate of glucose appearance and disappearance from the circulation

A

Hypoglycemia

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9
Q

Hypoglycemia is rare in individuals with?

A

normal glucose metabolism

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10
Q

In individuals without diabetes, diagnosis of hypoglycemia should be made only in those who demonstrate the?

A

Whipple Triad

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11
Q

under the Whipple Triad

A

1.) Hypoglycemic symptoms
2.) Plasma glucose <50 mg/dL
3.) Symptoms are relieved by correction of hypoglycemia when glucose or glucagon is administered

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12
Q

T/F: The Whipple Triad is only observed in persons without diabetes.

A

True

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13
Q

Hormones that regulate Hypoglycemia

A
  • Glucagon
  • Epinephrine
  • Norepinephrine
  • Cortisol
  • Growth Hormone
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14
Q

Classification of Hypoglycemia

due to fasting state

A

Post-absorptive (fasting)

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15
Q

Classification of Hypoglycemia

after eating

A

Postprandial (reactive)

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16
Q

Postprandial is observed how many hours after a meal?

A

4 hours

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17
Q

Level 1 (Glucose Alert Value)

A
  • <70mg/dL
  • sufficiently low for treatment with fast acting carbohydrate and dose adjustment of glucose lowering therapy
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18
Q

Level 2 (Clinically significant hypoglycemia)

A
  • <54mg/dL
  • sufficiently low to indicate serious hypoglycemia
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19
Q

Level 3 (Severe hypoglycemia)

A
  • no significant threshold
  • associated with severe cognitive impairment requiring external assistance for recovery
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20
Q

Symptom observed in Level 3

A

loss of consciousness

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21
Q

Characterized by a plasma (or serum) glucose concentration low enough to cause symptoms and/or signs including impairment of brain function

A

Clinical hypoglycemia

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22
Q

An intentional attempt to induce low blood glucose levels

A

Factitious hypoglycemia

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23
Q

Results from exogenous self-administration of insulin or insulin secretagogues medications

A

Factitious hypoglycemia

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24
Q

Factitious hypoglycemia is more common in?

A

women with diabetes, during third and fourth decades of life

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25
Q

Plasma Glucose Values

Glucagon and other glycemic hormones are released into the circulation

A

65-70 mg/dL

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26
Q

Plasma Glucose Values

Observable symptoms of hypoglycemia appear

A

50-55 mg/dL

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27
Q

Plasma Glucose Values

Considered low value and abnormal for infants (requires further diagnostic test)

A

< 50 mg/dL

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28
Q

Plasma Glucose Values

Impairment of cerebral function starts

A

<50 mg/dL

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29
Q

Result of the deficiency of a specific enzyme that causes an alteration of glycogen metabolism

A

Glycogen Storage Diseases

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30
Q

Increase in glycogen stored in the liver will result to?

A

Hepatomegaly

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31
Q

Type I Glycogen Storage Disease, most common

A

Von Gierke

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32
Q

Von Gierke

Defective enzyme

A

Glucose-6-phosphatase

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33
Q

Von Gierke

Organ affected

A

Liver and Kidney

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34
Q

Von Gierke

Genetic pattern

A

autosomall recessive

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35
Q

Von Gierke

Diagnosis

A

Liver Biopsy using Glycogen stain

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36
Q

Von Gierke

Clinical features

A
  • Severe hypoglycemia
  • Ketosis
  • Hyperuricemia
  • Hyperlipemia
  • Elevated lactate levels
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37
Q

Von Gierke

Treatment

A

Liver transplantation (Liver cells)

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38
Q

Type II Glycogen Storage Disease, affects all organs

A

Pompe

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39
Q

Pompe

Defective enzyme

A

a-1,4-Glucosidase

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40
Q

Other enzyme defects causing hypoglycemia

A
  • Glycogen synthase deficiency
  • Fructose 1,6-biphosphate deficiency
  • Phosphoenolpyruvate carboxykinase deficiency
  • Pyruvate carboxylase deficiency
  • Glycogen debrancher enzyme deficiency
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41
Q

This enzyme deficiency causes hepatomegaly but no hypoglycemia due to gluconeogenesis.

A

Glycogen debrancher enzyme deficiency

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42
Q

Cause of failure to thrive syndrome in infants

A

Galactosemia

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43
Q

Congenital deficiency of one of three enzymes involved in galactose metabolism leading to?

A

increased galactose in plasma

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44
Q

Galactosemia

Defective enzyme

A

Galactose-1-phosphate uridyltransferase (G1PU)

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45
Q

Galactosemia inhibits?

A

Glycogenolysis

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46
Q

Galactosemia

Symptoms

A
  • hypoglycemia
  • hyperbilirubinemia
  • mental retardation and cataracts
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47
Q

Galactosemia

Treatment

A

remove galactose from diet

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48
Q

Fructosuria is also known as?

A

Fructose-1-phosphate aldolase deficiency (Fructosuria)

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49
Q

Fructosuria

Defective enzyme

A

Fructose-1-phosphatase aldolase

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50
Q

Fructosuria

can also be a deficiency due to?

A

Fructose-1,6-diphosphatase

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51
Q

Fructosuria

Symptoms

A
  • nausea
  • hypoglycemia
  • fructose in urine
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52
Q

Fructosuria

Treatment

A

removal of fructose in diet

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53
Q

Other causes of Hypoglycemia

A
  • Errors in amino acid metabolism
  • Long chain fatty acid oxidation
  • Alimentary hypoglycemia
  • Idiopathic hypoglycemia
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54
Q

Specimen for glucose

A
  • blood (serum/plasma)
  • urine
  • CSF
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55
Q
A
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56
Q

Specimen for Glycated /Gycosylated Hemoglobin

A

Whole blood

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57
Q

Specimen for Insulin testing

A

Blood (serum/plasma)

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58
Q

Diagnostic test for screening DM suspects

A

Fasting Blood Sugar (FBS)

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59
Q

FBS

requires how many hours of fasting?

A

8 hours

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60
Q

FBS

fasting hours should not exceed?

A

16 hours

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61
Q

FBS

Abnormal indicative value

A

> 126 mg/dL

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62
Q

FBS

Percentage of Whole Blood Glucose

A

11%

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63
Q

T/F: Fasting of FBS is not followed if patient’s request include lipid profile analysis.

A

True

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64
Q

Glucose is increased and decreased in?

A

increased: morning
decreased: afternoon

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65
Q

Collection of FBS in the afternoon, after fasting in the morning will result to?

A

false decrease

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66
Q

This refers to simple glucose loading to check insulin secretion

A

Two hour post prandial (2hr PPBS)

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67
Q

2hr PBBS

Standardized glucose loading is?

A

75g (taken 2 hours after)

68
Q

2hr PBBS

DM value after 2 hours

A

> 200 mg/dL

69
Q

This is not recommended for routine use under ADA guidelines

A

Glucose Tolerance Test

70
Q

OGTT stands for?

A

Oral Glucose Tolerance Test

71
Q

2 types of OGTT:

A
  • 3 hours
  • 5 hour
72
Q

5 hour OGTT is done after a?

A

3 hour blood glucose dip

73
Q

OGTT

Medications to be avoided

A
  • salicylates
  • diuretics
  • anti convulsants
  • OCPS
  • corticosteroid

3 days prior

74
Q

OGTT

Glucose load for children

A

1.75 g/kg of weight ng child

75
Q

OGTT

Glucose load for adult

A

75g

76
Q

OGTT

Glucose load for pregnant women

A

100g

77
Q

This GTT is done if there is a defect in GI glucose absorption.

A

Intravenous Glucose Tolerance Test (IGTT)

78
Q

IGTT

____ is administed via IV

A

25mg of glucose

79
Q
A
80
Q

IGTT

How many minutes should glucose be administered?

A

1-2 minutes

81
Q

IGTT

Blood draw must be done during?

A
  • before infusion
  • 1,3,5,10,20,30,40,60 & 120 minutes following infusion
82
Q

This is an index for long term plasma glucose, indicates compliance and efficacy of tretment.

A

Glycosylated/Glycated Hemoglobin (HbA1c)

83
Q

HbA1c

Rate of formation is directly proportional to?

A

glucose levels

84
Q

T/F: HbA1c can be used to control glucose levels if patient is diagnosed with DM.

A

True

85
Q

HbA1c

2 Methods of measurements

A
  • charge
  • structure of glycogroups
86
Q

HbA1c

Methods under charged differences

A
  • cation-exchange chromatography
  • electrophoresis
  • isoelectric focusing
  • hplc
87
Q

HbA1c

Methods under structural characteristics of glycogroups

A
  • affinity chromatography
  • immunoassay
88
Q

HbA1c

Most common method for charged differences

A

High-pressure liquid chromatography (HPLC)

89
Q

For every 1% increase of A1c, how much Mean Plasma Glucose is increaased?

A

by 35

90
Q

4% A1c

A

65 mg/dL

91
Q

Testing for Plasma Glucose and HbA1c

patients with stable glycemic control

A

2 times a year (EVERY 6 MONTHS)

92
Q

Testing for Plasma Glucose and HbA1c

patients with unstable glycemic control

A

4 times a year (EVERY QUARTER)

93
Q

Testing for Plasma Glucose and HbA1c

Two factors

A
  1. RBC Life Span
  2. Average Glucose Concentration
94
Q

Old red cells, anemia, iron deficiency, pernicious, alcoholism, uremia, illicit and therapeutic drugs, hyperbilirubinemia

A

False increased HbA1c

95
Q

Shortened RBC survival, hemolytic anemia, recovery from acute blood loss, abnormal hemoglobin

A

False decreased HbA1c

96
Q

Other Laboratory tests for glucose

A
  • Oral Glucose Challenge Test (OGCT)
  • Random Blood Sugar (RBS)
  • Fructosamine
  • 1,5-anhydroglucitol (1,5-AG)
97
Q

This tolerance test determines fasting hypoglycemia with blood samples drawn at 2 minutes to 2 intervals (6 specimens) to measure glucose and insulin

A

Tolbutamide tolerance test

98
Q

Intervals for Tolbutamide tolerance test

A

2 minutes to 2 hours intervals of 6 specimens

99
Q

This tolerance test determines reactive hypoglycemia by measuring response of insulin to a cocktail meal

A

Mixed-meal tolerance test

100
Q

Mixed-meal tolerance test

Meal with a mixture of carbohydrate, protein, fats

A

cocktail meal

101
Q

Mixed-meal tolerance test

Blood sample may be drown at what intervals?

A

15, 30, 45, 60, 90, 120

102
Q

Capillary blood glucose is identical to?

A

arterial blood glucose

103
Q

CSF glucose concentrations should be approximately?

A

60-80%

104
Q

What tube is used for Chemistry in CSF?

A

1st tube

105
Q

Normal value of Glucose

Conventional Unit

A

70-99 mg/dL

106
Q

Normal value of Glucose

SI unit

A

3.9-5.5 mmol/L

107
Q

Normal value of Glucose

Conversion factor

A

0.055

108
Q

This enzymatic method targets the consumption of H20.

A

Glucose Oxidase

109
Q

Glucose Oxidase

What is used alongside peroxidase to oxidize H202

A

Reduced chromogen

110
Q

Glucose Oxidase

This enzyme converts alpha D glucose to beta D glucose

A

Mutarotase

111
Q

Glucose Oxidase

Glucose that GOD can measure

A

beta D glucose

112
Q

Glucose Oxidase

Monitoring

A
  1. consuming H202 in a side reaction
  2. rate of disappearance of oxygen
113
Q

Glucose Oxidase

Colorimetric Method

A

Saifer Gernstenfield Method

114
Q

Glucose Oxidase

Coupling peroxidase reaction

A

Trinder reaction

115
Q

Glucose Oxidase

Chromogen

A

3-methyl-2-benzothiazolinone hydrazone or N,N-dimethylaniline

116
Q

Glucose Oxidase

Source of errors

A

False decreased: BUA, bilirubin,
ascorbic acid

False elevated: strong oxidizing agents, bleach

117
Q

Glucose Oxidase

Oxygen consumption is also referred to as?

A

Polarographic GOD

118
Q

Glucose Oxidase

Catalase utilizes?

A

ethanol to acetaldehyde

119
Q

Glucose Oxidase

Molybdate utilizes?

A

Iodine

120
Q

This enzymatic method is most accurate

A

Hexokinase Method

121
Q

This is used for the REFERENCE METHOD FOR GLUCOSE DETERMINATION

A

Hexokinase Method

122
Q

Hexokinase Method

False decrease

A
  • gross hemolysis
  • high bilirubin
123
Q

Hexokinase Method

Product of G6PD

A

NADPH

124
Q

This methods are done under clinical microscopy to monitor glucose levels in urine, or other body fluids.

A

Non-enzymatic Methods

125
Q

Nelson Somogyi is also known as a?

A

Copper Reduction Method

126
Q

Nelson Somogyi measures?

A

true glucose

127
Q

Nelson Somogyi

What does it use to remove non-glucose?

A

Barium Sulfate

128
Q

Nelson Somogyi

Reagent

A

arsenomolybdic acid

129
Q

Nelson Somogyi

Product

A

arsenomolybdenum blue

si nelson smurf

130
Q

This is known as the ferric reduction method.

A

Hagedorn Jensen

131
Q

Hagedorn Jensen

Principle

A

Inverse colorimetry

132
Q

Hagedorn Jensen

Reagent

A

Ferricyanide (yellow)

133
Q

Hagedorn Jensen

Product

A

Ferrocyanide (colorless)

134
Q

This non-enzymatic method utilizes condensation with aromatic amines.

A

Ortho-toluidine

135
Q

Ortho-toluidine

Reagent

A

O-toluidine in glacial acetic acid

136
Q

Ortho-toluidine

Product

A

Schiff’s base (green)

137
Q

Ortho-toluidine

Disadvantage

A

corrosiveness and toxicity of reagent

138
Q

T/F: Ortho-toluidine is the most specific non-enzymatic method.

A

True

139
Q

Benedict’s and Fehling’s test is also known as what method?

A

copper reduction

140
Q

Benedict’s and Fehling’s test

Stabilizer

A

citrate or tartrate

141
Q

Benedict’s and Fehling’s test

Result

A

deep blue solution to red ppt

142
Q

This is produced by the liver through fatty acid metabolism as energy source when carbohydrates are low.

A

Ketones

143
Q

T/F: Ketones are normally low in the body.

A

True

144
Q

Types of Ketones in body

A
  • Acetone (20%)
  • Acetoacetic acid (20%)
  • 3-B-hydroxybutyric acid (78%)
145
Q

High ketones is observed/will result to?

A
  • DM
  • starvation/fasting
  • high-fat diets
  • prolonged vomiting
  • glycogen storage disease
146
Q

Used to detect acetoacetic acid

A

Nitroprusside

147
Q

Used to detect acetone

A

Nitroprusside with glycerin

148
Q

Result in Nitroprusside

A

purple color

149
Q

This refers to a DM complication in which glucose passes through the glomerula.

A

DM nephropathy

150
Q

DM nephropathy can lead to?

A

increased urinary albumin

151
Q

Microalbumin is also known as?

A

Albuminuria

152
Q

Persistent albuminuria

Urinary albumin to creatinine ratio

A

30-299 mg/g

153
Q

Normal creatinine ratio

A

<25mg

154
Q

Persistent albuminuria

Urine collections

A

3 collections over 3-6 month period

2 of which ay dapat nasa mataas na ratio

155
Q

Albuminuria is an early indicator of?

A

diabetic kidney disease

156
Q

Factors increasing albumin excretion:

A
  • exercise within 24 hours
  • infection
  • fever
  • congestive heart failure
  • marked hyperglycemia
  • marked hypertension
157
Q

This is a characteristic of Type 1 DM

A

Islet autoantibody

158
Q

Islet autoantibody

Method

A

Direct ELISA

159
Q

Islet autoantibody

under direct ELISA

A
  • sample with IgG against islet cells
  • ICA-IgG enzyme conjugate
  • Substrate
160
Q

Islet autoantibody

IFA produces?

A

Apple green fluorescence

161
Q

This is used for hypoglycemic state testing

A

Insulin

162
Q

Insulin

Method

A

HTRF Sandwich

163
Q

This peptide is produced with Insulin

A

C-peptide

164
Q

under C-peptide ELISA

A

C-peptide/creatinine ratio and antibody screening

165
Q

C-peptide

used for diagnosis of?

A
  • MODY
  • LADA
  • Uncertainty about type 1 versus type 2 diagnosis

MT6317 CLIN CHEM 1 (11 decks)

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