Unit 3: Carbohydrates (Part 2) Flashcards
If we are going to use fat as energy, what is the byproduct present in the blood?
Ketone bodies
What are the 3 ketone bodies produced when fat is used as energy?
Acetoacetate, Beta-hydroxybutyrate, Acetone
Condition wherein there is too much ketone bodies in the blood
Ketoacidosis
What would happen if insulin is not working or malfunctioning?
Glucose would stay in the blood (ECF)
T/F: People with Diabetes mellitus does not have insulin.
HALF TRUE HALF FALSE LOL. Some conditions don’t produce insulin (Type 1), some conditions produce insulin, but is not enough (Type 2)
Any substance present in the urine will increase its?
- Specific Gravity
- Osmolality
Why would there be acidosis in hyperglycemia?
Because of ketone bodies
Ketones in serum (blood)
Ketonemia
Ketones in urine
Ketonuria
T/F: Electrolyte imbalance is due to sodium going into the cell.
FALSE. Potassium going OUT
This can also be a finding in hyperglycemia if potassium is outside the cell.
Hyperkalemia
What is the pH of urine if it is acidic?
Lower than 7.30
Insulin is not enough or effect of insulin is
not working, hyperglycemia persists
Diabetes mellitus (DM)
A group of metabolic diseases characterized by Hyperglycemia
Diabetes Mellitus (DM)
DM is due to:
- Defects in insulin secretion
- Defects in insulin action
3 classical signs of DM
- Polyuria
- Polydipsia
- Polyphagia
Frequent urination
Polyuria
Excessive thirst
Polydipsia
Excessive hunger/ Increased Appetite
Polyphagia
T/F: Involuntary weight loss is also a symptom of DM.
TRUE
Other symptoms of DM:
- Hyperventilation
- Loss of consciousness
Why would there be loss of consciousness if someone has DM?
- Excessive glucose in the brain
- No glucose (mental confusion)
Glucosuria happens when the glucose exceeds the renal threshold of:
more than 180 mg/dL
Complications of DM
- Neuropathy
- Nephropathy
- Retinopathy
- Atherosclerosis
- Heart disease
Methods of DM Diagnosis
- HbA1c
- Fasting blood glucose
- Oral Glucose Tolerance Test (OGTT)
- Random plasma glucose
HbA1c is based on:
National Glycohemoglobin Standardization Program (NGSP)-certified method
T/F: Point-of-care assay methods for either plasma glucose or HbA1c are recommended for diagnosis.
FALSE, they are not recommended for diagnosis.
Categories of Fasting Plasma Glucose
Normal fasting glucose
FPG 70-99 mg/dL (3.9-5.5 mmol/L)
Categories of Fasting Plasma Glucose
Impaired fasting glucose
FPG 100-125 mg/dL (5.6-6.9 mmol/L)
Categories of Fasting Plasma Glucose
Provisional diabetes diagnosis
FPG more than or equal to 126 mg/dL (more than or equal to 7.0 mmol/L)
This diagnostic method is a long-term measurement method
HbA1c
How many months of RBC are measured in HbA1c for glucose?
3 months
What is the value of HbA1c for it to be considered DM?
more than or equal to 6.5%
In OGTT, how long should a patient wait for glucose testing?
2 hours
T/F: OGTT is a 4 hour post load test.
FALSE, 2 hours (usually)
What is the glucose load in OGTT?
75 g glucose load
T/F: Fasting is not required for OGTT.
FALSE, the patient should have fasted.
Categories of OGTT
Normal glucose tolerance
2-h PH less than or equal to 140 mg/dL (less than or equal to 7.8 mmol/L)
Categories of OGTT
Impaired glucose tolerance
2-h PH 140-199 mg/dL (7.6-11.1 mmol/L)
Categories of OGTT
Provisional diabetes diagnosis
2-h PH more than or equal to 200 mg/dL (more than or equal to 11.1 mmol/L)
T/F: Provisional diabetes diagnosis must be confirmed.
TRUE
In Random Blood Sugar, the patient is considered to have DM if they have a test value of:
more than 200 mg/dL
T/F: Random Blood Sugar is a confirmatory test.
FALSE, it is a screening test.
T/F: To be diagnosed with DM, the patient should meet all the criteria for FBS, OGTT, and HbA1c.
FALSE, just one + signs or symptoms
Type 1 is associated with (onset)
Genetics, childhood onset
Type 2 is associated with (onset)
Lifestyle choices; adult onset
T/F: ALL fat people have DM
FUCK U!
Type 1 DM is also known as
Insulin-dependent DM (IDDM) and Juvenile onset DM
This is due to pancreatic islet beta-cell destruction
Type 1 DM
Type 1 DM is the ____________________ of beta cells
autoimmune destruction
Type 1 DM is the ___________ insulin secretion deficiency
Absolute
________ of cases of DM are Type 1
10%
Type 1 DM commonly occurs in
Childhood/ adolescence (24 y.o.)
Characteristics of Type 1 DM
- Abrupt onset
- Insulin dependence
- Ketotic tendencies
There would be an excess of this hormone in DM
Glucagon
Ketotic tendencies can be characterized by
Fruity smelling breath
This characteristic is only present in Type 1 DM
Ketoacidosis
T/F: Type 1 DM is genetically related.
TRUE
Markers of Type 1 DM
- Islet cell autoantibodies
- Insulin autoantibodies
- Glutamic acid decarboxylase (GAD) antibodies
- Tyrosine phosphate IA-2 and IA-2B autoantibodies
- Zinc transporter 8 antibodies (ZnT8)
This is an idiopathic type of DM classified under type 1:
Fulminant Type 1 Diabetes (FT1D)
Associated with the destruction of beta cells but there are no beta-cell autoantibodies
Fulminant Type 1 Diabetes (FT1D)
Methods of detecting Type 1 DM autoantibodies
- Immunofluorescence
- Immunohistologic techniques using GOD (glucose oxidase)
- Radiobinding Assay (RBA)
- Enzyme linked immunoabsorbent assay (ELISA)
Other names for Type 2 DM
Non-insulin dependent DM (NIDDM) and Adult onset DM
Type 2 DM is due to _________ resistance to _________ which leads to __________ action of ___________
Peripheral; insulin; Decreased; Insulin
Type 2 DM is a _______ insulin deficiency
Relative
_________% of DM are Type 2
90%
Type 2 DM Risks
- Increase in age
- Obesity
- Lack of physical exercise
Type 2 DM Characteristics
- Adult onset
- Milder symptoms
- Hyperosmolar coma
Type 2 DM Complications
- Macrovascular complications
- Microvascular complications
Microvascular complications (Type 2)
- Nephropathy
- Neuropathy
- Retinopathy
- Gangrene
RELATIONSHIP
_____ glucose = ______ osmolality
High, High
Osmolality can affect the brain and induce
Hyperosmolar coma
Hyperglycemia in Type 2 DM results from 3 major metabolic defects:
- Increased glucose production (liver)
- Impaired insulin secretion (pancreas)
- Insulin resistance (in peripheral tissues)
This is the intermediate stage between normal and DM status
Impaired fasting glucose/ glucose tolerance
Impaired FBG/OGTT has glucose levels _______ normal limits but not to the level of _________
Above; diabetes
T/F: There is a low risk to develop DM if the patient’s result is within the impaired levels.
FALSE, there is HIGH RISK
Impaired is a __________ condition
Pre-diabetes condition
Gestational DM onset
2nd-3rd trimester of pregnancy
T/F: Patients who developed gestational DM normally return to normal conditions post partum
TRUE
Gestational DM is associated with
- Increased risk of perinatal complications (miscarriage, respiratory distress syndrome in the infant)
- Development of DM
When a mother has gestational DM, the infant may experience
Severe hypoglycemia
Why would the infant experience hypoglycemia if the mother has gestational DM?
Since the mother has excess glucose, the abrupt termination of the umbilical cord on delivery would cause the infant to have low sugar levels.
Main cause of Gestational DM
Hormonal
What hormones produced by the placenta can inhibit the function of insulin?
- Estrogen
- Cortisol
- Human placental lactogen
High risk group for Gestational DM
- Familial history for DM
- Race (East Asian, Asian-American)
- Age older than 25yo
- Overweight
- History of poor obstetric outcomes
- Glycosuria
Screening for GDM
2 positive FBS results of different instances
Two testing approaches for GDM
- 1 step: 2-hr OGTT (75 g. glucose load)
- 2 step: 1-hr post load of 50g glucose, if (+), 3 hr OGTT using 100g glucose.
Term for “diagnosis is confirmed”
Rendered
(2 step) Test value if positive for FBS
More than 140 mg/dL (7.8 mmol/L)
GDM test results
FBS =
1 hr OGTT =
2 hr OGTT =
FBS = >92
1 hr OGTT = >180
2 hr OGTT = >153
GDM screening should be performed:
between 24-28 weeks of gestation
T/F: If results are normal for GDM, the test should be repeated during the third trimester.
TRUE
To diagnose GDM, how many values should exceed in 2-step testing?
2 out of 4 values
GDM Diagnosis (100g load)
Fasting =
1 hour =
2 hour =
3 hour =
Fasting = 95 mg/dL
1 hour = 180 mg/dL
2 hour = 155 mg/dL
3 hour = 140 mg/dL
GDM Diagnosis (75g load)
Fasting =
1 hour =
2 hour =
3 hour =
Fasting = 95 mg/dL
1 hour = 180 mg/dL
2 hour =155 mg/dL
3 hour = —-
T/F: If 75 g OGTT is employed, it is necessary to get the blood sugar levels on the 3rd hour.
FALSE, only until the 2nd hour
Patient preparation:
_______ of fasting after at least ___ days of unrestricted diet and unlimited physical activity
8-14 (10 hours) hours; 3 days
Unrestricted diet carbohydrate per day
> 150g carbohydrate per day
At _____ y.o.: If results are normal, testing should be done every ______-
45 y.o.; 3 years
When to test for DM?
- Habitually physically inactive
- Family history (first-degree relative)
- High-risk minority group
- History of GDM or delivering a baby weighing more than 9lb.
- Hypertension
- Low HDL concentrations
- Elevated triglyceride concentrations
- History of impaired FBG/OGTT
- Women with PCOS
- Presence of clinical conditions associated with insulin resistance (severe obesity and acanthosis nigricans)
- History of cardiovascular disease
When to test for Type 2 DM?
- Testing at 10 y.o or at onset of puberty
- Overweight
- Family history of type 2 DM (first or second degree)
- Race/ ethnicity
- Signs of insulin resistance or conditions associated
- Maternal history of diabetes or GDM
Every how many years is the follow up for Type 2 DM testing?
Every 2 years
Dominantly inherited disorder of NIDDM before 25 y.o
Maturity-Onset Diabetes of the Young (MODY)
MODY occurs when there are mutations in which genes
- Glucokinase (GCK)
- HNF1A
This gene is like a sensory of glucose
Glucokinase
This gene produces a gene that helps insulin
HNF1A
MODY is often misdiagnosed as:
Type 1 or Type 2 DM
T/F: MODY is polygenic.
FALSE, it is monogenic
T/F: MODY is a “type 1” DM patient with autoantibodies.
FALSE, no autoantibodies
T/F: MODY is a “type 1” DM patient with insulin secretion years beyond diagnosis.
TRUE
T/F: MODY is a “type 2” DM patient with normal weight or significantly overweight with signs of insulin resistance.
FALSE, there are no signs of insulin resistance
T/F: MODY is a diabetes patient who is part of a family in which three or more consecutive generations who has not been diagnosed with diabetes.
FALSE, diagnosed with diabetes
T/F: MODY is a diabetes patient with abnormally high blood sugars, often found incidentally during a check-up.
FALSE; stable, mildly elevated blood sugars
T/F: Patients with MODY usually have autoantibodies against the islets of Langerhans.
FALSE
LADA is a disease of
Adults (adult onset)
LADA
Latent autoimmune diabetes of adults
LADA does not need insulin for glycemic control at least in how many months after diagnosis:
first six months
LADA is also known as
Type 1.5 DM (Type 1a DM)
T/F: LADA shares genetic, immunologic, and metabolic features with type 1 diabetes
FALSE, BOTH type 1 and type 2
Criteria for the diagnosis of LADA
- Age greater than 35 years
- Positive autoantibodies to islet beta cells
- Insulin independence for at least the initial 6 months after diagnosis
T/F: There are autoantibodies in LADA.
TRUE
Autoantibody for LADA
GAD (glutamate decarboxylase) autoantibodies
This organization set the criteria for LADA diagnosis
Immunology for Diabetes Society (IDS)
Develops as an outcome of a pancreatic disease such as chronic pancreatitis or carcinoma.
Pancreatogenic DM (PDM)
PDM is also known as
Type 3C
NDM is also known as
Infantile diabetes/ congenital diabetes
NDM is a form of monogenic diabetes that occurs in an infant _________
<6 mos. of age
Insulin-dependent hyperglycemia that persists longer than a week should raise suspicion for this and prompt genetic testing
Neonatal Diabetes Mellitus (NDM)
Most common cause of permanent NDM
Genetic mutations in KCNJ11 and ABCC8
