GESTATIONAL DIABETES MELLITUS

Question 1

– pregnancy-related hyoerglycemia

Answer 1

HUMAN PLACENTAL LACTOGEN

Question 2

– similar to action of GH (inhibits insulin)

Answer 2

HUMAN CHORIONIC SOMAMOTROPIN

Question 3

Glucose intolerance which develops in [?] of pregnancies

Answer 3

7%

Question 4

Abnormal glucose concentration discovered for the 1st time during pregnancy

Answer 4

GESTATIONAL DIABETES MELLITUS

Question 5

ONE-STEP STRATEGY

Answer 5

2011 Standards of Care – ADA

Question 6

TWO-STEP STRATEGY

Answer 6

2013 – NIH

Question 7

24 to 28 weeks of gestation

Answer 7

ONE-STEP STRATEGY
TWO-STEP STRATEGY

Question 8

Step 1: Perform a 75-g OGTT (fasting, 1H, and 2H BGL)

Answer 8

ONE-STEP STRATEGY

Question 9

Step 1: Perform a 50-g GLT (non-fasting)

Answer 9

TWO-STEP STRATEGY

Question 10

1H PG measurements

Answer 10

TWO-STEP STRATEGY

Question 11

If the 1H PG is [?], or [?], proceed to a [?]

Answer 11

> or = to 130 mg/dL
140 mg/dL
100-g OGTT

Question 12

Step 2: The 100-g OGTT should be performed when the patient is fasting

Answer 12

TWO-STEP STRATEGY

Question 13

ONE-STEP STRATEGY

Diagnosis of GDM is made when any or the PG values are = or > than any of the ff PG levels:

Fasting:

Answer 13

92 mg/dL (5.1 mmol/L)

Question 14

ONE-STEP STRATEGY

Diagnosis of GDM is made when any or the PG values are = or > than any of the ff PG levels:

1 h:

Answer 14

180 mg/dL (10.0 mmol/L)

Question 15

ONE-STEP STRATEGY

Diagnosis of GDM is made when any or the PG values are = or > than any of the ff PG levels:

2 h:

Answer 15

153 mg/dL (8.5 mmol/L)

Question 16

TWO-STEP STRATEGY

Diagnosis of GDM is made if at least two values are = to or > than any of the ff PG levels:

Fasting:

Answer 16

105 mg/dL

Question 17

TWO-STEP STRATEGY

Diagnosis of GDM is made if at least two values are = to or > than any of the ff PG levels:

1 h:

Answer 17

190 mg/dL

Question 18

TWO-STEP STRATEGY

Diagnosis of GDM is made if at least two values are = to or > than any of the ff PG levels:

2 h:

Answer 18

165 mg/dL

Question 19

TWO-STEP STRATEGY

Diagnosis of GDM is made if at least two values are = to or > than any of the ff PG levels:

3 h:

Answer 19

145 mg/dL

Question 20

Results from an imbalance between glucose utilization and production

Answer 20

HYPOGLYCEMIA

Question 21

Observable symptoms appear at about

Answer 21

50 to 55 mg/dL

Question 22

ADRENALINE

Answer 22

EPINEPHRINE

Question 23

 Triggered by the ANS

Answer 23

NEUROGENIC/ADRENERGIC

Question 24

 Tremulousness, palpitations, anxiety

Answer 24

NEUROGENIC/ADRENERGIC

Question 25

 Diaphoresis (cold sweat)

Answer 25

NEUROGENIC/ADRENERGIC

Question 26

 Hunger

Answer 26

NEUROGENIC/ADRENERGIC

Question 27

 Paresthesias (numbness)

Answer 27

NEUROGENIC/ADRENERGIC

Question 28

 CNS hypoglycemia

Answer 28

NEUROGLYCOPENIC

Question 29

 Dizziness, tingling, difficulty in concentrating, blurred vision

Answer 29

NEUROGLYCOPENIC

Question 30

 Confusion, behavioral changes, seizure, coma

Answer 30

NEUROGLYCOPENIC

Question 31

aka fast Hgb, glycosylated Hgb

Answer 31

Glycohemoglobin

Question 32

– major fraction; predominant form

Answer 32

HbA1c

Question 33

Non-enzymatic condensation between glucose and the N-terminal valine of each B-chain

Answer 33

HbA1c

Question 34

Occurs over the lifespan of the RBC (90 to 120 days)

Answer 34

HbA1c

Question 35

[?] -------- [N-terminal of B]

Answer 35

Glucose + Valine

Question 36

[?] (unstable aldimine) -------- [Amadori rearrangement]

Answer 36

SCHIFF BASE

Question 37

(stable)

Answer 37

KETOAMINE

Question 38

GHb testing provides an index of ave. BGL over the

Answer 38

past 2-4 months

Question 39

Values for [?] have a high degree of correlation

Answer 39

total HbA1 & HbA1c

Question 40

Labile fraction (Schiff base or pre-A1c): accounts for [?] of total HbA1

Answer 40

5 to 8%

Question 41

GHb testing Advantages: 1. Provides objective means of 2. Additional confirmation of the

Answer 41

reflecting control of DM clinical impression of control

Question 42

 Cation-exchange resin or carboxymethyl cellulose resin

Answer 42

ION-EXCHANGE CHROMATOGRAPHY

Question 43

 HbA1 elutes from the column first

Answer 43

ION-EXCHANGE CHROMATOGRAPHY

Question 44

 False elevation: labile fractions, HbF

Answer 44

ION-EXCHANGE CHROMATOGRAPHY

Question 45

 Low values: Hb variants

Answer 45

ION-EXCHANGE CHROMATOGRAPHY

Question 46

 Reference method

Answer 46

HPLC

Question 47

 Separates and quantifies HbA1c and other haemoglobin types

Answer 47

HPLC

Question 48

 Hb A1c --- acid --- 5-HMF

Answer 48

COLORIMETRY

Question 49

 Specific for ketoaminelinked

Answer 49

COLORIMETRY

Question 50

 Unaffected by HbF, Hb variants and labile intermediate

Answer 50

COLORIMETRY

Question 51

 Routine

Answer 51

COLORIMETRY

Question 52

 Antibodies against Hb A1c (sheep antiserum)

Answer 52

RADIOIMMUNOASSAY (RIA)

Question 53

 Partial cross-reactivity w/ HbA1c

Answer 53

RADIOIMMUNOASSAY (RIA)

Question 54

 Antiserum not commercially available

Answer 54

RADIOIMMUNOASSAY (RIA)

Question 55

Citrate agar electrophoresis (pH 6.0-6.2) - Buffer:

Answer 55

Citrate agar buffer (acidic)

Question 56

Citrate agar electrophoresis (pH 6.0-6.2) - Solid support:

Answer 56

agarose gel

Question 57

HbF migrates to the same region as HbA1

Answer 57

Citrate agar electrophoresis

Question 58

Cellulose acetate electrophoresis (pH 8.0) - Buffer:

Answer 58

Tris EDTA boric acid (alkaline)

Question 59

Cellulose acetate electrophoresis (pH 8.0) - Solid support:

Answer 59

cellulose acetate

Question 60

 Good resolution of Hb A & Hb A1

Answer 60

ELECTROPHORESIS

Question 61

 No interference from Hb variants

Answer 61

ELECTROPHORESIS

Question 62

 HbF migrates to the same region as HbA1

Answer 62

ELECTROPHORESIS

Question 63

 Scanned on high-resolution microdensitometer

Answer 63

ISOELECTRIC FOCUSING

Question 64

 Hb A1c is adequately resolved from HbA1a, A1b, S and F

Answer 64

ISOELECTRIC FOCUSING

Question 65

ISOELECTRIC FOCUSING MEDIUM

Answer 65

Polyacrylamide gel

Question 66

 Use of affinity gel columns

Answer 66

AFFINITY CHROMATOGRAPHY

Question 67

AFFINITY CHROMATOGRAPHY ADVANTAGES:

Answer 67

o No interference from non-glycosylated Hb o Negligible interference from the labile intermediate o Minimal dependence on variations in ambient T

Question 68

Total Hb A1 MEAN %

Answer 68

6.5

Question 69

Total Hb A1 RANGE

Answer 69

5.0 – 8.0

Question 70

Hb A1c only RANGE

Answer 70

3.0 – 6.0

Question 71

Hb A1c only MEAN %

Answer 71

4.5

Question 72

HbA1c (%) = Approximate Plasma Glucose mg/dL Mmol/L

Question 73

For patients with inaccurate HbA1c assays (hemglobinopathies and hemolytic anemias)

Answer 73

o Affinity chromatography o Immunoassays

Question 74

Turnover time of serum proteins: (primary albumin) 14 to 20 days

Answer 74

o Reflects glycemic control over narrower period of time

Question 75

Most widely used to assess short-term (3 to 6 week) glycemic control

Answer 75

FRUCTOSAMINE ASSAYS

Question 76

FRUCTOSAMINE ASSAYS ADVANTAGE:

Answer 76

Use of serum samples and automated equipment (simple to perform and low in cost)

Question 77

More reliable than other glycosylated protein assays

Answer 77

FRUCTOSAMINE ASSAYS