Glucose and Diabetes

Question 1

Fasting glucose serum/plasma reference range

Answer 1

3.3-6.0 mmol/L

Question 2

Random glucose serum/plasma reference range

Answer 2

3.3-11.1 mmol/L

Question 3

OGTT serum/plasma fasting reference range

Answer 3

2.2-6.0 mmol/L

Question 4

OGTT serum/plasma 2hr reference range

Answer 4

</= 7.8 mmol/L

Question 5

CSF glucose reference range

Answer 5

2.2-4.4 mmol/L

Question 6

HbA1C reference range

Answer 6

4.3-6.1%

Question 7

Lactic acid reference range

Answer 7

0.5-2.2 mmol/L
critical: >4.0 mmol/L

Question 8

What is hypoglycemia

Answer 8

abnormally low blood glucose concentration

Question 9

When is hypoglycemia most often seen

Answer 9

in patients with diabetes who are being treated with hypoglycemic drugs (insulin)

Question 10

What is fasting hypoglycemia associated with

Answer 10

ethanol and salicylates

Question 11

What is postprandial hypoglycemia associated with

Answer 11

insulin, antibodies to insulin or insulin receptors and inborn errors of metabolism

Question 12

When is a hypoglycemia diagnosis made

Answer 12

when the criteria of the Whipple Triad is met

• symptoms are known or likely to be caused by hypoglycemia
• blood glucose is low when the symptoms occur
• symptoms are relieved by administration of glucose

Question 13

What is hyperglycemia

Answer 13

abnormally high blood pressure caused by hormonal imbalance

Question 14

What is diabetes mellitus

Answer 14

a group of disorders characterized by underutilization of glucose as an energy store causing hyperglycemia

Question 15

What is type 1 diabetes mellitus

Answer 15

insulin-dependent diabetes

the insulin producing cells of the pancreas are destroyed by the hosts immune system, usually develops in children or teens

prone to ketosis

Question 16

What is the treatment for type 1 diabetes mellitus

Answer 16

insulin and meal planning

islet cell, pancreas, kidney transplants

Question 17

What is type 2 diabetes mellitus

Answer 17

the result of insulin resistance with or without defective secretion of insulin

normal levels of blood insulin are seen but the action of the insulin cells is defective, most common in adults

Question 18

What is the treatment for type 2 diabetes mellitus

Answer 18

lifestyle modifications such as diet and exercise or medications such as insulin

Question 19

What is gestational diabetes

Answer 19

a temporary condition characterized by glucose intolerance that begins or is first recognized during pregnancy

usually asymptomatic but is associated with increased morbidity and mortality as well as mother and child are at increased risk of developing diabetes

Question 20

What is prediabetes

Answer 20

individuals at high risk of developing type 2 diabetes and its complications

usually have abnormal fasting glucose, OGTT or HbA1C results but do not meet the criteria for diagnosis yet

Question 21

What is metabolic syndrome

Answer 21

individuals with type 2 diabetes and prediabetes can also present with additional symptoms of abdominal obesity, hypertension, dyslipidemia and elevated blood glucose

Question 22

What are complications of diabetes

Answer 22

retinopathy, neuropathy, angiopathy, nephropathy, infection, dyslipidemia and atherosclerosis

Question 23

When should patients start being screened for diabetes

Answer 23

around 40 years of age or older, every 3 years using fasting glucose or HbA1C

Question 24

What is the diagnosis criteria for diabetes

Answer 24

fasting blood glucose >7.0 mmol/L, OGTT >/= 11.1 mmol/L or Hba1C >6.5%

Question 25

What is the OGTT

Answer 25

a test to evaluate glucose clearance after loading with a defined dose under controlled conditions

Question 26

What is the procedure of the OGTT

Answer 26

ingest a minimum of 150g carbs per day for three days leading up to the procedure the patient then fasts for 10-16 hours the test should be performed between 7 and 9 am a fasting specimen is drawn and then the patient drinks a 75g glucose drink within 5 minutes a second draw is done after 2 hours

Question 27

What are variables that affect the glucose tolerance

Answer 27

illness, oral contraceptives, thiazide, corticoid steroids, length of fast, age, activity, weight, smoking, caffeine, anxiety, stress, posture

Question 28

What is the preferred specimen for blood glucose

Answer 28

serum or plasma immediately separated stable for 8 hours at RT leukocyte and bacterial contamination can falsely decrease 24 hour urine samples should be collected in containers with 5mL glacial acetic acid

Question 29

What is the hexokinase method of glucose testing used for

Answer 29

blood, urine and CSF

Question 30

What are interferences in the hexokinase method of glucose testing

Answer 30

hemolysis, icterus and lipemia

Question 31

What is the glucose oxidase method of glucose testing used for

Answer 31

blood and CSF

Question 32

What are the interferences in the glucose oxidase method of glucose testing

Answer 32

hemoglobin, bilirubin, ascorbic acid and uric acid

Question 33

When does glucose appear in the urine

Answer 33

when the blood levels exceed the renal threshold of 11.0 mmol/L commonly associated with uncontrolled diabetes mellitus, advanced renal disease, pregnancy

Question 34

When is a CSF glucose test done

Answer 34

to differentiate between viral and bacterial (low glucose) meningitis

Question 35

What is hemoglobin A1C

Answer 35

a test that can be used to diagnose and monitor diabetes HbA1C is proportional to the average plasma glucose concentration it is reported as a percentage of the normal hemoglobin in patients with unstable RBCs intra-individual results are compared rather than comparing to a reference range

Question 36

What is fructosamine

Answer 36

non-enzymatic attachment of glucose to amino groups of proteins other than hemoglobin fructosamine levels can be measured at 2-3 week intervals individuals with kidney or licer disease have decreased serum protein therefore fructosamine cannot be used

Question 37

How is fructosamine level determined

Answer 37

chromatography and photometric methods

Question 38

What is the urine albumin:creatinine ratio used to monitor

Answer 38

kidney function of people with diabetes screens for early kidney damage by detecting albumin in the urine an ACR of >/= 3mg/mmol is clinically significant

Question 39

Why do diabetics have increased ketones

Answer 39

a decreased use of carbs for energy causes the metabolization of fatty acids which produces ketones

Question 40

What is B-Hydroxybutyrate used for

Answer 40

to determine if a patient is in metabolic acidosis it can be detected by a colorimetric or gc-ms spectrophotometry

Question 41

What is the reference range for B-Hydroxybutyrate

Answer 41

<0.4 mmol/L

Question 42

What causes lactic acidosis

Answer 42

severe tissue hypoxia and association with disease (diabetes mellitus, liver disease, drugs and inborn errors of metabolism)

Question 43

What is the reference range for lactic acid

Answer 43

0.5-2.2 mmol/L critical: >4.0 mmol/L