UNIT 4 - Clinical Significance (Carbohydrates) Flashcards
elevated blood glucose level
Hyperglycemia
low blood glucose level
Hypoglycemia
HYPERGLYCEMIA dxs
DIABETES MELLITUS
A group of metabolic diseases characterized by
hyperglycemia resulting from defects in insulin secretion, insulin action or both
DIABETES MELLITUS
DIABETES MELLITUS types
New categories of Diabetes (American Diabetes
Association (ADA) and World Health Organization (WHO))
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Gestational Diabetes
Other specific types of diabetes
Other Specific Types of Diabetes
o Pancreatic disease (pancreatitis)
o Endocrine disease (growth hormone and cortisol)
o Drug or chemical induced
o Insulin receptor abnormalities
o Other genetic syndromes
Old Classification of diabetes mellitus by National Diabetes Group, 1979
Type 1, insulin-dependent diabetes mellitus
(IDDM)
Type 2, non-insulin-dependent diabetes mellitus (NIDDM)
What are the alternative names for Type 1 Diabetes Mellitus?
Insulin-dependent DM,
Juvenile Onset DM,
Brittle Diabetes,
Ketosis-Prone Diabetes.
In which age groups is Type 1 Diabetes usually diagnosed?
Children, teens, and young adults.
A form of diabetes characterized by unpredictable swings in blood glucose levels.
Brittle diabetes
production of ketone bodies coming from fat bodies
Ketosis-prone diabetes
Type 1 diabetes is the result of
cellular-mediated autoimmune destruction of the beta cells of the pancreas
Type 1 diabetes will cause what deficiency
absolute insulin deficiency
the antibodies that would destroy the beta cells of the pancreas
Islet cell autoantibodies
Insulin autoantibodies
Glutamic acid decarboxylase autoantibodies
Tyrosine phosphatase IA-2 and IA-2B
autoantibodies
Remember that Type 1 DM is autoimmune in
nature because of the presence of autoantibodies, the B cells in particular
What percentage of all diabetes cases does Type 1 Diabetes constitute?
10% to 20%
Risk factors of T1DM
genetic, autoimmune, environmental
T1DM Characteristics
abrupt onset, insulin dependence, and
ketosis tendency
T1DM Signs and Symptoms
polydipsia,
polyphagia,
polyuria,
rapid weight loss hyperventilation,
mental confusion, and
possible loss of consciousness
excessive thirst
Polydipsia
increased food intake
Polyphagia
excessive urine output
Polyuria
What are the microvascular complications of Type 1 Diabetes?
Nephropathy
Neuropathy
Retinopathy
kidney damage
Nephropathy
nerve damage
Neuropathy
retina of the eyes
Retinopathy
How is insulin administered in Type 1 Diabetes?
Via parenteral (injection) administration.
has no known etiology; is strongly inherited; does not have beta cell autoimmunity; requires insulin replacement
Idiopathic type 1 diabetes
A result of an individual’s resistance to insulin with an insulin secretory defect
Type 2 Diabetes Mellitus
What are alternative names for Type 2 Diabetes Mellitus?
Non-insulin Dependent DM,
Maturity Onset or Adult Type DM,
Stable Diabetes,
Ketosis-resistant Diabetes,
Receptor-Deficient DM.
What percentage of diabetes cases does Type 2 Diabetes constitute?
The majority of diabetes cases.
What are common characteristics of Type 2 Diabetes Mellitus?
Adult onset, milder symptoms than Type 1, and ketoacidosis is rare.
What are the risk factors for Type 2 Diabetes?
Genetic predisposition,
obesity,
sedentary lifestyle,
race/ethnicity,
PCOS,
dyslipidemia, and
hypertension
involves cystic structures in one or both ovaries and includes symptoms such as irregular menstruation, hirsutism, oily skin, and acne, which are risk factors for Type 2 Diabetes.
Polycystic Ovarian Syndrome (PCOS)
What are the macrovascular complications of Type 2 Diabetes?
Coronary artery disease,
stroke, and
heart attack.
What are the microvascular complications of Type 2 Diabetes?
Neuropathy,
nephropathy, and
retinopathy.
How is blood sugar managed in patients with Type 2 Diabetes?
oral agents or hypoglycemic agents
oral agents or hypoglycemic agents example
metformin
Any degree of glucose intolerance with onset or first recognition during pregnancy.
gestational diabetes
What are the risks for infants born to mothers with gestational diabetes?
Respiratory distress syndrome,
hypocalcemia, and
hyperbilirubinemia.
It is difficulty in breathing due to immature lungs, potentially caused by delayed lung development in infants of mothers with high glucose levels during pregnancy.
respiratory distress syndrome
It is an increase in bilirubin levels, often associated with prematurity and polycythemia (increased RBC count) in infants.
hyperbilirubinemia
How does polycythemia lead to hyperbilirubinemia?
Increased RBC count leads to increased degradation of hemoglobin, producing more bilirubin.
When should screening for gestational diabetes be performed?
Between 24 and 48 weeks of gestation.
A decrease in blood calcium levels due to reduced parathyroid hormone levels in the infant.
hypocalcemia in infants of mothers with gestational diabetes
What is a key characteristic of other specific types of diabetes?
associated with secondary conditions
What genetic defect can lead to other specific types of diabetes?
Genetic defects of beta cell function.
What pancreatic disease is associated with other specific types of diabetes?
Pancreatitis
What endocrine diseases are associated with other specific types of diabetes?
Acromegaly and Cushing’s syndrome (Hypercortisolism).
causes increased production of growth hormone, a hyperglycemic agent that raises blood glucose levels, leading to diabetes.
acromegaly
How does Cushing’s syndrome (hypercortisolism) contribute to diabetes?
It increases the production of cortisol, a hyperglycemic agent, which can lead to diabetes.
How can drugs or chemicals induce diabetes?
By causing insulin resistance or damaging the beta cells of the pancreas.
What abnormalities can lead to insulin resistance and contribute to diabetes?
Insulin receptor abnormalities.
Individuals with this syndrome have an increased risk of diabetes due to autoimmunity or the production of antibodies against the beta cells of the islets of Langerhans.
Down syndrome
What are the main laboratory findings in hyperglycemia related to glucose levels?
Increased glucose in plasma and urine
presence of glucose in urine
glucosuria
What happens to urine specific gravity in hyperglycemia?
Urine specific gravity is increased.
What ketone-related findings are seen in hyperglycemia?
Presence of ketones in serum (ketonemia) and urine (ketonuria).
How does hyperglycemia affect blood and urine pH?
Both blood and urine pH are decreased, leading to acidosis.
What electrolyte imbalances are commonly found in hyperglycemia?
Low sodium concentration (due to polyuria and glucose shift into cells) and
high potassium concentration.
According to ADA recommendations, at what age should all adults begin testing for diabetes, and how often?
All adults should begin testing at age 45 and be tested every 3 years.
What tests are recommended by the ADA for diabetes screening in adults?
Hemoglobin A1c (HbA1c),
fasting plasma glucose, or a
2-hour 75g oral glucose tolerance test (OGTT).
In which individuals should diabetes testing be done earlier than 45 years of age?
In individuals who are overweight and have additional risk factors.
What is a lifestyle-related risk factor for diabetes?
Being habitually physically inactive.
How does family history contribute to diabetes risk?
Having a family history of diabetes in a first-degree relative increases the risk.
Which high-risk minority populations are at greater risk for diabetes?
African American, Latino, Native American, Asian American, and Pacific Islander populations.
How does a history of gestational diabetes mellitus (GDM) or delivering a large baby impact diabetes risk?
It increases the risk, especially if the baby weighed more than 9 lbs (4.1 kg).
How does hypertension relate to diabetes risk?
Blood pressure ≥ 140/90 mm Hg is a risk factor for diabetes.
What level of HDL cholesterol is considered a risk factor for diabetes?
HDL cholesterol concentrations < 35 mg/dL (0.90 mmol/L).
What triglyceride level is a risk factor for diabetes?
Elevated triglyceride concentrations > 250 mg/dL (2.82 mmol/L).
How does a history of impaired fasting glucose or impaired glucose tolerance affect diabetes risk?
It increases the risk of developing diabetes.
Why are women with polycystic ovarian syndrome (PCOS) at higher risk for diabetes?
PCOS is associated with insulin resistance, increasing the risk of diabetes.
What other clinical conditions are associated with insulin resistance and increase the risk for diabetes?
Severe obesity and acanthosis nigricans.
How does a history of cardiovascular disease relate to diabetes risk?
It is a significant risk factor for developing diabetes.
o Hyperpigmentation of the skin, dark areas in the armpits or groins
o Get tested for diabetes
Acanthosis nigricans
At what age should testing for Type 2 diabetes begin in asymptomatic children, and how often should it be repeated?
Testing should begin at age 10 or at the onset of puberty, with follow-up testing every 2 years.
What are the criteria for testing Type 2 diabetes in overweight children?
Family history of Type 2 diabetes in first- or second-degree relatives
Race/ethnicity
Signs of insulin resistance
Maternal history of diabetes or GDM.
Signs of insulin resistance
acanthosis nigricans,
hypertension,
dyslipidemia,
PCOS
What HbA1c level is considered diagnostic of diabetes in children?
≥ 6.5%
What fasting blood glucose level is diagnostic of diabetes?
≥ 126 mg/dL
What 2-hour OGTT result is diagnostic of diabetes in children?
≥ 200 mg/dL
What random plasma glucose level, along with symptoms of diabetes, is diagnostic of diabetes?
≥ 200 mg/dL plus symptoms
Who should be screened for gestational diabetes according to the International Association of the Diabetes and Pregnancy Study Groups?
All nondiabetic pregnant women should be screened for GDM.
What test is used to screen for GDM in pregnant women?
A 2-hour oral glucose tolerance test (OGTT) with measurements of fasting plasma glucose, 1-hour plasma glucose, and 2-hour plasma glucose levels.
What are the fasting instructions for a pregnant woman before the 2-hour OGTT?
The patient should fast for 8-10 hours but not longer than 16 hours.
What happens during the 2-hour OGTT for GDM testing?
After fasting, a blood sample is taken for fasting plasma glucose, then the patient is given a 75g glucose load dissolved in 300mL water. Blood samples are taken 1 hour and 2 hours later.
At what stage of pregnancy is the 2-hour OGTT for GDM typically performed?
The test is usually done between 24 and 28 weeks of gestation.
What is a challenge associated with the 2-hour OGTT for pregnant women?
The test requires multiple blood draws over several hours, which can be inconvenient for the patient.
According to the revised ADA guidelines, what type of glucose test is used for diagnosing diabetes in non-pregnant individuals?
A fasting plasma glucose test and a 2-hour plasma glucose test using a 75g glucose load.
According to the revised ADA guidelines, what type of glucose test is recommended for pregnant women?
Pregnant women should undergo the 3-step oral glucose tolerance test (OGTT) involving fasting, 1-hour, and 2-hour plasma glucose measurements.
What is the fasting plasma glucose level diagnostic of gestational diabetes?
≥ 92 mg/dL (5.1 mmol/L).
What is the one-hour plasma glucose level diagnostic of gestational diabetes?
≥ 180 mg/dL (10 mmol/L).
What is the two-hour plasma glucose level diagnostic of gestational diabetes?
≥ 153 mg/dL (8.5 mmol/L).
At what plasma glucose level do glucagon and other glycemic factors get released in response to hypoglycemia?
65 to 70 mg/dL (3.6 to 3.9 mmol/L).
At what plasma glucose level do observable symptoms of hypoglycemia typically appear?
50 to 55 mg/dL (2.8 to 3.1 mmol/L).
What are common symptoms of hypoglycemia?
Increased hunger,
sweating,
nausea and vomiting,
dizziness,
nervousness and shaking,
blurring of sight, and
mental confusion.
What are the typical laboratory findings in hypoglycemia?
Decreased plasma glucose levels and extremely elevated insulin levels in patients with pancreatic β-cell tumors
pancreatic β-cell tumors
insulinoma
What condition is associated with extremely elevated insulin levels in hypoglycemia?
Pancreatic β-cell tumor (insulinoma), which produces excess insulin.
Deficiency of a specific enzyme that alters glycogen metabolism.
glycogen storage diseases
What is the most common form of glycogen storage disease?
Von Gierke disease (glucose-6-phosphatase deficiency).
How does liver transplantation affect Von Gierke disease?
Liver transplantation can correct the disease.
What are the key characteristics of Von Gierke disease (Type 1A Glycogen Storage Disease)?
Severe hypoglycemia due to the inability of glycogen to be converted into glucose units.
What are the characteristics of liver forms (types I, III, IV, VI, IX, and 0) of glycogen storage diseases?
Marked by hepatomegaly and hypoglycemia.
Types of glycogen storage diseases which are marked by hepatomegaly and hypoglycemia
types I, III, IV, VI, IX, and 0
Types of glycogen storage diseases characterized by muscle cramps, exercise intolerance, fatigue, and weakness
types V and VII
A cause of failure to thrive syndrome in infants, diarrhea, and vomiting.
Galactosemia
What is the primary result of Galactosemia?
Increased levels of galactose in plasma.
What is the most common enzyme deficiency in Galactosemia?
Galactose-1-phosphate uridyltransferase.
Name two other enzymes related to Galactosemia.
Galactokinase and Uridine diphosphate galactose-4-epimerase.
What laboratory test is used for diagnosing Galactosemia?
Erythrocyte galactose-1-phosphate uridyltransferase activity.
What laboratory findings are associated with Galactosemia?
Hypoglycemia, hyperbilirubinemia, and galactose accumulation in the blood, tissue, and urine following milk ingestion.
What is the enzyme deficiency in Essential Fructosuria?
Fructokinase deficiency.
What condition is characterized by a defect in fructose-1,6-bisphosphate aldolase B activity?
Hereditary Fructose Intolerance.
What is the defect associated with Fructose-1,6-Bisphosphatase Deficiency?
Defect in fructose-1,6-bisphosphatase.
