U3 LEC: CARBOHYDRATES (PT. 3) Flashcards
(165 cards)
1
Q
Condition in which levels of blood glucose are decreased
A
Hypoglycemia
2
Q
Glucagon is released if blood glucose level is?
A
65-70 mg/dL
3
Q
Symptoms of hypoglycemia appear if blood glucose level is?
A
50-55 mg/dL
4
Q
Symptoms of Hypoglycemia are related to?
A
CNS
5
Q
Hypoglycemia symptoms include:
A
- shaking
- fast heartbeat
- shivering
- dizziness
- anxiety
- irritable
- headache
6
Q
This causes brain fuel deprivation
A
Hypoglycemia
7
Q
Hypoglycemia results to?
A
- impaired judgement and behavior
- seizures
- coma
- functional brain failure
- death
8
Q
This is the imbalance in the rate of glucose appearance and disappearance from the circulation
A
Hypoglycemia
9
Q
Hypoglycemia is rare in individuals with?
A
normal glucose metabolism
10
Q
In individuals without diabetes, diagnosis of hypoglycemia should be made only in those who demonstrate the?
A
Whipple Triad
11
Q
under the Whipple Triad
A
1.) Hypoglycemic symptoms
2.) Plasma glucose <50 mg/dL
3.) Symptoms are relieved by correction of hypoglycemia when glucose or glucagon is administered
12
Q
T/F: The Whipple Triad is only observed in persons without diabetes.
A
True
13
Q
Hormones that regulate Hypoglycemia
A
- Glucagon
- Epinephrine
- Norepinephrine
- Cortisol
- Growth Hormone
14
Q
Classification of Hypoglycemia
due to fasting state
A
Post-absorptive (fasting)
15
Q
Classification of Hypoglycemia
after eating
A
Postprandial (reactive)
16
Q
Postprandial is observed how many hours after a meal?
A
4 hours
17
Q
Level 1 (Glucose Alert Value)
A
- <70mg/dL
- sufficiently low for treatment with fast acting carbohydrate and dose adjustment of glucose lowering therapy
18
Q
Level 2 (Clinically significant hypoglycemia)
A
- <54mg/dL
- sufficiently low to indicate serious hypoglycemia
19
Q
Level 3 (Severe hypoglycemia)
A
- no significant threshold
- associated with severe cognitive impairment requiring external assistance for recovery
20
Q
Symptom observed in Level 3
A
loss of consciousness
21
Q
Characterized by a plasma (or serum) glucose concentration low enough to cause symptoms and/or signs including impairment of brain function
A
Clinical hypoglycemia
22
Q
An intentional attempt to induce low blood glucose levels
A
Factitious hypoglycemia
23
Q
Results from exogenous self-administration of insulin or insulin secretagogues medications
A
Factitious hypoglycemia
24
Q
Factitious hypoglycemia is more common in?
A
women with diabetes, during third and fourth decades of life
25
Plasma Glucose Values
Glucagon and other glycemic hormones are released into the circulation
65-70 mg/dL
26
Plasma Glucose Values
Observable symptoms of hypoglycemia appear
50-55 mg/dL
27
Plasma Glucose Values
Considered low value and abnormal for infants (requires further diagnostic test)
< 50 mg/dL
28
Plasma Glucose Values
Impairment of cerebral function starts
<50 mg/dL
29
Result of the deficiency of a specific enzyme that causes an alteration of glycogen metabolism
Glycogen Storage Diseases
30
Increase in glycogen stored in the liver will result to?
Hepatomegaly
31
Type I Glycogen Storage Disease, most common
Von Gierke
32
Von Gierke
Defective enzyme
Glucose-6-phosphatase
33
Von Gierke
Organ affected
Liver and Kidney
34
Von Gierke
Genetic pattern
autosomall recessive
35
Von Gierke
Diagnosis
Liver Biopsy using Glycogen stain
36
Von Gierke
Clinical features
- Severe hypoglycemia
- Ketosis
- Hyperuricemia
- Hyperlipemia
- Elevated lactate levels
37
Von Gierke
Treatment
Liver transplantation (Liver cells)
38
Type II Glycogen Storage Disease, affects all organs
Pompe
39
Pompe
Defective enzyme
a-1,4-Glucosidase
40
Other enzyme defects causing hypoglycemia
- Glycogen synthase deficiency
- Fructose 1,6-biphosphate deficiency
- Phosphoenolpyruvate carboxykinase deficiency
- Pyruvate carboxylase deficiency
- Glycogen debrancher enzyme deficiency
41
This enzyme deficiency causes hepatomegaly but no hypoglycemia due to gluconeogenesis.
Glycogen debrancher enzyme deficiency
42
Cause of failure to thrive syndrome in infants
Galactosemia
43
Congenital deficiency of one of three enzymes involved in galactose metabolism leading to?
increased galactose in plasma
44
Galactosemia
Defective enzyme
Galactose-1-phosphate uridyltransferase (G1PU)
45
Galactosemia inhibits?
Glycogenolysis
46
Galactosemia
Symptoms
- hypoglycemia
- hyperbilirubinemia
- mental retardation and cataracts
47
Galactosemia
Treatment
remove galactose from diet
48
Fructosuria is also known as?
Fructose-1-phosphate aldolase deficiency (Fructosuria)
49
Fructosuria
Defective enzyme
Fructose-1-phosphatase aldolase
50
Fructosuria
can also be a deficiency due to?
Fructose-1,6-diphosphatase
51
Fructosuria
Symptoms
- nausea
- hypoglycemia
- fructose in urine
52
Fructosuria
Treatment
removal of fructose in diet
53
Other causes of Hypoglycemia
- Errors in amino acid metabolism
- Long chain fatty acid oxidation
- Alimentary hypoglycemia
- Idiopathic hypoglycemia
54
Specimen for glucose
- blood (serum/plasma)
- urine
- CSF
55
56
Specimen for Glycated /Gycosylated Hemoglobin
Whole blood
57
Specimen for Insulin testing
Blood (serum/plasma)
58
Diagnostic test for screening DM suspects
Fasting Blood Sugar (FBS)
59
FBS
requires how many hours of fasting?
8 hours
60
FBS
fasting hours should not exceed?
16 hours
61
FBS
Abnormal indicative value
> 126 mg/dL
62
FBS
Percentage of Whole Blood Glucose
11%
63
T/F: Fasting of FBS is not followed if patient's request include lipid profile analysis.
True
64
Glucose is increased and decreased in?
increased: morning
decreased: afternoon
65
Collection of FBS in the afternoon, after fasting in the morning will result to?
false decrease
66
This refers to simple glucose loading to check insulin secretion
Two hour post prandial (2hr PPBS)
67
2hr PBBS
Standardized glucose loading is?
75g (taken 2 hours after)
68
2hr PBBS
DM value after 2 hours
> 200 mg/dL
69
This is not recommended for routine use under ADA guidelines
Glucose Tolerance Test
70
OGTT stands for?
Oral Glucose Tolerance Test
71
2 types of OGTT:
- 3 hours
- 5 hour
72
5 hour OGTT is done after a?
3 hour blood glucose dip
73
OGTT
Medications to be avoided
- salicylates
- diuretics
- anti convulsants
- OCPS
- corticosteroid
3 days prior
74
OGTT
Glucose load for children
1.75 g/kg of weight ng child
75
OGTT
Glucose load for adult
75g
76
OGTT
Glucose load for pregnant women
100g
77
This GTT is done if there is a defect in GI glucose absorption.
Intravenous Glucose Tolerance Test (IGTT)
78
IGTT
____ is administed via IV
25mg of glucose
79
80
IGTT
How many minutes should glucose be administered?
1-2 minutes
81
IGTT
Blood draw must be done during?
- before infusion
- 1,3,5,10,20,30,40,60 & 120 minutes following infusion
82
This is an index for long term plasma glucose, indicates compliance and efficacy of tretment.
Glycosylated/Glycated Hemoglobin (HbA1c)
83
HbA1c
Rate of formation is directly proportional to?
glucose levels
84
T/F: HbA1c can be used to control glucose levels if patient is diagnosed with DM.
True
85
HbA1c
2 Methods of measurements
- charge
- structure of glycogroups
86
HbA1c
Methods under charged differences
- cation-exchange chromatography
- electrophoresis
- isoelectric focusing
- hplc
87
HbA1c
Methods under structural characteristics of glycogroups
- affinity chromatography
- immunoassay
88
HbA1c
Most common method for charged differences
High-pressure liquid chromatography (HPLC)
89
For every 1% increase of A1c, how much Mean Plasma Glucose is increaased?
by 35
90
4% A1c
65 mg/dL
91
Testing for Plasma Glucose and HbA1c
patients with stable glycemic control
2 times a year (EVERY 6 MONTHS)
92
Testing for Plasma Glucose and HbA1c
patients with unstable glycemic control
4 times a year (EVERY QUARTER)
93
Testing for Plasma Glucose and HbA1c
Two factors
1. RBC Life Span
2. Average Glucose Concentration
94
Old red cells, anemia, iron deficiency, pernicious, alcoholism, uremia, illicit and therapeutic drugs, hyperbilirubinemia
False increased HbA1c
95
Shortened RBC survival, hemolytic anemia, recovery from acute blood loss, abnormal hemoglobin
False decreased HbA1c
96
Other Laboratory tests for glucose
- Oral Glucose Challenge Test (OGCT)
- Random Blood Sugar (RBS)
- Fructosamine
- 1,5-anhydroglucitol (1,5-AG)
97
This tolerance test determines fasting hypoglycemia with blood samples drawn at 2 minutes to 2 intervals (6 specimens) to measure glucose and insulin
Tolbutamide tolerance test
98
Intervals for Tolbutamide tolerance test
2 minutes to 2 hours intervals of 6 specimens
99
This tolerance test determines reactive hypoglycemia by measuring response of insulin to a cocktail meal
Mixed-meal tolerance test
100
Mixed-meal tolerance test
Meal with a mixture of carbohydrate, protein, fats
cocktail meal
101
Mixed-meal tolerance test
Blood sample may be drown at what intervals?
15, 30, 45, 60, 90, 120
102
Capillary blood glucose is identical to?
arterial blood glucose
103
CSF glucose concentrations should be approximately?
60-80%
104
What tube is used for Chemistry in CSF?
1st tube
105
Normal value of Glucose
Conventional Unit
70-99 mg/dL
106
Normal value of Glucose
SI unit
3.9-5.5 mmol/L
107
Normal value of Glucose
Conversion factor
0.055
108
This enzymatic method targets the consumption of H20.
Glucose Oxidase
109
Glucose Oxidase
What is used alongside peroxidase to oxidize H202
Reduced chromogen
110
Glucose Oxidase
This enzyme converts alpha D glucose to beta D glucose
Mutarotase
111
Glucose Oxidase
Glucose that GOD can measure
beta D glucose
112
Glucose Oxidase
Monitoring
1. consuming H202 in a side reaction
2. rate of disappearance of oxygen
113
Glucose Oxidase
Colorimetric Method
Saifer Gernstenfield Method
114
Glucose Oxidase
Coupling peroxidase reaction
Trinder reaction
115
Glucose Oxidase
Chromogen
3-methyl-2-benzothiazolinone hydrazone or N,N-dimethylaniline
116
Glucose Oxidase
Source of errors
False decreased: BUA, bilirubin,
ascorbic acid
False elevated: strong oxidizing agents, bleach
117
Glucose Oxidase
Oxygen consumption is also referred to as?
Polarographic GOD
118
Glucose Oxidase
Catalase utilizes?
ethanol to acetaldehyde
119
Glucose Oxidase
Molybdate utilizes?
Iodine
120
This enzymatic method is most accurate
Hexokinase Method
121
This is used for the REFERENCE METHOD FOR GLUCOSE DETERMINATION
Hexokinase Method
122
Hexokinase Method
False decrease
- gross hemolysis
- high bilirubin
123
Hexokinase Method
Product of G6PD
NADPH
124
This methods are done under clinical microscopy to monitor glucose levels in urine, or other body fluids.
Non-enzymatic Methods
125
Nelson Somogyi is also known as a?
Copper Reduction Method
126
Nelson Somogyi measures?
true glucose
127
Nelson Somogyi
What does it use to remove non-glucose?
Barium Sulfate
128
Nelson Somogyi
Reagent
arsenomolybdic acid
129
Nelson Somogyi
Product
arsenomolybdenum blue
si nelson smurf
130
This is known as the ferric reduction method.
Hagedorn Jensen
131
Hagedorn Jensen
Principle
Inverse colorimetry
132
Hagedorn Jensen
Reagent
Ferricyanide (yellow)
133
Hagedorn Jensen
Product
Ferrocyanide (colorless)
134
This non-enzymatic method utilizes condensation with aromatic amines.
Ortho-toluidine
135
Ortho-toluidine
Reagent
O-toluidine in glacial acetic acid
136
Ortho-toluidine
Product
Schiff's base (green)
137
Ortho-toluidine
Disadvantage
corrosiveness and toxicity of reagent
138
T/F: Ortho-toluidine is the most specific non-enzymatic method.
True
139
Benedict's and Fehling's test is also known as what method?
copper reduction
140
Benedict's and Fehling's test
Stabilizer
citrate or tartrate
141
Benedict's and Fehling's test
Result
deep blue solution to red ppt
142
This is produced by the liver through fatty acid metabolism as energy source when carbohydrates are low.
Ketones
143
T/F: Ketones are normally low in the body.
True
144
Types of Ketones in body
- Acetone (20%)
- Acetoacetic acid (20%)
- 3-B-hydroxybutyric acid (78%)
145
High ketones is observed/will result to?
- DM
- starvation/fasting
- high-fat diets
- prolonged vomiting
- glycogen storage disease
146
Used to detect acetoacetic acid
Nitroprusside
147
Used to detect acetone
Nitroprusside with glycerin
148
Result in Nitroprusside
purple color
149
This refers to a DM complication in which glucose passes through the glomerula.
DM nephropathy
150
DM nephropathy can lead to?
increased urinary albumin
151
Microalbumin is also known as?
Albuminuria
152
Persistent albuminuria
Urinary albumin to creatinine ratio
30-299 mg/g
153
Normal creatinine ratio
<25mg
154
Persistent albuminuria
Urine collections
3 collections over 3-6 month period
2 of which ay dapat nasa mataas na ratio
155
Albuminuria is an early indicator of?
diabetic kidney disease
156
Factors increasing albumin excretion:
- exercise within 24 hours
- infection
- fever
- congestive heart failure
- marked hyperglycemia
- marked hypertension
157
This is a characteristic of Type 1 DM
Islet autoantibody
158
Islet autoantibody
Method
Direct ELISA
159
Islet autoantibody
under direct ELISA
- sample with IgG against islet cells
- ICA-IgG enzyme conjugate
- Substrate
160
Islet autoantibody
IFA produces?
Apple green fluorescence
161
This is used for hypoglycemic state testing
Insulin
162
Insulin
Method
HTRF Sandwich
163
This peptide is produced with Insulin
C-peptide
164
under C-peptide ELISA
C-peptide/creatinine ratio and antibody screening
165
C-peptide
used for diagnosis of?
- MODY
- LADA
- Uncertainty about type 1 versus type 2 diagnosis
