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From Flashcardlet > Clinical Lab Med 6 - Diabetes > Flashcards

Clinical Lab Med 6 - Diabetes Flashcards

1
Q

How many Americans have diabetes?

A

29.1 million Americans, or 9.3% of the population

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2
Q

Diabetes is the –th leading cause of death in the US?

A

7th

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3
Q

What is the dominant fuel of cellular energy?

A

Blood glucose

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4
Q

What organ is completely dependent on glucose?

A

Brain cannot get energy from another other source besides glucose

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5
Q

What are the cells that are the primary regulators of blood glucose?

A

Islets of Langerhans

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6
Q

Where are the islets of Langerhans located?

A

Pancreas

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7
Q

What are the three islets of Langerhans cell types?

A

Alpha, beta, delta

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8
Q

What are alpha cells?

A

Secrete glucagon

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9
Q

What percentage of islets cells are alpha?

A

25%

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10
Q

What are beta cells?

A

Source of hormone insulin

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11
Q

What percentage of islets cells are beta?

A

70%

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12
Q

What are delta cells?

A

Responsible for secreting somatostatin

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13
Q

What percentage of islets cells are delta?

A

5%

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14
Q

What three hormones closely regulate blood glucose?

A

Glucagon, insulin, somatostatin

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15
Q

When is insulin secreted?

A

Secreted into blood when glucose is absorbed in the intestine and available for cell use

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16
Q

What causes beta cells to secrete insulin?

A

Beta cells are sensitive to glucose levels and alter insulin secretion in direct response to its presence

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17
Q

When is glucagon secreted?

A

When blood glucose levels decrease

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18
Q

What is the relationship of glucagon and insulin?

A

Have opposite effects

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19
Q

What does glucagon do?

A

When glucose levels decrease, alpha cells secrete glucagon to take glucose out of storage and put it into circulation

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20
Q

What does secretion of insulin stimulate?

A

Cell uptake, utilization, and storage of glucose

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21
Q

What effect does insulin have on the liver?

A

Stimulates glycogenesis

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22
Q

What is glycogenesis?

A

When ample mounts of glucose is available, higher insulin levels promote the formation of glycogen as a means of storing glucose for later use

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23
Q

What is glycogen synthesized from?

A

Free fatty acids from glucose enter the blood and are carried to adipose tissue for storage

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24
Q

What two metabolic pathways are activated when insulin levels fall?

A
  • Glycogenolysis

- Gluconeogenesis

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25
Q

What is glycogenolysis?

A

Glucose is produced from the breakdown of glycogen - Fatty acids on glycogen in the adipose tissue are removed and the glucose is put into circulation

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26
Q

What is gluconeogenesis?

A

The liver makes glucose

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27
Q

What is the most common endocrine disorder?

A

Diabetes mellitus

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28
Q

What are some results from diabetes that affect other body systems?

A
  • Neuropathy
  • Nephropathy
  • Retinopathy
  • CAD and increased risk for heart attack and stroke
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29
Q

What is the key component in type I diabetes?

A

Beta cell destruction

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30
Q

What is the etiology in type I?

A

Autoimmune

Could be familial, viral, or inflammatory

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31
Q

How is type I diabetes autoimmune?

A

Antibodies against the pancreas attack beta cells, and beta cells can’t produce insulin

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32
Q

Why is hyperglycemia present in type I?

A

Beta cells can’t make insulin so glucose is not taken into cells

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33
Q

Why is glycosuria present in type I?

A

Glomerulus is unable to filter elevated amounts of glucose in the blood, so the sugar is excreted in urine

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34
Q

Why does the liver exacerbate the problems of type I diabetes?

A

Low insulin levels from damaged beta cells activate two pathways in the liver which cause the production of more sugar.
Insulin is still not produced so this sugar is never taken into the cells and hyperglycemia worsens

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35
Q

What kind of metabolism does low insulin levels stimulate, and what does this result in?

A

Lipid metabolism, causing hyperlipidemia

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36
Q

What other substance is stimulated to be produced in the liver due to low insulin levels?

A

Cholesterol

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37
Q

What is the feedback mechanism in the liver triggered by?

A

Insulin levels, NOT sugar levels

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38
Q

What is the pathogenesis of type II diabetes?

A

There is a loss of target tissue insulin receptors and flawed response to binding of the receptors

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39
Q

What happens to beta cells in type II?

A

Beta cells are normal

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40
Q

What happens to insulin levels in type II?

A

Insulin levels are normal or elevated

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41
Q

What can cause damage to insulin receptors?

A

High caloric diet causes less receptors for insulin

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42
Q

What can help rebuild insulin receptors?

A

Weight loss causes development of more receptors

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43
Q

What causes hyperglycemia in type II?

A

Target tissue insensitivity

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44
Q

What happens to glucose and insulin in the blood in type II?

A

They remain in the circulation because they can’t enter the cells due to lack of receptors

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45
Q

What happens to insulin levels in type II in the beginning and end stages of the disease?

A

At first, lots of insulin is produced because they body has lots of glucose
Beta cells work too hard for too long pumping out insulin, and eventually die out, so insulin levels are low in progressed stages of type II

46
Q

What does the liver do in progressed stages of type II diabetes?

A

Liver increases glucose production due to decreased levels of insulin, worsening the condition

47
Q

What are the signs and symptoms of type I diabetes?

A
  • 3 Ps - polyuria, polydipsia, polyphagia
  • Blurred vision
  • Numbness/tingling
  • Weakness/fatigue
  • Non healing wounds
48
Q

What are the signs and symptoms of type II diabetes?

A

Rarely symptomatic, only symptomatic in later stages of the disease

49
Q

How do we diagnose type II if patients are asymptomatic?

A

We look for type II patients - when patients are already overweight, have family history, sedentary lifestyle, CAD, HTN, high cholesterol, etc. we investigate to see if they also have type II diabetes

50
Q

What percentage of diabetes instances are type II?

A

90%

51
Q

What fraction of type I patients have a family history?

A

less than 1/5

52
Q

What fraction of type II patients have a family history?

A

greater than 1/2

53
Q

What is the age of onset in type I?

A

Less than 20

54
Q

What is the age of onset in type II?

A

Greater than 40, but much younger now

55
Q

What is the physique of type I patients?

A

Wasted

56
Q

What is the physique of type II patients?

A

Obese

57
Q

What is the clinical course of type I?

A

Acute, rapid

58
Q

What is the clinical course of type II?

A

Delayed, gradual

59
Q

What is the plasma insulin level of type I?

A

Low or absent

60
Q

What is the plasma insulin level of type II?

A

Normal or elevated

61
Q

What is the treatment and therapy for type I?

A

Insulin, diet

62
Q

What is the treatment and therapy for type II?

A

Diet and exercise, oral meds, eventually insulin

63
Q

How do we measure glucose in the lab?

A

Glucose oxidase in test strips

64
Q

How do we measure glucose in the urine?

A

Measure amounts of ketones or sugar in the urine

65
Q

What are some errors that present when measuring glucose levels?

A

When test strips are exposed to the air, causes falsely low results
Blood specimens with elevated WMC counts and high temperatures cause low results

66
Q

What is a normal fasting glucose?

A

60-99

67
Q

What is a normal bedtime glucose?

A

100-140

68
Q

What is a normal HbA1c?

A

Above 6.0

69
Q

What is the criteria for diagnosis of diabetes using random glucose tests?

A

Above 200 and signs and symtpoms

70
Q

What is the criteria for diagnosis of diabetes using fasting glucose?

A

Greater than 126 on two occasions

71
Q

What is the criteria for diagnosis of diabetes using a glucose tolerance test?

A

Greater than 200 on two occasions

72
Q

What is the criteria for diagnosis of diabetes using HbA1c?

A

Greater than 6.5

73
Q

When do we typically use glucose tolerance tests?

A

Gestational diabetes

74
Q

What levels of fasting glucose indicate pre diabetes?

A

100-125

75
Q

What are two other names for HbA1c?

A

Glycated hemoglobin

Glycosylated hemoglobin

76
Q

What does HbA1c indicate?

A

Glucose control over the last three months

77
Q

How is HbA1c formed?

A

When glucose in the blood binds irreversibly to hemoglobin to form a stable glycated hemoglobin complex

78
Q

What is HbA1c directly proportional to?

A

The concentration of glucose in the blood over the full lifespan on the RBC

79
Q

At what mean blood glucose level does the HbA1c hit 6?

A

124

80
Q

What are four instances when insulin levels are ordered?

A
  • Diagnose insulinoma
  • Diagnose hypoglycemia
  • Identify insulin resistance
  • Determine if type II needs additional treatment with insulin or oral meds
81
Q

What is an insulinoma?

A

Tumor on the pancreas that secretes insulin

82
Q

In what conditions does a patient present with elevated insulin levels?

A
  • Acromegaly
  • Cushings syndrome
  • Medications - cortiosteroids, OCP
  • Fructose/lactose intolerance
  • Obesity
  • Insulinoma
  • Insulin resistance
83
Q

In what conditions does a patient present with decreased insulin levels?

A
  • Diabetes
  • Hypopituiarism
  • Pancreatic cancer
  • Chronic pancreatitis
84
Q

What is C peptide?

A

Insulin is synthesized initially in the form of proinsulin

Proinsulin is linked to alpha and beta cells by C peptide

85
Q

For every C peptide there is one molecule of what?

A

Insulin

86
Q

What is C peptide a good indication of?

A

Levels can indicate whether or not a person is producing insulin and roughly how much

87
Q

What is C peptide a good measurement of?

A

Prediabetes - how close the person is to being diabetic

88
Q

What is the level of C peptide in pre diabetes and why?

A

C peptide is increased because the body wants to make more insulin because cells aren’t getting enough sugar

89
Q

What can C peptide be used to differentiate?

A

Can be used to help asses if high blood glucose is due to deuced insulin production or to reduced glucose intake by the cells

90
Q

What is C peptide a marker of?

A

Insulin production

91
Q

Why don’t we just use insulin levels to measure insulin production, rather than C peptide?

A

If patients develop antibodies to insulin, insulin levels cannot be accurately measured by C peptide can be

92
Q

When is C peptide ordered?

A
  • Newly diagnosed type I to evaluate if there is any residual insulin
  • Type II where insulin is being considered as a treatment
  • Recurring low blood sugar
  • Monitoring insulinoma
  • Prediabetic (sometimes, because C peptide could be normal in early stages of diabetes)
93
Q

What glucose tolerance test do we use to check for type II diabetes in those who are not pregnant?

A

75 gram oral GTT

94
Q

What should the fasting glucose be of a 75 gram oral GTT?

A

60-100

95
Q

What should the glucose be after an hour of a 75 gram oral GTT?

A

less than 200

96
Q

What should the glucose be after two hours of a 75 gram oral GTT?

A

less than 140

97
Q

When do we diagnose type II diabetes with a GTT?

A

If after an hour their glucose level is above 200

98
Q

What is gestational diabetes?

A

Hyperglycemia devleoping durin gpregnancy and resolving after delivery

99
Q

When is gestational diabetes tested for?

A

24 weeks

100
Q

What glucose tolerance test do we use for gestational diabetes?

A

50 grams, test after an hour

101
Q

What test do we use if the first GTT for gestational diabetes is abnormal?

A

Proceed to three hour GTT

102
Q

What is the major concern with gestational diabetes?

A

Glucose crosses the placenta to the baby, so the baby is making insulin in response to that demand. When the baby is delivered, it still is making a lot of insulin and its sugar level plummets

103
Q

What are some other risks with gestational diabetes?

A
  • Baby is very large - not enough amniotic fluid to protect it
  • Baby is at risk for diabetes
104
Q

What should the glucose be after an hour of a 50 gram oral GTT?

A

less than 135

105
Q

What is secondary diabetes?

A

Hyperglycemia due to other conditions

106
Q

What are some conditions that cause secondary diabetes?

A
  • Cushing’s syndrome
  • Acromegaly
  • Hyperthyroidism
  • Medications
  • Pancreatic destruction
107
Q

What is the most common cause of hypoglycemia?

A

Overtreatment of diabetes mellitus

108
Q

What are some signs and symptoms of hypoglycemia?

A
  • Wekness
  • Drowsiness
  • Confusion
  • Hunger
  • Heache
  • Trembling
  • Cold
  • Clammy and sweating
109
Q

When does hypoglycemia present in diabetic patients?

A
  • Taking too much medication
  • Missing or delaying a meal
  • Eating to little food for the amount of insulin taken
  • Drinking too much alcohol
110
Q

Why does drinking alcohol cause hypoglycemia?

A

The liver is busy working on removing alcohol from the blood ins tread of regulating blood glucose

111
Q

What are the criteria for diagnosing hypoglycemia?

A
  • Complaints of symptoms
  • Relief of symptoms after ingestion of sugar
  • BG less than 45 in women and 55 in men while symptoms are present

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