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Mercy CLS 5: Chemistry > 4) Carbohydrates > Flashcards

4) Carbohydrates Flashcards

1
Q

critical low glucose

A

<40 mg/dL

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2
Q

RR glucose

A

74-100 mg/dL

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3
Q

critical high glucose

A

<400 mg/dL

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4
Q

fasting glucose normal

A

70-99 mg/dL

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5
Q

fasting glucose prediabetic

A

100-125 mg/dL

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6
Q

DM fasting glucose

A

≥126 mg/dL

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7
Q

2hr/random glucose normal

A

<140 mg/dL

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8
Q

2hr/random glucose prediabetic

A

140-199 mg/dL

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9
Q

2hr/random glucose DM

A

≥200 mg/dL

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10
Q

A1c normal

A

<5.7%

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11
Q

A1c prediabetic

A

5.7-6.4%

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12
Q

A1c DM

A

≥6.5%

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13
Q

OGTT criteria (50g drink)

A

≥140 g/dL

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14
Q

OGTT criteria (100g drink)

A

fasting ≥95 mg/dL
1 hour ≥180 mg/dL
2 hour ≥155 mg/dL
3 hour ≥140 mg/dL

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15
Q

gray tube
time limit

A

sodium fluoride
measure within 1 hour of draw

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16
Q

renal threshold for glucose

A

160-180 mg/dL

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17
Q

CSF glucose normal
RR
decreased levels indicate…

A

60-70% of serum glucose
50-80 mg/dL
infection

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18
Q

whole blood glucose is…

A

15% lower than serum glucose (less concentrated)

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19
Q

sample type for A1c

A

whole blood (purple top)

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20
Q

fasting glucose time period

A

8-10 hours
nothing but water PO

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21
Q

other body fluids glucose

A

90% of plasma glucose

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22
Q

formation of G6P from noncarb sources; ketone byproduct

A

gluconeogenesis

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23
Q

conversion of glucose to glycogen after heavy meal

A

glycogenesis

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24
Q

regulates glucose between meals

A

glycogenolysis

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25
Q

conversion of glucose or other hexoses into 3C molecules (lactate or pyruvate)

A

glycolysis

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26
Q

——- linkage forms disaccharides

A

glycosidic

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27
Q

> 10 monosaccharides linked

A

polysaccharide

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28
Q

glucose + fructose

A

sucrose

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29
Q

glucose + galactose

A

lactose

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30
Q

glucose + O2 + H2O → gluconic acid + H2O2

A

glucose oxidase

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31
Q

glucose + ATP → G6P + ADP

A

hexokinase

most accurate and common methodology for instruments

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32
Q

measures reducing substances in urine
primarily to detect galactosemia in children

A

CLINITEST/Benedict’s test

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33
Q

increase glucose levels by inhibiting insulin, glucagon, GH, and other hormones

from D cells of Islets

A

somatostatin

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34
Q

produced by adrenal medulla
fight or flight
inhibits insulin, increases plasma glucose

A

epinephrine

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35
Q

produced by adrenal cortex
stimulated by ACTH
increases plasma glucose

A

cortisol

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36
Q

produced by anterior pituitary
release cortisol

A

ACTH

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37
Q

produced by anterior pituitary
release stimulated by low glucose, low cortisol

A

GH

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38
Q

produced by thyroid
stimulated by TSH
increase plasma glucose

A

thyroxine
triiodothyronine

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39
Q

incomplete fat metabolism when carbs cannot be used
DM, starving, vomiting, glycogen storage disease

A

ketones

40
Q

3 ketones

A

Beta-hydroxybutyrate 78%
acetoacetic acid 20%
acetone 2%

41
Q

early indicator of kidney damage in DM

A

microalbuminuria

42
Q

severe O2 deprivation
severe metabolic acidosis from DM

A

lactate

43
Q

hyperosmolar state dilutes plasma
requires close monitoring in DKA

A

potassium and sodium

44
Q

functions and examples of polysaccharides

A

storage + structural

starch
glycogen
cellulose

45
Q

Catabolizes polysaccharides to intermediate-sized glucosans called “limit dextrins” and maltose

A

salivary amylase

46
Q

Completes digestion of starch and glycogen to limit dextrins and maltose

A

pancreatic amylase

47
Q

Secretes a group of 3 disaccharide enzymes (maltase, lactase, and sucrase)

A

intestinal mucosa

48
Q

4 potential pathways for carbs

A

Converted to liver glycogen and stored

Metabolized completely to CO2 and H2O to provide immediate energy

Converted to keto acids, amino acids, and proteins

Converted to fats (triglycerides) and stored in adipose tissue

49
Q

Oxidizes glucose to ribose and CO2
Formation of NADPH

A

pentose-phosphate pathway
(hexose monophosphate shunt)

50
Q

Stored in secretory granules of the β-cells

A

proinsulin

51
Q

proinsulin cleaved in equal molar amounts to…

A

insulin
C-peptide

52
Q

check if insulin is endogenous or exogenous

A

C-peptide level
(should be = to endogenous insulin level)

53
Q

Tumor of the pancreas that is derived from beta cells

A

insulinoma

54
Q

Stimulates glycogenolysis, gluconeogenesis, and lipolysis (breakdown of fat)
Inhibits glycolysis, glycogenesis, and lipogenesis

A

glucagon

55
Q

stress and exercise can induce secretion &
DM can impair secretion

A

glucagon

56
Q

3 Ps of T1DM

A

Polydipsia: excessive thirst
Polyuria: increased secretion and discharge of urine
Polyphagia: increased appetite, eating large amounts of food

57
Q

Most commonly occurs in patients with Type II diabetes with a concurrent acute febrile illness that leads to a reduced fluid intake

A

Hyperosmolar hyperglycemic state (HHS)

58
Q

r/f for T2DM

A
  • Age ≥ 45 years
  • Overweight (BMI ≥ 25 kg/m2) or weight >120% of desirable body weight
  • Family history of diabetes (parents or siblings with diabetes)
  • Habitual physical inactivity
  • Race/ethnicity: Hispanic, Native American, African American, Pacific Islander
  • Previously identified Impaired Fasting Glucose (IFG) or Impaired glucose tolerance (IGT)
  • History of GDM or delivery of a baby weighing > 9 lb
  • HTN (≥ 140/90 in adults)
  • HDL cholesterol ≤35 mg/dL and/or a triglyceride level ≥250 mg/dL
  • PCOS
  • History of vascular disease
59
Q

medication often used for T2DM

A

metformin

60
Q

secondary conditions to T2DM

A
  • Heart disease is the leading cause of death in diabetics.
  • High blood pressure is present in about 73% of diabetics.
  • Heart disease and strokes occur two to four times more frequently due to arteriosclerosis because of hyperlipidemia
  • Diabetic nephropathy occurs in 20-40% of diabetics
  • Nervous system damage is present in 60 to 70% of diabetics.
  • Susceptibility to infection with limb wounds/amptuations
61
Q

Cushing’s
Acromegaly
Glucagonoma
Somatostatinoma
Hyperthyroidism
Certain drugs or chemicals
Genetic syndromes

A

causes of secondary DM

62
Q

GDM screening time

A

24-28 weeks

63
Q

non-DM causes of hyperglycemia

A
  • Imbalance of the regulatory hormones
  • Drugs (Corticosteroids, beta blockers, epinephrine, diuretics, statins, antipsychotics)
  • Critical illness (Stroke, myocardial infarction, sepsis)
  • Stress (Dysfunction of endocrine glands, pancreas issues, intracranial diseases)
64
Q

drugs that can induce DM

A

Vacor
Nicotinic acid
Thyroid hormone
Thiazides
Dilantin
Glucocorticoids

65
Q

4 tests for DM dx

A

Hemoglobin A1C
Fasting glucose
2-hour post load glucose
Random (casual) glucose

66
Q

A1c measures…

A

glycated hemoglobin
average BG over last 2-3 months

67
Q

OGTT

A

oral glucose tolerance test

68
Q

child OGTT dose

A

1.75 g/kg body weight, not to exceed 75 grams

69
Q

hypoglycemia BG

A

<50 mg/dL in men
<45 mg/dL in women

70
Q

Weakness
Shakiness, nervousness
Rapid pulse, sweating
Hunger, epigastric discomfort
Lightheadedness, dizziness, confusion
Nausea, vomiting
Slurring of speech, blurring of sight
Loss of motor coordination
Unconsciousness

A

hypoglycemia

71
Q

whipple’s triad for dx of hypoglycemia

A
  1. Signs and symptoms of hypoglycemia
  2. Documentation of low plasma glucose at the time patient is experiencing the signs and symptoms
  3. Alleviation of symptoms with the ingestion of glucose and an increase in plasma glucose
72
Q

over 50% of hypoglycemia cases

A

mismanagement of DM with insulin

73
Q

Diagnosed with a glucose level <50 mg/dL occurring after an overnight fast, between meals, or after physical activity.

Occurs within 12 hours of beginning a fast

Symptoms are usually neuroglycopenic and involve the central nervous system.

A

fasting hypoglycemia (pathologic)

74
Q

Islet cell adenoma or carcinoma (insulinoma)
Non B cell tumors
Insulin-receptor antibody hypoglycemia
Surreptitious insulin injection/accidental insulin overdose
Severe liver disease
Severe renal disease
Septicemia

A

causes of fasting hypoglycemia

75
Q

Usually benign and transient condition caused by excessive release of insulin from pancreas

Occurs 2-4 hrs after eating

Can be idiopathic, due to alimentary problems, or a result of congenital enzyme deficiencies

A

reactive/postprandial hypoglycemia (benign)

76
Q

adrenergic sx of reactive hypoglycemia

A

Sweating, shakiness, nervousness, faintness, tachycardia, hunger

77
Q

Hereditary fructose intolerance
Galactosemia
Alimentary hypoglycemia (gastrointestinal surgery: gastrectomy, gastrojejunostomy, pyloroplasty)
Adrenal insufficiency
Early onset type 2 diabetes mellitus
Idiopathic

A

causes of reactive hypoglycemia

78
Q

glycogen storage disease

A

Deficiency of one of the 8 enzymes that break down glycogen (glycogenolysis) leading to a build up of glycogen

79
Q

most common type of glycogen storage disease

A

Type I: Glucose-6-phosphatase deficiency, also known as von Gierke disease

80
Q

Severe hypoglycemia occurs because glycogen cannot be converted back to glucose via hepatic glycogenolysis

A

type 1 glycogen storage disease

81
Q

glycogen storage disease tx

A

avoid hypoglycemic events
liver transplant

82
Q

type 1 glycogen storage disease dx

A

Failure of blood glucose to increase after galactose load

83
Q

galactosemia

A

Lack of 1 of the 3 enzymes needed to metabolize galactose to glucose resulting in galactose in plasma

84
Q

“Failure to thrive”, liver disease, cataracts, and (irreversible) mental retardation. Hypoglycemia may also develop

A

galactosemia

85
Q

most common cause of galactosemia

A

galactose-1-phosphate uridyl transferase (Type 1)

86
Q

glucose specimen handling

A

separate cells from plasma within 1 hour (5-7% decrease in glucose/hour)

sodium fluoride tube used if delay is necessary

87
Q

CSF glucose term

A

glycorrhachia

88
Q

sodium nitroprusside

A

ketone detection

89
Q

Overproduction of ketones causes ketoacidosis, which results in a decreased ————- which therefore results in a decrease in blood pH.

(—— remains normal)

A

bicarbonate
pCO2

90
Q

ketone sample handling

A

Must be tightly stoppered and analyzed immediately, or else falsely decreased results can occur (ketones are volatile)

must add glycine to detect acetone

91
Q

a glucose molecule attached to the N-terminus of the B-polypetide chains of normal adult hemoglobin

A

HbA1C

92
Q

5 types of A1c methodologies

A

High-performance liquid chromatography
Enzymatic
Capillary electrophoresis
Boronate affinity chromatography
Immunoassay

93
Q

Used for patients who need to be monitored more frequently than once every 3 months (GDM, in therapy)

A

glycosylated albumin (fructosamine)

Non-enzymatic attachment of glucose to amino groups of proteins other than hemoglobin (serum proteins, membrane proteins, lens crystallins)

94
Q

microalbuminuria defined as…

A

30-300 mg of albumin/24 hours

95
Q

most sensitive microalbumin specimen

A

24 hour collection

96
Q

Important for detecting and monitoring impaired circulatory and tissue oxygenation in critically ill DM patients

A

lactic acid

97
Q

Collected in Gray top (Na fluoride), sent on ice, tested ASAP

A

lactic acid

Mercy CLS 5: Chemistry (24 decks)

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