Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
37 Cards in this Set
- Front
- Back
|
glucose
|
sources;
1. exogenous -foods 2. endogenous- glycogenolysis (breaking down glycogen), glucogenesis (making new) -metabolic fuel function -regulation: inulin and glucagon; counter regulatory hormones |
|
|
tight glucose control
|
-balance of insulin and anti-insulin hormone action
|
|
|
how to maintain homeostasis
|
-disturbed --> too much glucose in blood --> release of insulin from beta cells in pancreas
-too little glucose --> alpha cells release glucagon |
|
|
beta cells release insulin
|
-increasd rate of glucose transport
-increased rate of glucose utilization and ATP gen -increased conversion of glucose to glycogen -increased prtoein synthesis -increased fat synthesis |
|
|
alpha cells release glucagon
|
-increased breakdown of glycogen to glucose
-increased breakdown of fats to fatty acids -increased synthesis and relase of glucose |
|
|
as insulin is made...
|
C-peptide is made
-if you are giving yourself insulin then you wont have any c-peptide |
|
|
counterregulatory hormones
|
-act opposite to insulin
-act as defense mechanisms against hypoglycemia |
|
|
causes of hyperglycemia
|
-DM: type 1 and 2, gestational
-beta cell or insulin action genetic defects -disease of the exocrine pancreas -endocrine disorders (cushings - too much cortisole; acromegaly - too much growth hormone) -drug or chemical induced (can be reversible) |
|
|
diabetes mellitus
|
-disorder of carb metabolism with decreased or ineffective insulin secretion and/or action
-hyperglyemia and glucosuria (+/- ketosis and keotnuria) -glycosylation in tissues (nerves, bl vessels) results in microvascular and mascrovascular complications |
|
|
clinical presentations in diabetes
|
1. polyuria
2. polydipsia 3. blurred vision 4. weight loss 5. polyphagia 6. growth impairment 7. increased susceptibility to infection 8. ketoacidosis 9. nonketotis hyperosmolar coma |
|
|
type 1 DM
|
-do not have insulin
-beta cell destruction -younger people -need insulin injections |
|
|
type 2 DM
|
-MORE COMMON
-insulin resistnce and/or deficiency -need meds ot increase insulin production or decrease amt of glucose absorption |
|
|
who should get screened for diabetes
|
-people overweight (BMI >25) and have additional risk factors
-FH -physical inactivity -high risk ethnic populations -women with big babies -PCOS -impaired glucose tolerance or impaired fasting glucose previously -hx of cardiovascular disease (by 45 yo with none of these) |
|
|
screening for children
|
-overweight plus any of the 2:
Fh race/ethnicity signs of insulin resitance maternal hx of DM -start at 10 or onset of puberty and every 3 years |
|
|
screening/diagnostic tests
Fasting Blood Glucose |
-preferred
-dont eat for 8-12hrs -serum (red), plasma (gray), whole blood -adult reference range: 700-105 mg/dl -panic values <40 or >500 mg/dl |
|
|
fasting blood glucose comesb ack high
|
-hyperglycemia
-from any of those reasons -hypoglycemia: on insulin-overdose, insulinoma (adenoma in islet of langerhans), endocrine disorders (addisions- too little cortisol), liver disease, enzyme deficiency, nonfasting hypoglycemia, drugs, intense exercise, hematocrit >55% |
|
|
screening test:
Oral Glucose Tolerance Test |
-not required to dx DM
-indications: borderline FBG unexplained increase in triglycerides, neuropathy, impotence, renal disease or retinopathy confirmation of elevated FBG gestational DM screening |
|
|
pt prep for oral glucose test
|
-fast 12-16 hrs, no smoking and prologned bed rest
-eat >150 g of carbs for 3 days prior -D/C for 3 days hormones, oral contraceptives, steroids, salicylates, anti-inflammatory drugs, diuretics, hypoglycemic agents, antihypertensive agents, anticonvulsants, alcohol -hold daily insulin or oral hypoglycemix -reschedule if ill -no smoking or exercise during test |
|
|
OGTT steps
|
-drink cola, take blood urine sample at 30, 60, 120, 180 min
-look at glucose curves -blood glucose should peak in about 1 hour and come back to baseline in 2 hours |
|
|
diabetes diagnostic criteria
|
1. DM criterion 1: symptoms of DM with random plasma glucose >200
2. criterion 2: fasting plasma glucose (FPG) > 126 3. criterion 3: 2 hr post-prandial > 200 during OGTT *Impaired fasting glucose (IFG): 110-125 mg/dL *Impaired glucose tolerance (IGT): 2 hr post-prandial 140-199 *in b/t pre-diabetic |
|
|
gestational DM
|
-7% of preg
-pt develops hyperglycemia when preg -low risk: non screening if all true <25 yo, normal body weight, no FH of DM, no hx of abnl GTT, no hx of poor obstetric outcome, member of an ethinic group with low prevalence for DM |
|
|
hemoglobin A1
|
-currently used as a DM screening test but may be used as a diagnostic test in the furture
-it gves you a better index of the overall glucose exposure |
|
|
gestational DM- avg and high risk
|
-avg screen at 24-8wks
-high: obese, history, large baby, PCOS, glucosuria, FH |
|
|
screening for gestational DM
|
1 hour glucose challenge test:
-50 gram glocola challenge without fasting -if 1 hour glu > 140 mg/dl --> 3 hr OGTT 3 hour: -100 gram glucola challenge with fasting |
|
|
diagnostic criteria for 3 hr OGTT
|
Diagnostic criteria
FBG >95 mg/dL 1 hour > 180 mg/dL 2 hour > 155 mg/dL 3 hour > 140 mg/dL > 2 samples in diagnostic criteria = gestational DM |
|
|
home and office plasma blood glucose
|
-monitoring glycemic control
-checking for current bl. gluc level -serum, plasma, fingerstick -instrument and user variable, frequency variable (type 1 --> check several times a day; type 2 -->?) -allows rapid adjustment in treatment plan |
|
|
urinanalysis
|
-tests for monitoring glycemic control
-tels about previous blood gluc levels -gross screen for blood glucose control -look for glucose, protein and ketones in urine dipstick method: keep container closed tightly, false negatives for gluc with excess ingestion of salicylates or ascorbic acid (vit c) |
|
|
glycosylated hemoglobin
(hemoglobin A1c) |
-test for monitoring glycemic control
-reflects long term glycemic control (2-3 mo) -plasma blood specimen -no special pt prep -goal for diabetics <7% -test at time of diagnosis and for follow up -test limitations: increased RBc turnover, heme variants, drug use |
|
|
fructosamine
|
-test for monitoring glycemic control
-Glycosylated serum protein -Reflects short term glycemic control (3 weeks) -Useful as backup when Hgb A1c is unreliable -Serum blood sample (red top or SST tube) -Reference range 1.6-2.6 mmol/L |
|
|
summary of glycemic recommendations for non-preg adults with diabetes
|
**
|
|
|
diabetic ketoacidosis (DKA)
|
-life threatening type 1 complication
-serum glucose ~250-800 mg/dl -urine glucose 4+ -urine ketones 4+ -blood pH < 7.3 serum bicarb < 15 mEg/L |
|
|
nonketotic hyperosmolar syndrome
|
-life threatening type 2 complication
-Serum glucose >600 -Urine ketones ~ neg -Blood pH>7.3 morei n eldery, present dehydrated, lethargic or in coma; often precipitaed with lack of fluid intake -Prerenal azotemia -Serum bicarb > 20 mEq/L |
|
|
hypoglycemia
|
true:
-low serum glucose (<50 mg/dl) with coexisting symptoms consistent with hypoglycemia that dissipate with treatment (whipples triad) adrenergic symptoms: sweating, tremor, tachycardia, anxiety, weakness, hunger neuroglycopenic symtoms: dizziness, headache, blurry vision, confusion, convulsions, coma |
|
|
postprandial hypoglycemia
|
-Usually acute adrenergic symptoms
Etiology: -Functional hypoglycemia -Alimentary hypoglycemia (change in GI tract; ie gastrectomy) -Congenital deficiency of enzymes (galactosemia) -required for CHO metabolism |
|
|
fasting hypoglycemia
|
-subacute or chronic neuroglycopenic symptoms
etiology: 1. hyperinsulinism: insulinoma, meds, factitious (test and they have a lot of insulin but its not being made in their body) 2. alcohol and drugs 3. acquired liver or renal disease 4. enzyme defects 5. substrate deficiency 6. endocrine disorders |
|
|
hypoglycemia risks in pts with DM
|
-Excessive medication
-Wrong timing of medication -Missed meals -Excessive exercise -Alcohol -Increased age -Decreased renal function -Poor nutrition -Drug interactions |
|
|
hypoglycemia- dx
|
difficult without standardized diagnostic tests and cut off points
labs: glucose tolerance test 4-5 hrs, FBS, measure insulin level wtih C-peptide, thyroid function test, liver function test, cortisol levels, estrogen |
