Carb Seminar Flashcards
(15 cards)
Is it possible to have Glucosuria and 5mmol/L serum glucose?
- Yes
- if proximal renal tubule is defected.
- FANCONI SYNDROME: Na/Glu defect so glucose not reabsorped.
Is it possible to not have glucosuria and 15mml/L gluose serum?
- Yes
- If GFR down (as in chronic renal failure in DM late stage)
- so less flucose is filtered into renal tubules per time.
- GFR = 120-15ml/mm
- normal RGT: 160-180 mg/dl
A 15-year-old girl has been losing weight in spite of having a good appetite, and she feels
tired lately. She has been admitted to a hospital for vomiting, being dizzy and disoriented.
Laboratory findings: urine glucose: strongly positive ketone bodies: positive blood glucose: 28.5 mmol/l blood pH: 7.1 serum K+: 5.4 mmol/l What is your diagnosis, and what is to be done with her?
DM1
- glucosuria
- Ketone bodies (hence why she vomits)
- Hyperglycemia (as blood glucose > 6.5mmol/L
- Hyperkalemia:
- due to metabolic acidosis as K/H+ in kidney trying to secrete H+ and lack of insulin to take up the K+
-Check her CRP levels (will be low/0)
—–
Treatment:
1) insulin 4U/Hr
2) fluid (cells are dehydrated so water moves to blood hence neurological symptoms)
3) electrolyte adminstration (the hyperkalemia will become hypokalemia with the insulin treatment)
A 56 year-old man who used to be healthy complains of polyuria. Laboratory findings:
fasting blood glucose: 7.3 mmol/l,
fasting blood glucose a week later: 7.6 mmol/l.
What is your diagnosis, and what would you do with him?
Clinical findings:
>polyuria indicates hyperglycemia
>age and slow development indicates T2DM
Lab findings:
>Fasting blood glucose > 7mmol/L (both primary and secondary indicates DM)
Further Tests:
>C-peptide (T2DM -> normal or increased)
Conclusion:
>lifestyle changes
>oral anti-diabetics (Induce insulin secretion/inhibit liver gluconeogenesis)
A 60 year-old woman, weighing 90 kg. Fasting blood glucose concentration: 6.9 mmol/l.
Neither glucose nor ketone bodies are found in her urine.
The results of oral glucose tolerance test:
fasting value: 6.4 mmol/l
2h value: 8.5 mmol/l
What is your diagnosis, and what would you advise to her?
- initial blood glucose is 6.9 (between 6 and 7 is indication for OGTT)
- OGTT shows after 2 hours = 8.5mmol/L -> impaired glucose tolerance
- IGT is prediabetic stage (lifestyle changes, checkups, look for signs of beginning DM complication/CVD/Neuro and retinopathy)
parameters for 2hrs OGTT
> Normal: 3-6mmol/L
> Impaired fasting glucose: 6.1-7.8
> Impaired Glucose tolerance: 7.8-11.1
> DM: >11.1
Laboratory findings of a person:
fasting blood glucose: 6.2 mmol/l
Oral glucose tolerance test was performed on another occasion:
fasting value: 6.3 mmol/l
2h value: 6.5 mmol/l.
What is the diagnosis, and what is the clinical significance of it?
- initial fasting glucose 6.2mmol/L => OGTT
- the 2hr for OGTT is 6.5 (impaired fasting glucose: 6.1-7.8)
IMPAIRED FASTING GLUCOSE:
>is associated with insulin resistance and other late complications even when full T2DM does not develop)
>prediabetic stage
>lifestyle and checkups
What are your options to check the glucose metabolism of your diabetic patient, to decide
if the current treatment needs to be changed or not?
> HbA1c (glycosylated HB)
reflects the mean [Glucose] over 8 weeks.
treatment goal < 7% and done twice a year
(normally present but elevated in hyperglycemia)
(elevation increase risk for CVD/Neuro/Retinopathy)
> NOT APPROPRIATE when recent change in diet/treatment within 2-6 weeks / Hemolytic anemia/ recent blood loss/ sickle cell disease
> Fructosamine used in this situation (gives mean in 2-3weeks)
A diabetic patient treated with insulin has a fasting blood glucose concentration of 6.4
mmol/l. No glucose was detected on the morning of the examination. The Hb-A1C level is
10 % (normal value: 3–6 %).
Do you think the control of glucose concentration was acceptable in the last 1–2 months?
NO the control of glucose was bad.
> 6.4mmol/L => hyperglycemia (should be below 5)
HbA1C = 10% (should be below 7)
TREATMENT INSUFFICIENT
>too small dose??
>patient to blame??????
A type 1 diabetic man has been eating very little for the last couple of days, due to a
febrile illness, so he decided to stop administering his insulin. He checked his blood
glucose, because he felt worse and worse, and was suprised to see, that it was more than
20 mmol/l.
What is the explanation?
Inflammation/stress:
>body release catecholalmines/cortisol -> increase proteolysis -> MORE SUBSTRATE FOR GLUCONEOGENESIS
Not eating alot:
-hypoglycemia -> stress -> catecholamines + cortisol -> promote glucose mobilization (in addition to no insulin adminstration)
Feeling Worse:
-ketoacidosis (due to mobilization of FA) - due to stress/fasting/decr. insulin levels
A diabetic man treated with insulin skipped his late evening meal before going to bed,
without any change in his insulin administration. He has been sweating a lot during the
night, and glucose has been detected in his urine in the morning.
What is the explanation for this?
-he still injected his insulin which still will work (even without food)
*Somogyi phenomenon:
>Hypoglycemia -> strong symp activation -> cortisol + epinephrine -> increase glucose production (lipolysis, gluconeogen, glycogenolysis) so HYPERGLYCEMIA occurs.
Sweating: due to sympathetic stimulation
To stop: decre insulin, incr. food
A man with type 1 diabetes, cooperating very well with his physician, keeps his diet and
insulin administration very precisely. He is an employee of a bank, and currently attends a
team building training, a several-day-long survival tour causing significant physical
exertion. The man, who is known to be reserved, starts shouting and quarreling with his
coworkers, then he begins to sweat, quiver and develops cramps.
What do you think is the explanation of his behaviour?
> Hypglycemia (affects autonomic and CNS) -> they behave drunk.
> Strenous exersize:
-incr utilization of glucose by muscles and upregulation of glut 4 (independent of insulin)-> hypoglycemia
also patient NOT EATING WELL
*NB: exersize imp in DM ptnt -> incr insulin sensitivity (but take care with blood glucose)
> TREATMENT:
- Mild: eat food to incr glucose
- Severe: eat sugar
A woman was admitted to the hospital with the complaint of recurring seizures.
Her fasting blood glucose level is 2.7 mmol/l.
What can cause these symptoms? What tests would you perform to establish the
diagnosis?
-Hypoglycemia
-CNS effects:
>nervousness, disorientation, altered behaviour, cramps, coma
-ANS effects:
>cold sweats/ hunger/ tremor/ tachycardia
NON DIABETIC CAUSES OF HYPOGLYCEMIA:
1) insulinoma: endocrine tumour of pancrease (check insulin lvl)
2) Lack of insulin antagonists (thyroid, cortisol, catechol)
3) Alcholism + liver disease
TEST:
HbA1C
A breast-fed infant was admitted to the hospital with weight loss, vomiting and jaundice.
Blood glucose level is somewhat low. Glucose is not, but a reducing substance is
detectable in the urine.
What is the likely diagnosis?
GALACTOSEMIA
> AR
deficiency in Galactose-1-uridyltransferase
glucose not formed (hypoglycemia
galactose accumulates ( incr fermentation by bacteria -> vomitting/diahorrhea
Galictol -> cateracts, CNS damage, liver damage)
A small boy gets regularly sick after eating sugar containing foods: he is sweating, feels
dizzy, vomits. He does not eat sweets for this reason. These symptoms were shown to be
caused by reactive hypoglycemia, on examination.
What is the likely diagnosis?
Herditory Fructose Intolerance (aldolase B deficiency)
F-1-P -> DHAP and Glyceraldhyde
thus P trap (lack of P for metabolic pathways such as ATP formation
> decrease ATP causes:
- hypoglycemia (insuff gluconeogenesis)
- hyperlactimea
- hyperuricemia
- kidney failure
EAT TABLE SUGAR
