Carbohydrates Flashcards
(275 cards)
1
Q
Compounds (biomolecules) containing C, H, and O
A
Carbohydrates
2
Q
Functional groups found in carbohydrates
A
C=O (carbonyl) and -OH (hydroxyl)
3
Q
Major food source and energy supply for the body
A
Carbohydrates
4
Q
The general formula for a carbohydrate
A
Cx(H2O)y
5
Q
Different properties for the classification of carbohydrates
A
Size of the base carbon chain
Location of the CO function group
Number of sugar units
Stereochemistry of the compound
6
Q
Carbohydrates classifications based on the number of carbons in the molecule
A
Trioses contain three carbons
Tetroses contain four
Pentoses contain five
Hexoses contain six
7
Q
Example of carbohydrates reducing substances
A
Glucose
Maltose
Fructose
Lactose
Galactose
8
Q
Most common non reducing carbohydrate
A
Sucrose
9
Q
The primary energy source for brain, erythrocytes, and retina cells in human body
A
Carbohydrates
10
Q
In order for a carbohydrate to be considered as reducing substance, they must contain _____
A
Active aldehyde and/or ketone group
11
Q
Carbohydrates are hydrates of aldehyde or ketone derivatives based on the location of the CO functional group. True or False?
A
True
12
Q
Two forms of carbohydrates
A
Aldose
Ketose
13
Q
Carbohydrate that has a terminal carbonyl group (O=CH-)
A
Aldose
14
Q
Carbohydrate that has a carbonyl group (O=C) in the middle linked to two other carbon atoms
A
Ketose
15
Q
Known as the structural arrangement of atoms on a given molecule
A
Stereoisomers
16
Q
If the hydroxyl group (OH) projects to the right in the Fisher projection, the sugar belongs to
A
Dextrorotatory series and receives the prefix D-
17
Q
If the hydroxyl group (OH) projects to the left in the Fisher projection, the sugar belongs to
A
Levorotatory series and receives the prefix L-
18
Q
The chaining of sugars relies on the formation of _____ that are bridges of oxygen atoms
A
Glycoside bonds
19
Q
A glycosidic bond or glycosidic linkage is a type of covalent bond that joins a carbohydrate (sugar) molecule to another group, which may or may not be another carbohydrate. True or False?
A
True
20
Q
The process of producing water molecule when two carbohydrate molecules join
A
Dehydration
21
Q
The process of using water molecule to split carbohydrate, forming individual compounds
A
Hydrolysis
22
Q
Simple sugars that cannot be hydrolyzed to a simpler form
A
Monosaccharides
23
Q
Common examples of monosaccharides
A
Glucose
Fructose
Galactose
24
Q
Sugar formed when two monosaccharide units are joined by a glycosidic linkage
A
Disaccharides
25
Common examples of disaccharides
Maltose
Lactose
Sucrose
26
Sugar chaining of 3 to 10 sugar units
Oligosaccharides
27
Sugar formed by the linkage of many monosaccharide units
Polysaccharides
28
Common examples of polysaccharides
Starch
Glycogen
29
What will happen if the bond forms with one of the other carbons on the carbohydrate other than the anomeric (reducing) carbon
The anomeric carbon is unaltered and the resulting compound remains a reducing substance
30
What will happen if the bond is formed with the anomeric carbon on the other carbohydrate
The resulting compound is no longer a reducing substance
31
Responsible for the digestion of nonabsorbable carbohydrate polymers to dextrins and disaccharides
Salivary and pancreatic amylase
32
Enzyme that further hydrolyze disaccharide to monosaccharides
Maltase
33
Enzyme that hydrolyze sucrose to glucose and fructose
Sucrase
34
Sugar that consists of 1 glucose, 1 fructose, and 1 galactose
Raffinose
35
Sugar that consists of 1 glucose, 1 fructose, and 2 galactose
Stachyose
36
Enzyme that hydrolyze lactose to glucose and galactose
Lactase
37
Venous system that returns blood from the digestive track to the liver
Hepatic portal system
38
The only carbohydrate to be directly used for energy or stored as glycogen
Glucose
39
Carbohydrates that must be converted to glucose before they can be used
Galactose
Fructose
40
The ultimate goal of the cell is to convert glucose to
Carbon dioxide and water
41
3 major metabolic pathways for carbohydrates
Embden-Meyerhof pathway
Hexose monophosphate (HMP) shunt
Glycogenesis
42
The first step for all three pathways requires glucose to be converted to _____ using the high energy molecule, _____
Glucose-6-phosphate; ATP
43
The reaction of converting glucose to glucose-6-phosphate is catalyzed by
Hexokinase
44
Metabolism of glucose molecule to pyruvate or lactate for production of energy
Glycolysis
45
Formation of glucose-6-phosphate from noncarbohydrate sources
Gluconeogenesis
46
Breakdown of glycogen to glucose for use as energy
Glycogenolysis
47
Conversion of glucose to glycogen for storage
Glycogenesis
48
Responsible for the straight forward production of glycogen from glucose
Glycogen synthase
49
Conversion of carbohydrates to fatty acids
Lipogenesis
50
Decomposition of fat
Lipolysis
51
Effect of glycolysis to plasma glucose concentration
Decreased
52
Effect of gluconeogenesis to plasma glucose concentration
Increased
53
Effect of glycogenolysis to plasma glucose concentration
Increased
54
Effect of glycogenesis to plasma glucose concentration
Decreased
55
Effect of lipogenesis to plasma glucose concentration
Decreased
56
Effect of lipolysis to plasma glucose concentration
Increased
57
Two major hormones responsible for blood glucose control
Insulin
Glucagon
58
Organ that produce insulin and glucagon
Pancreas
59
The primary hormone responsible for the entry of glucose into the cell
Insulin
60
Insulin is synthesized by
b-cells of islets of Langerhans in the pancreas
61
Insulin responds to
Increase in glucose
62
The only hormone that decreases glucose levels and can be referred to as a hypoglycemic agent
Insulin
63
The primary hormone responsible for increasing glucose levels
Glucagon
64
Glucagon is synthesized by
a-cells of islets of Langerhans in the pancreas
65
Glucagon responds to
Decrease in glucose
66
The hormone that increases glucose levels and can be referred to as a hyperglycemic agent
Glucagon
67
Two hormones produced by the adrenal gland that affects carbohydrate metabolism
Epinephrine
Glucocorticoids (cortisol)
68
Epinephrine is produced by
Adrenal medulla
69
Epinephrine is produced during
Stress
70
Effect of epinephrine in glucose level
Increased
71
How does epinephrine increase glucose levels?
Inhibits insulin secretion, increases glycogenolysis, and promotes lipolysis
72
Glucocorticoids primarily cortisol, are released from
Adrenal cortex (Zona fasciculata)
73
Hormone stimulating the release of glucocorticoids
Adrenocorticotropic hormone (ACTH)
74
Effect of glucocorticoids in glucose level
Increased
75
How does glucocorticoids increase glucose levels?
Decreases intestinal entry into the cell and increases gluconeogenesis, liver glycogen, and lipolysis
76
Two anterior pituitary hormones that promotes increased plasma glucose
Growth hormone
ACTH
77
Growth hormone is inhibited by
Increased glucose
78
How does ACTH increase plasma glucose levels?
Converts liver glycogen to glucose and promotes gluconeogenesis
79
Two other hormones that affects glucose levels
Thyroxine
Somatostatin
80
Thyroxine is released by
Thyroid gland
81
Somatostatin is produced by
d-cells of the islets of Langerhans of the pancreas
82
How does thyroxine affect plasma glucose levels
Increases plasma glucose levels by increasing glycogenolysis, gluconeogenesis, and intestinal absorption of glucose
83
How does somatostatin affect plasma glucose levels
Increases plasma glucose levels by the inhibition of insulin, glucagon, growth hormone, and other endocrine hormones
84
Embden-Meyerhof pathway is formally known as
Glycolysis
85
Hexose monophosphate (HMP) shunt is also known as
Pentose Phosphate Pathway or Phosphogluconate pathway
86
Metabolic pathway that allows the metabolic use of glucose to generate ATP, NADH, and several biosynthetic precursors such as 3-phosphoglycerate or pyruvate
Embden-Meyerhof pathway
87
Metabolic pathway for the conversion of glucose-6-phosphate to 6-phosphogluconic acid, which permits the formation of ribose-5-phosphate and NADPH
Hexose monophosphate (HMP) shunt
88
Metabolic pathway in which glucose-6-phosphate is converted to glucose-1-phosphate, which is then converted to uridine diphosphoglucose and then to glycogen by glycogen synthase
Glycogenesis
89
An increase in plasma glucose levels
Hyperglycemia
90
A group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both
Diabetes mellitus
91
Characterized by inappropriate hyperglycemia primarily a result of pancreatic islet b-cell destruction and a tendency to ketoacidosis
Type 1 DM
92
Includes hyperglycemia cases that result from insulin resistance with an insulin secretory defect
Type 2 DM
93
A type of diabetes that was retained in women who developed glucose intolerance during pregnancy
Gestational diabetes mellitus (GDM)
94
Other names of Type 1 DM
Insulin Dependent DM
Juvenile Onset DM
Brittle or Labile Diabetes
Ketosis-Prone Diabetes
95
Why is it called Juvenile Onset DM?
Because it is usually diagnosed with teens and young adults
96
Why is it called Brittle or Labile Diabetes?
Because it is associated with the severe and unpredictable swings in the blood glucose concentrations
97
Why is it called Ketosis-Prone Diabetes?
Because of the increase production of ketone bodies coming from fat metabolism
98
Autoantibodies causing cellular-mediated autoimmune destruction of the pancreas
Islet cell autoantibodies
Insulin autoantibodies
Glutamic acid decarboxylase autoantibodies
Tyrosine phosphatase IA-2 and IA-2B autoantibodies
Zinc transporter 8 antibody
99
Signs and symptoms of Type 1 DM
Polydipsia
Polyphagia
Polyuria
Rapid weight loss
Hyperventilation
Mental confusion
Possible loss of consciousness
100
Complications of Type 1 DM
Microvascular problems
Nephropathy
Neuropathy
Retinopathy
101
Management of Type 1 DM
Administration of insulin
102
A diabetes that has no known etiology; is strongly inherited; does not have β-cells autoimmunity; requires insulin replacement
Idiopathic type 1 diabetes
103
Type 2 DM os also known as
Non-Insulin Dependent DM
Maturity Onset or Adult Type DM
Stable Diabetes
Ketosis-Resistant Diabetes
Receptor-Deficient DM
104
Diabetes that constitutes the majority of the diabetes cases
Type 2 DM
105
Diabetes that constitutes only 5% to 10% of all cases of diabetes
Type 1 DM
106
Characteristics of Type 2 DM
Adult onset
Milder symptoms than in type I
Ketoacidosis is rare
107
Abnormal lipid concentration in the blood
Dyslipidemia
108
Complications of Type 2 DM
Macrovascular Problems
Coronary artery diseases
Cardiovascular Diseases
Microvascular Problems
Nephropathy
Neuropathy
Retinopathy
109
Any degree of glucose intolerance with onset or first recognition during pregnancy
Gestational Diabetes Mellitus (GDM)
110
Risks of GDM for infants
Respiratory Distress Syndrome
Hypocalcemia
Hyperbilirubinemia
111
High glucose concentration in the infant can delay the maturation of the lungs. True or False?
True
112
Screening for GDM should be performed during
Between 24 and 28 weeks of gestation
113
A condition when there is an increased Growth Hormone production by the pituitary gland
Acromegaly
114
Growth Hormone is a hypoglycemic agent. True or False?
False; hyperglycemic agent
115
A condition when there is an increased cortisol levels in the body
Cushing Syndrome
116
Cortisol is a hyperglycemic agent. True or False?
True
117
Risk factors of Type 1 DM
Genetics
Autoimmune
Environmental
118
Risk factors of Type 2 DM
Genetic
Obesity
Sedentary lifestyle
Race/ethnicity
PCOS (Polycystic Ovarian Syndrome)
119
Conditions that can result to diabetes
Genetic defects of β-cell function
Pancreatic disease
Endocrine disease
Drug or chemical induced
Insulin receptor abnormalities
Other genetic syndromes
120
Condition that occur after the renal tubular transporter system for glucose becomes saturated
Glucosuria
121
Renal threshold for glucose
160-180mg/dL
122
Condition that causes plasma glucose concentration to reach a plateau around 300 to 500 mg/dL (17 to 28 mmol/L)
Hepatic glucose overproduction
123
Describes a potassium level in blood that's higher than normal
Hyperkalemia
124
According to the ADA recommendations all adults beginning at the age of _____ should be tested for diabetes every _____
45y/o; 3 years
125
Criteria for the diagnosis of DM
HbA1c ≥ 6.5%
FBS ≥ 126 mg/dL (≥ 7.0 mmol/L)
OGTT with a 2-hour post load (75g glucose load) level ≥ 200 mg/dL (≥ 11.1 mmol/L)
Symptoms of diabetes plus a RBS level ≥ 200 mg/dL (≥ 11.1 mmol/L)
126
All nondiabetic pregnant women should be screened for GDM at _____ weeks of gestation
24-28
127
Criteria for the diagnosis of GDM
FBS value ≥ 92 mg/dL (5.1 mmol/L)
1-hour value ≥ 180 mg/dL (10 mmol/L),
2-hour glucose value ≥ 153 mg/dL (8.5 mmol/L)
128
A hyperpigmentation condition wherein the skin in the leg, armpit, and groin areas have dark patches
Acanthosis nigricans
129
Decreased plasma glucose levels
Hypoglycemia
130
Extremely elevated insulin levels in patients with pancreatic b-cell tumors
Insulinoma
131
Diagnostic criteria for hypoglycemia
65 to 70 mg/dL (3.6 to 3.9 mmol/L) - glucagon and other glycemic factors are released
50 to 55 mg/dL (2.8 to 3.1 mmol/L) - observable symptoms of hypoglycemia appear
132
Diagnostic criteria for an insulinoma
Glucose level ≥ 25 mg/dL (1.4 mmol/L) coincident with an insulin level ≥ 6 μU/mL (41.7 pmol/L)
C-peptide levels ≥ 0.2 nmol/L
Proinsulin levels ≥ 5 pmol/L
B-hydroxybutyrate levels ≤ 2.7 mmol/L
133
Deficiency of a specific enzyme that causes an alternation of glycogen metabolism
Glycogen storage diseases
134
The most common congenital form of glycogen storage disease
Von Gierke disease
135
Correction for Von Gierke disease
Liver transplantation
136
Von Gierke disease is characterized by
Severe hypoglycemia that coincides with metabolic acidosis, ketonemia, and elevated lactate and alanine
137
GSD that does not cause hypoglycemia but does cause hepatomegaly
Glycogen debrancher enzyme deficiency
138
A cause of failure to thrive syndrome in infants, is a congenital deficiency of one of three enzymes involved in galactose metabolism, resulting in increased levels of galactose in plasma
Galactosemia
139
Correction for Galactosemia
Galactose must be removed from the diet
140
Deficient Enzyme in Galactosemia
Galactose-1-phosphate uridyltransferase (most common)
Galactokinase
Uridine diphosphate galactose-4-epimerase
141
Laboratory findings in Galactosemia
Hypoglycemia
Hyperbilirubinemia
Galactose accumulation in the blood, tissue, and urine following milk ingestion
142
Cause of essential fructosuria
Fructokinase deficiency
143
Cause of hereditary fructose intolerance
Defect in fructose-1,6-biphosphate aldolase B activity
144
Cause of fructose-1,6-biphosphatase deficiency
Defect in fructose-1,6-biphosphatase
145
Enzyme deficient in IA (Von Gierke) GSD
Glucose-6-phosphate
146
Enzyme deficient in IB GSD
Glucose-6-phosphate translocase
147
Enzyme deficient in II (Pompe) GSD
1,4-glucosidase
148
Enzyme deficient and tissue affected in IIIA (Cori Forbes) GSD
De Brancher; Liver and muscle
149
Enzyme deficient and tissue affected in IIIB GSD
De Brancher; Liver
150
Enzyme deficient in IV (Andersen) GSD
Amylopectinase/Glycogen branching enzyme
151
Enzyme deficient in V (Mc Ardle) GSD
Muscle phosphorylase
152
Enzyme deficient in VI (Hers) GSD
Liver phosphorylase
153
Enzyme deficient in VII (Tarui) GSD
Phosphofructokinase
154
Enzyme deficient in VIII GSD
Adenyl kinase
155
Enzyme deficient an tissue affected in IXA GSD
Phosphorylase kinase; Liver
156
Enzyme deficient in IXB GSD
Phosphorylase; Liver and muscle
157
Enzyme deficient in X GSD
Cyclic AMP-dependent kinase
158
Enzyme deficient in XI (Fanconi Bickel) GSD
Glycogen transporter-2
159
Enzyme deficient in 0 GSD
Glycogen synthase
160
Specimens used to measure glucose
Whole blood
Serum
Plasma
CSF
Pleural fluid
Urine
161
The glucose concentration in whole blood is approximately _____ lower than the glucose concentration in plasma
11%
162
Serum or plasma must be refrigerated and separated from the cells within
1 hour
163
Often used as an anticoagulant and preservative of whole blood for glucose determination
Sodium fluoride ions (gray-top tubes)
164
Fasting plasma glucose values have a diurnal variation. True or False?
True
165
Most commonly used specimen for glucose determination
Serum and plasma
166
POCT device for glucose determination
Glucometer
167
Conversion factor for glucose
0.0555
168
The most common methods of glucose analysis use the enzyme
Glucose oxidase or hexokinase
169
The most specific enzyme reacting with only b-d-glucose
Glucose oxidase
170
Glucose oxidase converts b-d glucose to
Gluconic acid
171
Reference method for glucose
Hexokinase method
172
Screening test for DM
FBS/FBG
173
Normal fasting glucose
70-99 mg/dL (3.9-5.5 mmol/L)
174
Impaired fasting glucose
100-125 mg/dL (5.6-6.9 mmol/L)
175
Provisional diabetes diagnosis
≥126 mg/dL (≥7.0 mmol/L)
176
Individual with impaired fasting glucose are under
Prediabetic state
177
Glucose testing that can be done anytime
RBS
178
Glucose testing that is done 2 hours after eating
2-hour PPBS
179
Most common test under GTT
Oral glucose tolerance test
180
Glucose tolerance test for patients with malabsorption syndrome
Intravenous glucose tolerance test (IVGTT)
181
In performing OGTT, the patient should be _____
Ambulatory
182
In OGTT, what should we do if FBG is >140mg/dL
Test should be terminated
183
In OGTT, what should we do if FBG is <140mg/dL
Glucose load should be given to the patient
184
The glucose load for adult is
75 g
185
The glucose load for children is
1.75g/kg body weight (up to a 75 g maximum is given)
186
The glucose should be dissolved in _____ of water, and ingested within _____
300 mL; 5 minutes
187
In OGTT, what should we do if the patient vomits?
Discontinue the test
188
Fasting for OGTT
8-10 hrs, not >16hrs
189
When (time) to perform OGTT?
Morning 7AM-9AM
190
In OGTT, patient is asked to consume _____ CHO per day for _____ prior to the test
150g; 3 days
191
Samples collected in pregnant women during OGTT
Fasting plasma glucose sample
1 hour sample
2 hours sample
192
Samples collected in non-pregnant patient during OGTT
Fasting sample
2 hours OGTT
193
Normal glucose tolerance
Two-hour PG ≤140 mg/dL (≤7.8 mmol/L)
194
Impaired glucose tolerance
Two-hour PG 140-199 mg/dL (7.8-11.1 mmol/L)
195
Provisional diabetes diagnosis (OGTT)
Two-hour PG ≥ 200 mg/dL (≥11.1 mmol/L)a
196
Individuals with impaired glucose tolerance are at risk of having
Diabetes (pre-diabetic state)
197
Is the term used to describe the formation of a hemoglobin compound produced when glucose reacts with the amino group of hemoglobin
Glycosylated hemoglobin/HbA1c
198
A more reliable method of monitoring long-term diabetes control over the previous 2-3 month period
HbA1c
199
Specimen for HbA1c
Whole blood in EDTA
200
For every 1% increase in HbA1c, there is a _____ change in plasma glucose
35 mg/dL (2 mmol/L)
201
Normal HbA1c value
4%-6%
202
Relationship between HbA1c formation and plasma glucose concentration
Directly proportional
203
Two factors determine the glycosylated hemoglobin levels
The average glucose concentration
Red blood cell life span
204
HbA1c result that indicates increased risk for diabetes
5.7%-6.4%
205
HbA1c result that indicates diabetes
≥ 6.5%
206
HbA1c goal for nonpregnant adults in general is
<7%
207
Preferred method of HbA1c measurement
Affinity chromatography
208
HbA1c measurement method that is temperature dependent and affected by hemoglobinopathies
Cation exchange chromatography
209
In cation exchange chromatography, the presence of HbF yields
False increased levels
210
In cation exchange chromatography, the presence of HbS yields
False decreased levels
211
In cation exchange chromatography, the presence of HbC yields
False decreased levels
212
A common point-of-care instrument HbA1c assay is based on a
Latex immunoagglutination inhibition methodology
213
Methods used to separate the various forms of hemoglobin
High-performance liquid chromatography (HPLC)
Electrophoresis
214
Fructosamine is also known as
Glycosylated albumin
Glycated albumin
Plasma protein ketoamine
215
Clinical use of fructosamine
Used for monitoring glucose control over the previous 3-6 weeks
216
Reference value for fructosamine
205-285 μmol/L
217
Chemical methods for glucose determination
Oxidation reduction method
Condensation method
218
Principle of Alkaline Copper Reduction Method
Reduction of cupric ions to cuprous ions forming cuprous oxide in hot alkaline solution by glucose
219
Substrate of Folin Wu Method
Cuprous ions + Phosphomolybdate
220
Product of Folin Wu Method
Phosphomolybdic Acid or Phosphomolybdenum Blue
221
Substrate of Nelson Somogyi Method
Cuprous ions + Arsenomolybdate
222
Product of Nelson Somogyi Method
Arsenomolybdic Acid or Arsenomolybdenum Blue
223
Substrate of Neocuprein Method
Cuprous ions + Neocuprein
224
Product of Neocuprein Method
Cuprous-Neocuprein Complex
(Yellow or Yellow Orange)
225
Reagent of Neocuprein Method
2,9-Dimethy-1,10-Phenantroline Hydrochloride
226
It is used for the detection and quantitation of reducing substances in body fluids like body and urine
Benedict’s Method (Modification of Folin Wu)
227
Stabilizing agent for Benedict’s Method
Citrate or tartrate
228
Substrate of Benedict’s Method
Copper Sulfate (blue) + glucose + heat
229
Product of Benedict’s Method
Brick red precipitate
230
Process of Alkaline Ferric Reduction Method (Hagedorn Jensen)
Reduction of a yellow ferricyanide to a colorless ferrocyanide by glucose
231
Principle of Alkaline Ferric Reduction Method (Hagedorn Jensen)
Inverse Colorimetry
232
Result of Alkaline Ferric Reduction Method when using Colorimetry
Colored complex
233
Result of Alkaline Ferric Reduction Method when using Inverse Colorimetry
Colorless ferrocyanide
234
Substrates of Ortho-toluidine (Dubowski Method)
Glucose + Aromatic Amines
235
Products of Ortho-toluidine (Dubowski Method)
Glycosylamine + Schiff’s base (green-colored end product)
236
Enzymatic methods for glucose determination
Glucose dehydrogenase method
Glucose oxidase method
Hexokinase method
237
Most specific enzyme in glucose determination
Hexokinase
238
Enzymes used in glucose dehydrogenase method
Mutarotase: to produce B-D glucose
Glucose dehydrogenase: to produce reduced form of NAD (NADH)
Diaphorase: to see colored end product (blue)
239
In Glucose dehydrogenase method, what is the relationship between NADH and the amount of glucose in the sample?
Directly proportional
240
Colorimetric Glucose Oxidase Method is also known as
Saifer Gernstenfield Method
241
Chromogens in Colorimetric Glucose Oxidase Method
3-methyl-2-benzothiazolinone hydrazone
N, N-dimethylaniline
242
Coupling enzyme under the colorimetric glucose oxidase method
Peroxidase
243
Interference in the colorimetric glucose oxidase method
Falsely decreased values: increased levels of uric acid, bilirubin, and ascorbic acid
Falsely increased values: bleach
244
Measures the rate of oxygen consumption which is proportional to glucose concentration
Polarographic Glucose Oxidase Method
245
Coupling enzymes under the polarographic glucose oxidase method
Catalase
Molybdate
246
Maximum absorption peak of NADPH
340 nm (wavelength)
247
Coupling enzyme under the Hexokinase method
G-6-PD
248
Produced by the liver through metabolism of fatty acids
Ketones
249
Ketones are produced when _____
The body detects a decrease in blood glucose
250
Types of Ketones
Acetone
Acetoacetic acid
3-β-hydroxybutyric acid
251
Most abundant form of ketones
3-β-hydroxybutyric acid (78%)
Acetone (2%)
Acetoacetic acid (20%)
252
Specimen used for ketone measurements
Fresh serum or urine
253
Elevated ketone levels are seen in
DM
Starvation/fasting
High-fat diets
Prolonged vomiting
GSD
254
Accumulation of ketones in blood
Ketonemia
255
Accumulation of ketones in urine
Ketonuria
256
Different tests for ketones
Gerhardt’s test
Sodium nitroprusside test
Enzymatic test
257
Principle of Gerhardt’s test
Ferric chloride reacts with acetoacetic acid to produce a red color
258
Principle of Sodium nitroprusside test
Sodium nitroprusside reacts with acetoacetic acid to produce a purple color
259
Enzymatic test for ketones
Uses 3-hydroxybutyrate dehydrogenase to detect 3-β-hydroxybutyric acid or acetoacetic acid
260
Defined as persistent albuminuria in two out of three urine collections of 30 to 300 mg/24 h, 20 to 200 μg/min, or an albumin–creatinine ratio of 30 to 300 μg/mg creatinine
Microalbuminuria
261
Clinical significance of microalbumin measurements
Useful to assist in diagnosis at an early stage and before the development of proteinuria
262
Clinical proteinuria or macroalbuminuria is established with an albumin–creatinine ratio
≥300 mg/24 h
>200 μg/min
≥300 μg/mg
263
Methods of Specimen Collection for microalbumin
Random spot collection for albumin-creatinine ratio
24-hour collection
Timed 4-hour overnight collection
264
Preferred method for microalbumin measurement
Random spot collection for albumin-creatinine ratio
265
Patient is determined to have microalbuminuria when
Two of three specimens collected within a 3- to 6-month period are abnormal
266
Factors that may elevate the urinary excretion of albumin
Exercise within 24 hours
Infection
Fever
Congestive heart failure
Marked hyperglycemia
Marked hypertension
267
The presence of autoantibodies to the b-islet cells of the pancreas is characteristic of
Type 1 diabetes
268
A slower autoimmune β-cell destruction that can occur in adults
Latent Autoimmune Diabetes of Adulthood (LADA) / Type 1a
269
Lab Findings in Hyperglycemia:
Decreased or absent insulin
Increased glucose in plasma and urine
Increased urine specific gravity
Ketones in serum and urine
Decreased blood and urine pH (acidosis)
Electrolyte imbalance
270
Diabetes testing recommended by ADA
Hemoglobin A1c (HbA1c),
Fasting plasma glucose
2-hour 75 g OGTT
271
Criteria for the testing and diagnosis of GDM: (NEW)
Fasting: > 95 mg/dL (5.3 mmol/L)
1-hour plasma glucose: ≥ 180 mg/dL (10.0 mmol/L)
2-hour plasma glucose: ≥ 155 mg/dL (8.6 mmol/L)
3-hour plasma glucose: ≥ 140 mg/dL (7.8 mmol/L)
272
Classification of hypoglycemia
Postabsorptive (fasting)
Postprandial (reactive)
273
Whipple triad
Hypoglycemic symptoms
Plasma glucose is low (< 50 mg/dL)
Symptoms are relieved by administration of glucose or glucagon
274
Symptoms of hypoglycemia
Increased hunger
Sweating
Nausea and vomiting
Dizziness
Nervousness and shaking,
Blurring of sight,
Mental confusion
275
Glucose is metabolized at room temperature at a rate of _____; at 4°C, glucose decreases by approximately _____
7 mg/dL/hour
2 mg/dL/hour
