(M) Lec 2: Carbohydrates (Part 2) Flashcards by Kchianna Lauren Coronel

Presence of Insulin and its Receptors

Once glucose enters the cell, it will undergo what pathway/s to be converted into pyruvate along with lactate and ATP?

EMP or glycolysis

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Presence of Insulin and its Receptors

Pyruvate will enter what pathway to produce more ATP along with CO2 and H2O indicating that higher ATP is offered to the cells?

Tricarboxylic Acid Cycle

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Absence of Insulin and its Receptors

If glucose cannot enter the cells, energy will be sourced from where through the process of gluconeogenesis?

Clue: 2 answers

Fats and Proteins

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Absence of Insulin and its Receptors

What will also be produced along with glucose once energy is sourced from fats and proteins?

Clue: 2 answers

Ketone bodies and Urea

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Absence of Insulin and its Receptors

Increased ketones will result to what?

Ketoacidosis

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Any degree of glucose intolerance with an onset or first recognition during pregnancy caused by a deficiency of insulin, metabolic, and hormonal changes

Gestational DM

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The screening test for gestational DM is performed between 24-28 weeks of pregnancy through what test?

Glucose Tolerance Test

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TOF: Pregnant women who are diabetic are counted as cases of Gestational DM

False (it is only counted as GDM when the diabetes is brought about by the pregnancy)

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How many Gestational DM cases may lead to DM? (in percent)

30-40%

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Refers to when FBS concentrations are between normal and diabetic values (quantitated at 100-125 mg/dL)

Impaired Fasting Glucose

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What is the normal glucose level range when anything above 100 mg/dL is considered diabetic?

70-100 mg/dL

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Refers to when blood glucose concentrations are less than those required for diagnosis of DM (the Oral Glucose Tolerance Test results are between normal and diabetic values)

Impaired Glucose Tolerance

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Glucose Measurement

What is the best specimen choice for glucose measurement?

Serum

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Glucose Measurement

Whole blood results are how many percent lower (compared to serum) since cells use glucose as a source of energy?

11%

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Glucose Measurement

CSF glucose is approximately how many percent of plasma concentrations?

60%

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Glucose Measurement

The liquid portion of blood must be separated within how many hours and put in a gray tube containing fluoride?

1 hour

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Glucose Measurement

A gray top tube is aka as what? (it prevents a false-decrease in glucose since cells use it as a source of energy in cases of high WBC count)

Antiglycolytic agent

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Glucose Measurement

Fasting should be done for how many hours not succeeding how long?

Note: Provide 2 answers in hours

Standard: 8-10 hours
Not more than: 16 hours

Also recommended to last for 6-8 hours

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Glucose Measurement

Glucose decreases by how many percent per hour at room temperature (20-25ºC) in uncentrifuged blood?

5-7%

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Glucose Measurement

Glucose is metabolized at refrigerated temperatures (4ºC) at about how many mg/dL per hour?

1-2 mg/dL

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Glucose Measurement

What cells metabolize glucose in clotted and uncentrifuged blood resulting in false decreased values?

Clue: 2 answers

RBCs and WBCs

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Oxidation-Reduction Methods

Principle: Cupric ions are converted to cuprous ions in an alkaline solution through the action of glucose

Alkaline Copper Reduction

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Oxidation-Reduction Methods

In Alkaline Copper Reduction, what is the basis of the color change?

Amount of glucose

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Oxidation-Reduction Methods

This type of Alkaline Copper Reduction Test is a modification of the Folin-Wu method which uses citrate and tartrate with a stabilizing agent

Benedict’s

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# Oxidation-Reduction Methods This type of Alkaline Copper Reduction Test uses alkaline copper tartrate

Fehling's

# Oxidation-Reduction Methods This type of Alkaline Copper Reduction Test uses phosphomolybdate

Folin-Wu

# Oxidation-Reduction Methods This type of Alkaline Copper Reduction Test uses arsenolmolibdate

Nelson-Somogyi

# Oxidation-Reduction Methods Principle: Yellow ferricyanide is converted to a colorless ferrocyanide by glucose (e.g. Hagedorn Jensen)

Alkaline Ferric Reduction

# Condensation Methods Principle: The ability of glucose to form glycosylamine and Schiff bases with aromatic amines

Ortho-Toluidine (Dubowski) Method

# Condensation Methods Main reagent: Hot acid or Glacial acid solution End product: Colored compound

Ortho-Toluidine (Dubowski) Method

# Condensation Methods The Ortho-Toluidine (Dubowski) Method is not only positive for glucose but also for what 2 sugars? (these can interfere with results)

Galactose and Mannose

# Enzymatic Methods This method measures the beta-D-glucose through the use of mutaratose which converts the alpha-D-glucose to beta-D-glucose (indirect measurement of alpha-D-glucose)

Glucose Oxidase Method

# Enzymatic Methods Enzymatic tests act on glucose only and they do not react on other reducing sugars making enzymatic tests what?

Specific

# Enzymatic Methods How many enzymes does the Glucose Oxidase Method use and what are those?

1. Glucose Oxidase 2. Peroxidase

# Enzymatic Methods What are the 2 products of the glucose oxidase method?

Gluconic acid and Hydrogen Peroxide

# Enzymatic Methods How are Gluconic acid and Hydrogen Peroxide measured, what are the 2 methods?

Using Electrodes and Chromogen | Colorimetric Method - Chromogen Polarographic Method - Electrode

# Enzymatic Methods Hydrogen peroxide will react with phenol and 4-aminoantipyrine through peroxidase to produce what dye?

Quinoneimine Dye (aka Oxidized Chromogen Substance) and water

# Enzymatic Methods Glucose Oxidase Methods can measure glucose levels from what body fluid?

CSF

# Enzymatic Methods False increase or decrease for the Glucose Oxidase Method? Bleach

False increase

# Enzymatic Methods False increase or decrease for the Glucose Oxidase Method? Bilirubin Uric Acid Ascorbic Acid (a non-glucose reducing substance)

False decrease

# Enzymatic Methods The most specific glucose method because of the reagent (G6PD), an enzyme specific to G6P that is only produced through glucose

Hexokinase

# Enzymatic Methods Hexokinase is a reference/standard method because it is able to measure all forms of what?

Glucose

# Enzymatic Methods What is the specimen of choice using heparin, EDTA, fluoride, oxalate, and citrate for Hexokinase?

Serum or Plasma

# Enzymatic Methods Hexokinase values are falsely decreased in the presence of what 2 substances as they compete with G6P?

Hgb and Bilirubin

# Enzymatic Methods Glucose with ATP will be acted upon by hexokinase which will produce what (2)?

G6P and ADP

# Enzymatic Methods When G6P is acted upon by G6PD in the hexokinase method, it becomes what?

6-phosphogluconate (with the coenzyme NAD, converted to NADH) | Is measured photometrically at 340nm

# Enzymatic Methods This method involves generated NADH which is proportional to the glucose concentration (the enzyme acts on glucose and uses NADH as a coenzyme)

Glucose Dehydrogenase Method | Note: Mutaratose can be used to shorten the time to reach equilibrium

# Enzymatic Methods This method is important for establishing correct insulin amounts; a strip contains glucose oxidase, peroxidase, and chromogen (it changes color depending on the amount of glucose)

Dextrostics

# Enzymatic Methods This measures B-D glucose which is effective to use in reducing the rate of diabetic complications

Dextrostics

# Tests for Hyperglycemia - The specimen can be collected any time of the day - Useful for insulin shock, hyperglycemic ketonic coma, and emergency cases

Random Blood Sugar (RBS)

# Tests for Hyperglycemia What is the normal and hyperglycemic range for Random Blood Sugar?

Normal: < 140mg/dL Hyperglycemic: ≥ 200 mg/dL

# Tests for Hyperglycemia Done after 8-10 hours of fasting to diagnose DM and GDM (measures glucose homeostasis)

Fasting Blood Sugar (FBS)

# Tests for Hyperglycemia What is the hypoglycemic and hyperglycemic range for Fasting Blood Sugar?

Hypoglycemic: < 50 mg/dL Hyperglycemic: ≥ 126 mg/dL

# Tests for Hyperglycemia What is the normal and hypoglycemic onset range for Fasting Blood Sugar?

Normal: 70-100 mg/dL Onset of Hypoglycemia: 50-55 mg/dL

# Tests for Hyperglycemia - Useful for monitoring glycemic control - Blood glucose is determined 2 hours after a meal - Not used to diagnose DM but used to determine if a patient with DM has good control of their sugar

2-Hour Post Prandial Blood Sugar (PPBS)

# Tests for Hyperglycemia What are the ranges for good and poor glycemic control for the 2-Hour Post Prandial Blood Sugar Test?

Good: < 130 mg/dL Poor: ≥ 140 mg/dL

# Tests for Hyperglycemia - This is a multiple blood sugar test as it involves the collection of blood from a patient multiple times depending in the request of the physician - Aids in the diagnosis of DM - Determines how well the body metabolizes glucose over a given time required

Glucose Tolerance Test (GTT)

# Tests for Hyperglycemia What is the hypoglycemic value for the Glucose Tolerance Test?

≤ 50 mg/dL

# Tests for Hyperglycemia What are the ranges for the following manifestations in the Glucose Tolerance Test? 1. When the 3P’s appear 2. Severe polydipsia 3. Critical value for blood glucose (needs insulin)

1. ≥ 200 mg/dL 2. ≥ 300 mg/dL 3. ≥ 400 mg/dL

# Requirements for Glucose Tolerance Tests The patient should be (blank) as carbohydrates deplete during bedrest and inactivity

Ambulatory

# Requirements for Glucose Tolerance Tests The patient should have an unrestricted diet of how many grams of carbs a day for how many days to stabilize the synthesis of glycolytic enzymes?

150g for 3 days

# Requirements for Glucose Tolerance Tests TOF: Stopping exercise is not required prior to this test

False

# Requirements for Glucose Tolerance Tests This is usually an orange substance that contains purely glucose and is taken orally in liquid form (if it comes in powder, it needs to be dissolved)

Glucose Load

# Requirements for Glucose Tolerance Tests How many grams of the glucose load is needed for adults?

75 grams

# Requirements for Glucose Tolerance Tests How many grams of the glucose load is needed for pregnant patients or those suspected to have GDM?

100 grams

# Requirements for Glucose Tolerance Tests How many grams of the glucose load is needed for children?

1.75 grams per kg of body weight

# Glucose Tolerance Tests What blood glucose specimen can also be collected during GTT to assess whether glucose is present?

Fasting Blood Sugar

# Glucose Tolerance Tests After drinking the glucose load, what are the time intervals wherein a blood sample is collected?

1. 30 minutes 2. 1 hour 3. 2 hours 4. 3 hours

# Glucose Tolerance Tests Diagnostic values for GTT includes the results of what time intervals?

1. FBS result 2. 1 hour 3. 2 hours | Note: Some physicians omit the 3rd hour

# Kinds of Glucose Tolerance Tests - This is more comonly done than the other method - Includes the Janney-Isaacson Method (Single Dose Method) and Exton Rose Method (Divided Oral Dose/Double Dose Method)

Oral Glucose Tolerance Test (OGTT)

# Kinds of Glucose Tolerance Tests Methods of Oral Glucose Tolerance Test: Patients are given 75-100 grams of the glucose load

Janney-Isaacson Method (Single Dose Method)

# Kinds of Glucose Tolerance Tests Methods of Oral Glucose Tolerance Test: A glucose load is given twice: 50 grams after FBS and another 50 grams after the 30-minute blood is taken

Exton Rose Method (Divided Oral Dose/Double Dose Method)

# Kinds of Glucose Tolerance Tests What added value after an Oral Glucose Tolerance Test is indicative of the glucose level?

Plasma Glucose

# Kinds of Glucose Tolerance Tests Give the added amount of Plasma Glucose correspondent to the time frame: 30 minutes

30-60 mg/dL above fasting

# Kinds of Glucose Tolerance Tests Give the added amount of Plasma Glucose correspondent to the time frame: 1 hour

20-50 mg/dL above fasting

# Kinds of Glucose Tolerance Tests Give the added amount of Plasma Glucose correspondent to the time frame: 2 hours

5-15 mg/dL above fasting

# Kinds of Glucose Tolerance Tests Give the added amount of Plasma Glucose correspondent to the time frame: 3 hours

Equal to Fasting level or Below

# Kinds of Glucose Tolerance Tests What are the 2 diagnostic values for DM from the Oral Glucose Tolerance Test?

FBS and the 2-hour specimen

# Kinds of Glucose Tolerance Tests In the case of OGTT, what hour value should return to normal values (which are the FBS values)?

2nd-hour Values

# Kinds of Glucose Tolerance Tests - Mainly for diabetes patients with GIT disorders since oral glucose loads may not be absorbed properly - 0.5g of glucose/kg of body weight is given through IV - A fasting sample is needed - The 1st blood collected is after 5 minutes of IV glucose

Intravenous Glucose Tolerance Test

# Intravenous Glucose Tolerance Test TOF: Patients are able to tolerate a large carbohydrate load

False

# Intravenous Glucose Tolerance Test TOF: Altered gastric physiology is a contraindication for Intravenous Glucose Tolerance Test

False (indication)

# Intravenous Glucose Tolerance Test TOF: Those who have undergone surgery in the intestines are candidates for this test

True

# Intravenous Glucose Tolerance Test TOF: Those who have chronic malabsorption syndromes are not recommended to undergo this test

False (it is an indication)

# Criteria of Fasting Plasma Glucose Give the glucose level for non-diabetic patients (pre-diabetes)

< 100 mg/dL

# Criteria of Fasting Plasma Glucose Give the glucose level for impaired plasma glucose patients

100-125 mg/dL

# Criteria of Fasting Plasma Glucose Give the glucose level for diabetes mellitus patients

≥ 126 mg/dL

# Criteria of Oral Glucose Tolerance Test Give the glucose level for normal or non-diabetic patients

2-hr plasma glucose of < 140 mg/dL

# Criteria of Oral Glucose Tolerance Test Give the glucose level for impaired glucose tolerance test patients

2-hr plasma glucose of 140-199 mg/dL

# Criteria of Oral Glucose Tolerance Test Give the glucose level for DM patients

2-hr plasma glucose of ≥ 200 mg/dL

What is the conversion factor for glucose in order to convert it into mmol/L?

0.056

# Diagnostic Criteria for DM Give the glucose level of DM patients from a Random Blood Sugar specimen

≥ 200 mg/dL

# Diagnostic Criteria for DM Give the glucose level of DM patients from a Fasting Blood Sugar specimen

≥ 126 mg/dL

# Diagnostic Criteria for DM Give the glucose level of DM patients from a 2-Hour Post Prandial specimen

≥ 200 mg/dL

# Screening for Gestational DM - This is done between 24 to 28 weeks of pregnancy - It screens women to check if they have GDM especially when they: 1. Had GDM during previous pregnancies 2. Gave birth to a baby weighing over 9 pounds 3. Are over 25 years old 4. Are overweight prior to getting pregnant

Glucose Challenge Test (GCT)

# Screening for Gestational DM This approach to a Glucose Challenge Test (GCT): - performs a 2-hr OGTT using 75g of glucose load - is done in the morning after 8 hrs. of overnight fasting - does not require any patient preparation for GDM OGTT since they are already pregnant

One-Step Approach

# Screening for Gestational DM (One-Step Approach) Criteria for GDM (give the glucose level): For FBS

≥ 92 mg/dL

# Screening for Gestational DM (One-Step Approach) Criteria for GDM (give the glucose level): For 1-Hr. Plasma Glucose

≥ 180 mg/dL

# Screening for Gestational DM (One-Step Approach) Criteria for GDM (give the glucose level): For 2-Hr. Plasma Glucose

≥ 153 mg/dL

# Screening for Gestational DM This approach to a Glucose Challenge Test (GCT): - Measures plasma glucose 1 hour after a 50g oral glucose load - If (+), proceed to OGTT with 100g of glucose load - A (+) value is indicated by a plasma glucose of ≥ 140 mg/dL

Two-Step Approach

# Screening for Gestational DM In the Two-Step Approach, the patient is considered to be (+) for GDM if the glucose levels are abnormal in how many parameters out of 4?

2/4

# Screening for Gestational DM (Two-Step Approach) Criteria for GDM (give the glucose level): For FBS

≥ 95 mg/dL

# Screening for Gestational DM (Two-Step Approach) Criteria for GDM (give the glucose level): For 1-hr. Plasma Glucose

≥ 180 mg/dL

# Screening for Gestational DM (Two-Step Approach) Criteria for GDM (give the glucose level): For 2-hr. Plasma Glucose

≥ 155 mg/dL

# Screening for Gestational DM (Two-Step Approach) Criteria for GDM (give the glucose level): For 3-hr. Plasma Glucose

≥ 140 mg/dL

# Tests for Hyperglycemia This method is: - used for self monitoring but not for diagnosing - not accurate but precise - performed 3-4x a day in cases of Type 1 DM

Capillary Blood Glucose (CBG)

# Tests for Hyperglycemia This is defined as the glucose molecule that is attached to one or both end terminal valines of the beta-polypeptide chain of Hgb

Glycosylated Hgb (HbA1c)

# Tests for Hyperglycemia This substance: - has a directly proportional relationship to plasma glucose levels - monitors long-term glucose control - reflects average blood glucose levels for the previous 2-3 months - the specimen of choice is whole blood anticoagulated with EDTA

Glycosylated Hgb (HbA1c)

# Tests for Hyperglycemia For every 1% change in HbA1c there's a how many mg/dL change in plasma glucose?

35 mg/dL

# Tests for Hyperglycemia What 2 factors can affect HbA1c levels?

1. Average glucose levels 2. RBC life span (60-90 days)

# Tests for Hyperglycemia (HbA1c) Give the reference range for the following parameters: Normal glycosylation

4-6% HbA1c

# Tests for Hyperglycemia (HbA1c) Give the reference range for the following parameters: Prolonged hyperglycemia

18-20% HbA1c

# Tests for Hyperglycemia (HbA1c) Give the reference range for the following parameters: Diabetic patient with poor control of hyperglycemia

7% HbA1c

# Tests for Hyperglycemia (HbA1c) What is the cut off value for HbA1c set by the ADA?

# Methods of Measuring HbA1c The 2 methods, Immunoassays and Affinity Chromatography, are based on what?

Structural Characteristics

# Methods of Measuring HbA1c The 4 methods, Ion-Exchange Chromatography, Electrophoresis, Isoelectric Focusing, and HPLC, are based on what?

Charge Differences

# Methods of Measuring HbA1c Falsely increased or decreased HbA1c? (+) for Hgb F

Increased

# Methods of Measuring HbA1c Falsely increased or decreased HbA1c? (+) for Hgb S and Hgb C

Falsely decreased

# Methods of Measuring HbA1c (identify the method) - Is based on structural differences - Uses polyclonal or monoclonal antibodies

Immunoassays

# Methods of Measuring HbA1c (identify the method) - Is based on structural differences - Uses borate to bind with glycosylated proteins - Is not temperature-dependent - Is not affected by other Hgbs

Affinity Chromatography

# Methods of Measuring HbA1c (identify the method) - Is based on charge differences - Uses a positive-charge resin bed - Is temperature-dependent - Is affected by other hemoglobinopathies

Ion-exchange chromatography

# Methods of Measuring HbA1c (identify the method) - is based on charge differences - a hemoglobin F level of > 7% interferes with the results

Electrophoresis

# Methods of Measuring HbA1c (identify the method) - is based on charge differences - uses a midpoint for separation - pre-HbA1c interferes with results

Isoelectric Focusing

# Methods of Measuring HbA1c (identify the method) - is based on charge differences - forms on ion exchange - separates all forms of glycosylated Hgb

HPLC

# Tests for Hyperglycemia - aka glycosylated or glycated albumin or plasma protein ketoamine - is dependent on the lifespan on albumin (19 days) - reflects short term glucose control usually 2-3 weeks - uses non-fasting serum as the specimen

Fructosamine

# Tests for Hyperglycemia Fructosamine is useful for monitoring diabetic individuals with chronic hemolytic anemias and hemoglobin variants, 2 Hgb variants have shorter lifespans than RBC, what are those 2?

Hgb S and Hgb C

# Tests for Hyperglycemia What is the reference range for fructosamine?

205-285 umol/L

# Tests for Hyperglycemia Fructosamine cannot be measured if the plasma albumin level of an individual is less than how many g/dL because low fructosamine levels lead to inaccurate results?

30 g/dL

# Tests for Hyperglycemia - this test is an indicator for pancreatic and insulin secretions (function of a B cell) - it differentiates type 1 and 2 DM - used to monitor responses to pancreatic surgery - evaluates hypoglycemia and B cell function

C-Peptide Test

# Tests for Hyperglycemia What is the normal ratio of C-Peptides to Insulin?

5:1 to 15:1

# Tests for Hyperglycemia A condition wherein there is a tumor that increases the release of insulin

Insulinoma

# Tests for Hyperglycemia The C-peptide is decreased in what type of DM?

Type 1

# Tests for Hyperglycemia This is the starting substance of insulin which contains alpha and beta chains + the c-peptide

Preproinsulin

# Tests for Hyperglycemia Preproinsulin will become what substance where the winding of different components occurs?

Proinsulin

# Tests for Hyperglycemia C-peptide will separate as a byproduct and insulin will be made up of only what? (2 answers)

Alpha and Beta Chains | Note: Without insulin, there is no C-Peptide

# Tests for Hyperglycemia - this is produced in the liver through metabolism of fatty acids - an increase in the serum levels of this substance can be seen when there is a defect in CHO metabolism - this increases in cases of type 1 diabetes, high fat diets, and starvation - the preferred specimen is either urine or serum

Ketones

# Tests for Hyperglycemia What is the ratio on B-hydroxybutyrate to Acetoacetic Acid?

1:1

# Tests for Hyperglycemia (methods of measuring ketones) It uses ferric chloride as the main reagent and reacts mainly with acetoacetate and results to a red color

Gerhardt's Ferric Chloride Test

# Tests for Hyperglycemia (methods of measuring ketones) Is 10x more sensitive to acetoacetate than it is to acetone; adding glycerin makes it able to detect acetone

Nitroprusside Test

# Tests for Hyperglycemia (methods of measuring ketones) Uses sodium nitroprusside to detect both acetoacetic acid and acteone resulting to a purple color

Acetest Tablets

# Tests for Hyperglycemia (methods of measuring ketones) This reagent strip detects acetoacetate more than acetone

Ketostix

# Tests for Hyperglycemia (methods of measuring ketones) This reagent strip detects b-hydroxybutyrate although it is not widely used

KetoSite Assay

# Tests for Hyperglycemia - a condition that serves as the first sign of diabetic renal nephropathy as related to type 1DM - measured through a Micral Test or Dipstick Test

Albuminuria

# Tests for Hyperglycemia What is the result of the albumin creatinine ratio? | I'm not sure what this means basta nasa last page siya ng transes

30-299 mg/g of creatinine

# Inborn Errors of Carbohydrate Metabolism - presence of galactose in the blood - caused by a deficiency in one of the three main enzymes involved in galactose metabolism (galactose-1-phosphate uridyl transferase, galactokinase, and uridine diphosphate galactose-4-epimerase) - other features include galactosuria, hyperbilirubinemia, and hypoglycemia

Galactosemia

# Inborn Errors of Carbohydrate Metabolism - is indicated by a problem with the metabolism of glycogen (lacks the enzyme for it) - most are inherited as autosomal recessive traits

Glycogen Storage Disease

# Inborn Errors of Carbohydrate Metabolism - the most common Glycogen Storage Disease - characterized by hyperlipidemia (increased blood lipids) and severe hypoglycemia - there is an increase in ketones, lactate, alanine, and uric acid - built up glycogen leads to hepatomegaly

Von Gierke Disease (VGD)

# Types of Glycogen Storage Diseases The IV GTT Method may be used to measure glucose for hypo or hyperglycemia

Types 1A and 1B

# Types of Glycogen Storage Diseases There is no hypoglycemia but there is a positive result for hepatomegaly

Types 3A, 3B, and 4

# Types of Glycogen Storage Diseases Characterized by liver damage (hepatomegaly)

Types 1, 3, 4, 6, 9, and 11

# Types of Glycogen Storage Diseases Characterized by having muscular defects (muscle weakness)

Types 5 and 7

(M) Lec 2: Carbohydrates (Part 2) Flashcards

(151 cards)