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>=126 mg/dl

Diagnostic value of FBS in hyperglycemia

Carbohydrates

Hydrates of aldehyde or ketone derivates based on location of CO functional group

Types of carbohydrates

Monosaccharides, disaccharides, oligosaccharides, polysaccharides

MDOP

Glycol aldehyde

Simplest carbohydrate

Glucose

The only carbohydrate to be directly used for energy and stored as glycogen

Blood glucose

Brain is completely dependent on ????? for energy production

Central nervous system

2/3 of glucose utilization in resting adults occurs in????

Pyruvic acid, lactic acid, acetylcoenzyme A

Intermediate products of glucose metabolism

PLA

Carbon dioxide, water, adenosine triphosphate

Complete oxidation of glucose yields ...?????

CWA

Glucose, maltose, fructose, lactose, galactose

Reducing substances/sugars

GMFLG

Double bond and negative charge

present in enol anion that makes glucose an active reducing substance

Sucrose

Most common nonreducing sugar

Fructose + glucose

Pancreas

It is both an endocrine and exocrine organ in the control of carbohydrate metabolism

Pancreas as an endocrine gland

Secretes the hormones: insulin, glucagon and somatostatin from different cells residing in islets of Langerhans in the pancreas

Pancreas as an exocrine gland

Produces and secretes enzymes: amylase (responsible for the breakdown of ingested complex carbohydrates)

Pancreas

Its main function is for carbohydrate metabolism

An organ

Insulin

The primary hormone responsible for the entry of glucose into the cell

Insulin

Synthesized by the beta cells of the islets of Langerhans in the pancreas

Insulin

It is normally released when glucose levels are high

Insulin

It is the only hormone that decreases glucose levels; hypoglycemic agent

Insulin

It is stored from sources such as liver, fat, muscles

Insulin

It has a reciprocal relationship with glucagon

A hormone

Glycogenesis, lipogenesis, glycolysis

Insulin promotes... ???

3 process involved in CHO metabolism

Insulin

It decreases glycogenolysis

A hormone

Membrane permeability

Insulin enhances ...... to cells in the liver, muscle and adipose tissue

MP

Insulin-degrading enzyme

Found in RBCs as well as in other tissues that is responsible for serum insulin measurements to be falsely low in the presence of hemolysis

Glucagon

It is primary hormone responsible for increasing glucose; hyperglycemic agent

Glucagon

Synthesized by the alpha-cells of the islets of Langerhans in the pancreas

Glucagon

It is released during stress and fasting states

A hormone

Catabolic functions

Glucagon enhances ..... during fasting periods

CF

Glucagon

A hormone that promotes glycogenolysis

G

25-50 pg/mL

Normal value of fasting plasma glucagon concentrations

Hyperglycemic hormones

Other hormones that tend to increase glucose concentrations

CCGTAS

Hyperglycemic hormones

Cortisol and corticosteroids (glucocorticoids)

Primary promoter of gluconeogenesis

Hyperglycemic hormone

Cortisol and corticosteroids (glucocorticoids)

Hormones that are secreted by the cells of the zona fasciculata and zona reticularis of the adrenal cortex

Cortisol and corticosteroids (glucocorticoids)

Hormones that decrease intestinal entry of glucose into the cell

C and c

Cortisol and corticosteroids (glucocorticoids)

Hormones that promote gluconeogenesis and lipolysis

Catecholamines

Hormone that is released from the chromaffin cells of the adrenal medulla

Catecholamines

Hormone that inhibits insulin secretion and promotes glycogenolysis and lipolysis

Growth hormone (somatotrophic)

Hormones that is secreted by the anterior pituitary gland

Growth hormone (somatotrophic)

Hormone that decreases the entry of glucose into the cell

Growth hormone (somatotrophic)

Hormone that promotes glycogenolysis and glycolysis

Thyroid hormones

Hormone that promotes glycogenolysis, gluconeogenesis and intestinal absorption of glucose

T3 and T4

2 thyroid hormones

Adrenocorticotropic hormone (ACTH)

Secondary promoter of gluconeogenesis

Adrenocorticotropic hormone (ACTH)

Hormone that stimulates release of cortisol from the adrenal cortex

Adrenocorticotropic hormone (ACTH)

Hormone that promotes glycogenolysis and gluconeogenesis

Somatostatin

Hormone that is produced by the delta cells of the islets of Langerhans in the pancreas

Somatostatin

Hormone that is synthesized in the paraventricular and arcuate nuclei of the hypothalamus

Somatostatin

A neuroendocrine hormone

Somatostatin

Hormone that primarily inhibits the action of insulin, growth hormone and glucagon

Hyperglycemia and hypoglycemia

Clinical conditions of carbohydrate metabolism

Hyperglycemia

A clinical condition which is an increase in blood glucose concentrations

Hyperglycemia

A clinical condition that is toxic to beta cell function and impairs insulin secretion

SSD/PPHI

Causes of hyperglycemia

Stress, severe infection, dehydration/pregnancy, pancreatectomy, hemochromatosis, insulin deficiency or abnormal insulin receptor

>=126 mg/dl

Diagnostic value of FBS in hyperglycemia

70-110 mg/dl

Normal value of FBS

Laboratory findings of hyperglycemia

Increase glucose in plasma and urine; increase urine specific gravity; ketones in serum and urine; decrease blood and urine pH (acidosis); electrolyte imbalance (dec. Na+, inc. K+, dec. HCO3)

IIKDE

300-500mg/dl

value of period of plateau of plasma glucose with normal renal function

high serum osmolality

as a result of hyperglycemia

low sodium concentration

due to polyuria and in part to a shift of water from cells because of hyperglycemia

type 1 DM

more likely to produce ketones opposed to type 2 DM

type of DM

ketoacidosis

resulting from pH imbalance results from dehydration, electrolyte imbalance and acidosis

Hyperkalemia

It is almost always present as a result of the displacement of potassium from cells in acidosis

Kussmaul-Kien respiration

It usually decrease bicarbonate and total carbon dioxide

Deep respirations

Hypoglycemia

A clinical condition that results from an imbalance between glucose utilization and production

Hypoglycemia

A clinical condition that involves decreased glucose levels

Hypoglycemia

A clinical condition that affects the CNS (warning signs and symptoms) and is asymptomatic

Whipple's triad

Low blood glucose concentration, typical symptoms and symptoms alleviated by glucose administration

Hinimatay tapos pinainom ng juice (any sweet drinks) at biglang nagising

5-hour GTT

Diagnostic test of hypoglycemia

Glucose tolerance test

65-70 mg/dl

Hypoglycemic value where glucagon and other glycemic hormones are released into the circulation

<=60 mg/dl

value that strongly suggest hypoglycemia (series of random fasting serum specimens)

50-55 mg/dl (2.8-3.0 mmol/l)

Value of observable symptoms of hypoglycemia appear

55-60 mg/dl

Hypoglycemic value of plasma glucose of healthy males

40 mg/dl

Hypoglycemic value of plasma glucose in healthy females

Neurogenic and neuroglycopenic

Symptoms of hypoglycemia

Neurogenic

Tremors, palpitations, anxiety, diaphoresis

Neuroglycopenic

Dizziness, tingling, blurred vision, confusion, behavioral changes

Classification of hypoglycemia

Drug administration, critical illness, hormonal deficiency, endogenous hyperinsulinism, autoimmune hypoglycemia, non-beta cell tumors, hypoglycemia of infancy AMD childhood, alimentary (reactive) hypoglycemia, idiopathic (functional) postprandial hypoglycemia

DCHEANHAI

Drug administration

Insulin, alcohol, salicylates, sulfonamides, pentamidine

Classification of hypoglycemia; IASSP

Critical illness

Hepatic failure, sepsis, renal failure, cardiac failure, malnutrition

Classification of hypoglycemia; HSRCM

Hormonal deficiency

Epinephrine, glucagons, cortisol, growth hormone

Classification of hypoglycemia; EGCG

Endogenous hyperinsulinism

Pancreatic beta cell disorders

Classification of hypoglycemia

Autoimmune hypoglycemia

Insulin antibodies

Classification of hypoglycemia

Non-beta cell tumors

Leukemia, hepatoma, pheochromocytoma, lymphoma

Classification of hypoglycemia; LHPL

Hypoglycemia of infancy and childhood

Galactosemia, GSD, Reye's syndrome

Classification of hypoglycemia; GGR

Alimentary (reactive) hypoglycemia

Post-gastric surgery

Classification of hypoglycemia

Idiopathic (functional) postprandial hypoglycemia

Classification of hypoglycemia

Diabetes mellitus

It is a group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin receptors or both

DM

>=126 mg/dl

Diagnostic value of fasting plasma glucose concentration in DM

Glucosuria

It occurs when the plasma glucose level exceeds 180 mg/dl (9.99 mmol/l) with normal renal function

Ketosis

It develops in DM from excessive synthesis of acetyl-CoA

6:1

In severe DM, what is the ratio of beta-hydroxybuterate to acetoacetate

Insulin administration

The entire process of ketosis can be reversed by....

Type 1 and Type 2 DM

Classification of diabetes mellitus

Type 1 DM

Formerly known as Insulin Dependent Diabetes Mellitus (IDDM), Juvenile Onset Diabetes Mellitus, Brittle Diabetes, Ketosis-Prone Diabetes

IJBK

Type 1 DM

It is a result of cellular-mediated autoimmune destruction of the Beta cells of the pancreas

Type 1 DM

A classification of DM where diabetic individuals have insulinopenia (absolute insulin deficiency) due to loss of pancreatic beta cells and depend on insulin to sustain life and prevent ketosis

80-90%

Percentage of reduction in the volume of the beta cells required to induce symptomatic type 1 DM

Glutamic acid decarboxylase (GAD65) and insulin autoantibodies (IAA)

Individuals at greater risk of developing type 1 DM have high titer of multiple autantiodies - .... and .... (Free diabetes markers)

IAA

A free marker that is more common in young children who develop type 1 DM

GAD65

A free marker that is more common in adults

Signs and symptoms of type 1 DM

Polyuria, polydipsia, polyphagia, rapid weight loss, hyperventilation, mental confusion, possible loss of consciousness

PPPRHMP

Complications of type 1 DM

Microvascular disorders: nephropathy, neuropathy, retinopathy

Microalbuminuria test

test if glucose level reached to 50-200 mg/dl per hour (diabetic nephropathy)

Microalbuminuria test

Earliest indication of glomerular dysfunction associated with type 1 DM

Idiopathic type 1 DM

A form of type 1 DM that has no known etiology; it is strongly inherited; it does not have beta cell autoantibodies and have episodic requirements for insulin replacement

Type 2 DM

Formerly known as Non-Insulin Dependent Diabetes Mellitus, Adult Type/Maturity Onset Diabetes Mellitus, Stable Diabetes, Ketosis-Resistant Diabetes, Receptor-Deficient Diabetes Mellitus

NASKR

Kidney

First organ to be affected if you have type 1 DM; filters blood; glomeruli (filter)

Type 2 DM

It is characterized by hyperglycemia due to an individual's resistance to insulin; there is relative insulin deficiency

Type 2 DM

It is a classification of diabetes mellitus that is associated with strong genetic predisposition and not related to an autoimmune disease

Nonketotic hyperosmolar coma

Untreated type 2 DM will result to ????? due to overproduction of glucose (>300 mg/dl) accompanied by severe dehydration, electrolyte imbalance, increased BUN and creatinine

Risk factors of type 2 DM

Obesity, family history, advanced age, hypertension, lack of exercise, GDM, impaired glucose metabolism

OFAHLGI

45 and older; 3 years

It is recommended that adults ages ??????? be screened for diabetes every ?????, but screening should be performed earlier or more frequently if the individual is at high risk

Comparison between type 1 DM and type 2 DM is according to:

Pathogenesis, incidence rate, onset, risk factors, c-peptide levels, pre-diabetes, symptomatology, ketosis, medication

PIORCPSKM

Beta cells destruction

Pathogenesis of type 1 DM

Beta cells destruction

Pathogenesis of type 1 DM

Insulin resistance

Pathogenesis of type 2 DM

5-10%

Incidence rate of type 1 DM

Autoantibodies (-)

Pre-diabetes of type 2 DM

Symptoms develop abruptly

Symptomatology of type 1 DM

Symptoms develop gradually (asymptotic)

Symptomatology of type 2 DM

Common; poorly controlled

Ketosis of type 1 DM

Rare

Ketosis of type 2 DM

Insulin absolute

Medication of type 1 DM

Oral agents

Medication of type 2 DM

Metformin

Oral agents used for medication in type 2 DM

90-95%

Incidence rate of type 2 DM

Any; most common to childhood/teens

Onset of type 1 DM

Any; most common with advancing age, race/ethnicity, hypertension, dyslipidemia, polycystic ovarian syndrome

ARHDP

Genetic, autoimmune

Risk factors of type 1 DM

Genetic, obesity, sedentary lifestyle, polycystic ovarian syndrome, dyslipidemia and hypertension

Risk factors of type 2 DM

GOSPDH

C-peptide

Mainly differentiate type 1 and type 2 DM using fasting serum of 8-14 hours

Decreased or undetectable

C-peptide levels of type 1 DM

Detectable

C-peptide levels of type 2 DM

Autoantibodies (+)

Pre-diabetes of type 1 DM

5-10%

Incidence rate of type 1 DM

Autoantibodies (-)

Pre-diabetes of type 2 DM

Symptoms develop abruptly

Symptomatology of type 1 DM

Symptoms develop gradually (asymptotic)

Symptomatology of type 2 DM

Common; poorly controlled

Ketosis of type 1 DM

Rare

Ketosis of type 2 DM

Insulin absolute

Medication of type 1 DM

Oral agents

Medication of type 2 DM

Metformin

Oral agents used for medication in type 2 DM

Gestational diabetes mellitus (GDM)

A disorder characterized by impaired ability to metabolize carbohydrate usually caused by a deficiency of insulin, metabolic or hormonal changes

90-95%

Incidence rate of type 2 DM

Any; most common to childhood/teens

Onset of type 1 DM

Any; most common with advancing age, race/ethnicity, hypertension, dyslipidemia, polycystic ovarian syndrome

ARHDP

Genetic, autoimmune

Risk factors of type 1 DM

Genetic, obesity, sedentary lifestyle, polycystic ovarian syndrome, dyslipidemia and hypertension

Risk factors of type 2 DM

GOSPDH

C-peptide

Mainly differentiate type 1 and type 2 DM using fasting serum of 8-14 hours

Decreased or undetectable

C-peptide levels of type 1 DM

Detectable

C-peptide levels of type 2 DM

Autoantibodies (+)

Pre-diabetes of type 1 DM

5-10%

Incidence rate of type 1 DM

Autoantibodies (-)

Pre-diabetes of type 2 DM

Symptoms develop abruptly

Symptomatology of type 1 DM

Symptoms develop gradually (asymptotic)

Symptomatology of type 2 DM

Common; poorly controlled

Ketosis of type 1 DM

Rare

Ketosis of type 2 DM

Insulin absolute

Medication of type 1 DM

Oral agents

Medication of type 2 DM

Metformin

Oral agents used for medication in type 2 DM

Gestational diabetes mellitus (GDM)

A disorder characterized by impaired ability to metabolize carbohydrate usually caused by a deficiency of insulin, metabolic or hormonal changes

Gestational diabetes mellitus (GDM)

It occurs during pregnancy and disappears after delivery but, in some cases, returned years later

90-95%

Incidence rate of type 2 DM

Any; most common to childhood/teens

Onset of type 1 DM

Any; most common with advancing age, race/ethnicity, hypertension, dyslipidemia, polycystic ovarian syndrome

ARHDP

Genetic, autoimmune

Risk factors of type 1 DM

Genetic, obesity, sedentary lifestyle, polycystic ovarian syndrome, dyslipidemia and hypertension

Risk factors of type 2 DM

GOSPDH

C-peptide

Mainly differentiate type 1 and type 2 DM using fasting serum of 8-14 hours

Decreased or undetectable

C-peptide levels of type 1 DM

Detectable

C-peptide levels of type 2 DM

Autoantibodies (+)

Pre-diabetes of type 1 DM

5-10%

Incidence rate of type 1 DM

Autoantibodies (-)

Pre-diabetes of type 2 DM

Symptoms develop abruptly

Symptomatology of type 1 DM

Symptoms develop gradually (asymptotic)

Symptomatology of type 2 DM

Common; poorly controlled

Ketosis of type 1 DM

Rare

Ketosis of type 2 DM

Insulin absolute

Medication of type 1 DM

Oral agents

Medication of type 2 DM

Metformin

Oral agents used for medication in type 2 DM

Gestational diabetes mellitus (GDM)

A disorder characterized by impaired ability to metabolize carbohydrate usually caused by a deficiency of insulin, metabolic or hormonal changes

Gestational diabetes mellitus (GDM)

It occurs during pregnancy and disappears after delivery but, in some cases, returned years later

90-95%

Incidence rate of type 2 DM

Gestational diabetes mellitus (GDM)

It is a type of glucose intolerance with onset or first recognition during pregnancy (diabetic women who become pregnant are not included in this category)

Any; most common to childhood/teens

Onset of type 1 DM

Any; most common with advancing age, race/ethnicity, hypertension, dyslipidemia, polycystic ovarian syndrome

ARHDP

Genetic, autoimmune

Risk factors of type 1 DM

Genetic, obesity, sedentary lifestyle, polycystic ovarian syndrome, dyslipidemia and hypertension

Risk factors of type 2 DM

GOSPDH

C-peptide

Mainly differentiate type 1 and type 2 DM using fasting serum of 8-14 hours

Decreased or undetectable

C-peptide levels of type 1 DM

Detectable

C-peptide levels of type 2 DM

Autoantibodies (+)

Pre-diabetes of type 1 DM

5-10%

Incidence rate of type 1 DM

Autoantibodies (-)

Pre-diabetes of type 2 DM

Symptoms develop abruptly

Symptomatology of type 1 DM

Symptoms develop gradually (asymptotic)

Symptomatology of type 2 DM

Common; poorly controlled

Ketosis of type 1 DM

Rare

Ketosis of type 2 DM

Insulin absolute

Medication of type 1 DM

Oral agents

Medication of type 2 DM

Metformin

Oral agents used for medication in type 2 DM

Gestational diabetes mellitus (GDM)

A disorder characterized by impaired ability to metabolize carbohydrate usually caused by a deficiency of insulin, metabolic or hormonal changes

Gestational diabetes mellitus (GDM)

It occurs during pregnancy and disappears after delivery but, in some cases, returned years later

90-95%

Incidence rate of type 2 DM

Gestational diabetes mellitus (GDM)

It is a type of glucose intolerance with onset or first recognition during pregnancy (diabetic women who become pregnant are not included in this category)

Last trimester or 6-7 months

Stage of pregnancy where GDM occurs

Any; most common to childhood/teens

Onset of type 1 DM

Any; most common with advancing age, race/ethnicity, hypertension, dyslipidemia, polycystic ovarian syndrome

ARHDP

Genetic, autoimmune

Risk factors of type 1 DM

Genetic, obesity, sedentary lifestyle, polycystic ovarian syndrome, dyslipidemia and hypertension

Risk factors of type 2 DM

GOSPDH

C-peptide

Mainly differentiate type 1 and type 2 DM using fasting serum of 8-14 hours

Decreased or undetectable

C-peptide levels of type 1 DM

Detectable

C-peptide levels of type 2 DM

Autoantibodies (+)

Pre-diabetes of type 1 DM

24-28 weeks of gestation

Screening should be performed between ????? (Without fasting)

2-hour GCT (50g glucose load)

Screening and diagnosis of GDM is performed by

3-hour GTT (100g glucose load) (>140 mg/dl) with fasting

Confimatory test of GDM

FBS - >= 92-95 mg/dl


Glucose administration


1hr GTT - >= 180 mg/dl (positive)


2hr GTT - >= 153-155 mg/dl (positive)


3hr GTT - >= 140 mg/dl (optional) CONFIRMATORY

Diagnostic criteria for GDM

2 criteria is met

GDM is diagnosed if ????

Dilantin and pentamidine

Drug or chemical inducers of beta cell dysfunction; anti-epileptic and anticonvulsant drugs

Thiazides and glucocorticoids

Substances that Impair insulin action

Down syndrome, klinefelter's syndrome, rabson-mendengall syndrome, leprechaunism, huntington's chorea, Turner syndrome

Genetic syndromes

DKRLHT

Cystic fibrosis, neoplasia, hemochromatosis

Exocrine disorders

CNH

Venous plasma glucose

Standard clinical specimen in glucose methodologies

15% lower

Fasting glucose in whole blood is ????? than in serum or plasma

Within 30 minutes

Fdd

Respiratory distress syndrome, hypocalcemia and hyperbilirubinemia

Infants born to diabetic mothers are at increased risk for ??????

RHR

6-12 weeks postpartum

After giving birth, women with GDM should be evaluated for how many weeks????

10 years in 30-40% of cases

GDM converts to DM within ????

Pancreatic disorders/pancreatectomy, endocrine disorders, drug or chemical inducer of beta cell dysfunction, genetic syndromes, exocrine disorders

Other specific types of diabetes

PEnDGEx

Cushing's syndrome, pheochromocytoma, acromegaly, hyperthyroidism

Endocrine disorders

CPAH

Cushing's syndrome

Increased cortisol

Pheochromocytoma

Increased catecholamines

Acromegaly

Increased growth hormone in adult

Within 30 minutes; sodium fluoride

A serum specimen is appropriate for glucose analysis if serum is separated from cells ????? But if serum is in contact with cells for longer than 30 minutes, a preservative such as ????? that inhibits glycolysis should be added

7 mg/dl lower; tissue metabolism

Venous plasma glucose is ????? than capillary blood due to ?????

Oxidation-reduction method and condensation method

Chemical methods

Alkaline copper reduction method and alkaline ferric reduction method (hagedorn jensen)

2 oxidation reduction methods

Folin Wu method, Nelson Somogyi method, Neocuproine method (2,9 Dimethyl 1,10 Phenantroline Hydrochloride), Benedict's method (modification of Folin Wu)

4 alkaline copper reduction methods

Reduction of cupric ions to cuprous ions forming cuprous oxide in hot alkaline solution by glucose

Principle of alkaline copper reduction method

Arterial blood glucose

Capillary blood glucose is same with ????

CSF glucose concentrations

It should be approximately 60% of the plasma concentrations

Peritoneal fluid glucose

It is same with plasma glucose

Fasting (2 mg/dl/decade)


Postprandial (4 mg/dl/decade)


Glucose challenge (8-13 mg/dl/decade)

Plasma glucose levels increased with age

Room temperature (20-25 deg C); 7 mg/dl/hour

At ?????, glycolysis decreases glucose by ???? in normal uncentrifuged coagulated blood

Refrigerated temperature (4 deg C); 1-2 mg/dl/hour

At ????, glucose is metabolized at the rate of about ????

-20 deg C

With long term specimen storage, even at ????, glucose values decrease significantly and progressively

WBC and RBC

They metabolize glucose resulting to decrease value in clotted, uncentrifuged blood

Glycolysis

Leukocytosis leads to ????

Hot alkaline solution

Process on how to convert cupric to cuprous ions forming cuprous oxide

Cuprous ions

Alkaline copper tartrate using glucose and heat will yield to ?????

Phosphomolybdic acid or phosphomolybdenum blue

End product of folin wu method (cuprous ions + phosphomolybdate)

Arsenomolybdic acid or arsenomolybdenum blue

End product of nelson somogyi method (cuprous ions + arsenomolybdate)

Cuprous-Neocuproine complex

End product of neocuproine method (cuprous ions + neocuproine)

Blue

End color of Folin Wu method

Blue

End color of Nelson Somogyi method

Yellow or yellow orange

End color of neocuproine method

Benedict's method

Oxidation reduction method used for the detection and quantitation of reducing substances in body fluids like blood and urine

Citrate and tartrate

Stabilizing agent used in Benedict's method

Alkaline ferric reduction method

It involves reduction of yellow ferricyanide to a colorless ferrocyanide by glucose

Alkaline ferric reduction method

Also known as inverse colorimetry

Ortho-toluidine (dubowski method)

Only condensation method

Glycosamine and Schiff's base

End products of ortho-toluidine (dubowski method)

Dubowski method

Uses glucose and aromatic amines with glacial HAC and heat

Enzymatic methods

Method that acts on glucose ONLY but not on other sugars and not on other reducing substances

Glucose oxidase method

Enzymatic Method that measures the beta-D glucose

Glucose oxidase method

Enzymatic method that measures CSF and urine glucose

Colorimetric enzymatic method

Other term for glucose oxidase method

Glucose oxidase method, hexokinase method, glucose dehydrogenase method, dextrostics (cellular strip), interstitial glucose measuring device

Types of enzymatic method

GHGDI

Colorimetric glucose oxidase method (Saifer Gernstenfield Method) and polarographic glucose oxidase

Gluconic acid and peroxide (H2O2)

End products of the first reaction in Saifer Gernstenfield method

Oxidized chromogenic substance and water (H2O)

End products of the second reaction in Saifer Gernstenfield method)

H2O2 + chromogenic substance with peroxide will yield to

Ascorbic acid

It inhibits oxidized chromogenic substances and gives false decrease of glucose because it reacts on the second reaction

Polarographic glucose oxidase

A glucose oxidase method that measures rate of oxygen consumption which is proportional to glucose concentration

Hydrogen peroxide

Glucose oxidase in the reagent catalyzes the oxidation of glucose by oxygen under first order condition

Consumption of oxygen on an oxygen-sensing electrode

The enzymatic conversion of glucose is quantitated by ????

Molybdate, iodide, catalase, ethanol

The hydrogen peroxide is prevented from re-forming oxygen by ??????

MICE

CH3CHO (acetaldehyde) and 2H2O

End products of hydrogen peroxide and ethanol (h2o2 + C2H5OH) using catalase

I2 and 2H2O

End products of H2O2 + 2H + 2I with molybdate

Hexokinase method

Enzymatic method which is the most specific glucose method; reference method

Heparin, EDTA, fluoride, oxalate or citrate

Tubes used in plasma collection for hexokinase method

HEFOC

Urine, CSF, and serous fluids

Other samples used in hexokinase method

UCS

Nicotinamide Adenine Dinucleotide Phosphate (NADP)

Acts a coenzyme in hexokinase method

Glucose-6-phosphate dehydrogenase (G-6-PD)

Most specific reagent for glucose in hexokinase method

Glucose oxidase method and glucose dehydrogenase method

2 enzymatic methods that use mutarotase

Ascorbate, bilirubin, uric acid, glutathione, creatinine, l-cysteine, l-dopa, dopamine methyldopa and citric acid

False decreased values of glucose in glucose oxidase method is due to what substances ?????

ABUGCIIDMC

Nicotinamide Adenine dinucleotide hydrogen (NADH)

Increases the ability of RBC to consume glucose (cause of increase uptake of glucose in RBC); promotes glycolysis

Presence of bleach

Can cause false increase in glucose oxidase method

Hemolysis and icterisia

Can cause false decrease of plasma glucose in hexokinase method

Hemolysis

It is due to presence of hemoglobin that inhibits G6PD in hexokinase method

> 0.5 hemoglobin/dl

Hemolyzed samples containing ????? are unsatisfactory for hexokinase method because phosphate esters and enzymes released from RBCs interfere with the assay generating NADH

Ascorbic acid and uric acid

Hexokinase method is not affected by these substances????

NADH

Reduced form of NAD

Color change reaction

Enzymatic conversion of glucose to product is quantitated by a ????? at the last of a series of coupled chemical reactions (kinetic analysis)

Glucose Dehydrogenase Method

In this enzymatic method, glucose is reduced to produce a chromophore that is measured spectrophotometrically or an electric current

Glucose Dehydrogenase Method

In this enzymatic method, the amount of NADH generated is proportional to the glucose concentration

Glucose Dehydrogenase Method


Method


Method

This enzymatic method provides results in close agreement with hexokinase procedures

Mutarotase

This substance is added to shorten the time necessary to reach equilibrium

Beta-D glucose

End product of alpha-D glucose + mutarotase (first reaction in glucose dehydrogenase method)

D-gluconolactone + NADH

End products of Beta-D glucose + NAD with Glucose Dehydrogenase (2nd reaction in Glucose dehydrogenase method)

MTTH (blue color) + NAD

End products of MTT + NADH with diaphorase (3rd reaction in glucose dehydrogenase method)

Dextrostics (cellular strips)

An enzymatic method that is important in establishing correct insulin amount for next dose

Dextrostics (cellular strips)

An enzymatic method that is effective in reducing the rate of development of diabetic complications

>=140 mg/dl (7.8 mmol/L);


fasting plasma glucose, HbA1c, or OGTT;


venous samples

In Dextrostics (cellular strips), an individual with a capillary glucose of ????? should be rescreened with a ?????? using ??????

Glucometer

Example of Dextrostics (cellular strips)

Interstitial Glucose Measuring Device

An enzymatic method that is used for continuous monitoring of glucose levels in people with diabetes

Interstitial Glucose Measuring Device

An enzymatic method that uses electrochemical methods to automatically and frequently measure glucose levels in the interstitial fluid of dermis or subcutaneous fat tissue, and require repeated calibration to plasma or whole blood glucose levels

Interstitial Glucose Measuring Device

An enzymatic method that provides result that gives information about glucose patterns over hours to days

7 mg/dl lower; tissue metabolism

Venous plasma glucose is ????? than capillary blood due to ?????

Oxidation-reduction method and condensation method

Chemical methods

Alkaline copper reduction method and alkaline ferric reduction method (hagedorn jensen)

2 oxidation reduction methods

Folin Wu method, Nelson Somogyi method, Neocuproine method (2,9 Dimethyl 1,10 Phenantroline Hydrochloride), Benedict's method (modification of Folin Wu)

4 alkaline copper reduction methods

Reduction of cupric ions to cuprous ions forming cuprous oxide in hot alkaline solution by glucose

Principle of alkaline copper reduction method

Arterial blood glucose

Capillary blood glucose is same with ????

CSF glucose concentrations

It should be approximately 60% of the plasma concentrations

Peritoneal fluid glucose

It is same with plasma glucose

Fasting (2 mg/dl/decade)


Postprandial (4 mg/dl/decade)


Glucose challenge (8-13 mg/dl/decade)

Plasma glucose levels increased with age

Room temperature (20-25 deg C); 7 mg/dl/hour

At ?????, glycolysis decreases glucose by ???? in normal uncentrifuged coagulated blood

Refrigerated temperature (4 deg C); 1-2 mg/dl/hour

At ????, glucose is metabolized at the rate of about ????

-20 deg C

With long term specimen storage, even at ????, glucose values decrease significantly and progressively

WBC and RBC

They metabolize glucose resulting to decrease value in clotted, uncentrifuged blood

Glycolysis

Leukocytosis leads to ????

Interstitial Glucose Measuring Device

An enzymatic method that provides result that gives information about glucose patterns over hours to days

Trend analysis

In Interstitial Glucose Measuring Device, this can reveal useful findings for modifying treatment, such as unsuspected nocturnal hypoglycemia or postprandial hypoglycemia

Only supplemental

Interstitial Glucose Measuring Device used for glucose measurement is ????? - may supplement but cannot replace conventional home blood glucose monitoring

Slow (5-30) equilibrium with capillary blood glucose

Interstitial glucose is in ????? and therefore is not equal to blood glucose, except in stable systems

how many minutes

Random Blood Sugar (RBS)


Fasting Blood Sugar (FBS)


2-hour Postprandial Blood Sugar (2-Hour PBBS)


Glucose Tolerance Test (GTT)

Samples for glucose measurement

RF2G

RBS

Sample that is requested during insulin shock and hyperglycemic ketonic coma

FBS

It is a measure of overall glucose homeostasis

NPO at least 8 hours (6-8hrs) before the test

Requirement for FBS

RBS value: >=160 mg/dl (8.9 mmol/L)


FBS, HbA1c, 2-hour OGTT

RBS value of suspected for diabetes mellitus; must undergo what tests ???

2-hour PBBS

sample for glucose measurement without fasting (morning collection that evaluates hypoglycemia and hyperglycemia)

>= 140 mg/dl - hyperglycemia


<= 60 mg/dl - hypoglycemia

2-hour PBBS value for hyperglycemia and hypoglycemia

2-hour PBBS

It measures how well the body metabolize glucose

GTT

It is used to determine how well the body metabolize glucose over a required period of time, same with 2-HPBBS

GTT

It should be performed to diagnose gestational diabetes

GTT

It is not generally recommended for routine clinical use in the diagnosis of diabetes (for DM and GDM)

Thyrotoxicosis

Caused by hyperthyroidism

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Impaired glucose fasting

It is characterized by fasting blood glucose concentration less than those required for the diagnosis of diabetes

Impaired fasting glucose

The OGTT is between normal and diabetic values (2nd hour OGTT = 140-199mg/dL

True

True or False:



Normally, serum glucose levels rise and them fall within about a 2-hour period.

True

True or False:



If the glucose levels remain elevated, however, the diagnosis of diabetes mellitus may again be made.

True

True or False:



If glucose is detected in the urine at any point, evidence for this condition is also obtained, although absence of urinary glucose does not in any way rule out DM.

True

True or False:



If glucose is detected in the urine at any point, evidence for this condition is also obtained, although absence of urinary glucose does not in any way rule out DM.

Glycosylated Hemoglobin

Aso known as glycated hemoglobin.

HbA1c

Glycosylated Hemoglobin

It is the largest subfraction of normal hemoglobin A in both diabetic and nondiabtletic individuals.

Glycosylated hemoglobin

It is the hemoglobin A that is irreversibly glycosylated at one or both N-terminal valines of the Beta chains of the tetramic hemoglobin molecule, including hemoglobin that may also (but not solely) be fly cost later on lysine residues.

Glycosylated hemoglobin

It represents a "weighted" average of glucose levels, with youngest erythrocytes contributing to a greater extent than older ones.

Glycosylated hemoglobin

It is a reliable method in the monitoring of long-term glucose control.

HbA1c

3-6 months

HbA1c levels should be performed every ??? in the individuals with diabetes to monitor glycemic control using certified method.

12-24 weeks

Glycosylated hemoglobin

Traceable to diabetes Control and Complications Trial reference (DCCT) method.

Diabetes Control and Complications Trial

DCCT

True

True or False:



Dietary status on the day of the test has no effect on HbA1c.

Electrophoresis, Immunoassay, HPLC, Affinity Chromatography

Measurement Methods for HbA1c

EIHAC

True

True or False:



It is recommend that HbA1c be measured twice a year for patients who are meeting treatment goals, and quarterly for non-compliant patients.

2-4 months or 2-6 months

HbA1c Diagnostic Significance:



It reflects the average glucose level over the previous ???

Even number.

Carbohydrates

Compounds that contain, hydrogen and oxygen

Cx(H2O)y

What is the general formula of carbohydrates?

β€’ provide energy to the body


β€’ part of the structural integrity of the cell membrane


β€’ determines blood type


β€’ essential component of nucleic acids

What are the functions of carbohydrates?

β€’ glucose


β€’ galactose


β€’ fructose

Examples of Monosaccharides

GGF

β€’ Maltose = 2 glucose


β€’ Lactose = galactose + glucose


β€’ Sucrose = fructose + glucose

Examples of Dissacharides

MLS

β€’ starch


β€’ cellulose


β€’ glycogen

Examples of Polysaccharides

SCG

Ptyalin

Salivary amylase

Mouth


β€’ Salivary glands produce salivary amylase (ptyalin) which digest carbohydrates in the mouth



β€’ Food goes to the esophagus



β€’ Food goes to the stomach (no carbohydrate digestion)



β€’ Food goes to the intestine (pancreatic amylase) is released from the pancreas and passes through the bile duct and into the intestines



β€’ Long chain of carbohydrates are degraded into glucose by the action of pancreatic amylase



β€’ Glucose is absorbed into the blood circulation (leading to hyperglycemia)



β€’ Hyperglycemia triggers release of insulin by the Beta cells odlf the pancreas



β€’ Insulin release leads to increased cellular uptake of glucose



β€’ Glucose enters the cell



β€’ Glucose in the blood decreases

Pathway of Carbohydrate Metabolism

10

β€’ Glycolysis


β€’ Gluconeogenesis


β€’ Glycogenolysis


β€’ Glycogenesis


β€’ Lipogenesis


β€’ Lipolysis

Process involved in Carbohydrate Metabolism

GGGGLL

Glycolysis

Metabolism of glucose molecule to pyruvate or lactate

Glycolysis

Decrease blood glucose since glucose is consumed to produce lactate or pyruvate

Gluconeogenesis

Formation of glucose-6-phosphate from non-carbohydrate sources

Gluconeogenesis

Increase blood glucose since new glucoses are formed from other sources

Glycogenolysis

Breakdown of glycogen to glucose for use as energy

Glycogenolysis

Increases glucose since glycogen is degraded into glucose molecules

Glycogenesis

Conversion of glucose to glycogen for storage

Glycogenesis

Decreases glucose since excess glucoses in the body is stored in the liver and skeletal muscles as glycogen

Lipogenesis

Conversion of carbohydrates to fatty acids

Lipogenesis

Decreases glucose since carbohydrates are converted into fatty acids and stored as fats

Lipolysis

Decomposition of fats

Lipolysis

Increases glucose because fats are converted into consumable glucose

Pancreas and Liver

Organs involved in carbohydrate regulation

PL

Pancreas

Has exocrine and endocrine function

Pancreas as Endocrine gland

Refers to the production of hormones

Pancreas as Exocrine gland

Leads to production of enzyme

Glucagon

Hormone that secreted by the alpha cells of the pancreas and leads to the increase in the blood glucose levels

Glucagon

Hyperglycemic agent

Insulin

Hormone secreted by the Beta cells of the pancreas and leads to the decrease in blood glucose levels

Insulin

Synthesized as proinsulin, in which the C-peptide in cleaved in order to convert it to the active insulin.

Somatostatin

Hormone secreted by the delta cells of the pancreas and causes inhibition of glucagon and insulin

Pancreatic amylase

Enzyme that degrades carbohydrates

Lipase

Enzyme that cleaves triglycerides

Liver

Functions in the production and regulation of carbohydrates, lipids and protein

Liver

Reposnsible for the formation of glycogen

Diabetic ketoacidosis

pH imbalance results from dehydration, electrolyte imbalance and acidosis

Diabetic ketoacidosis

Serious complication of diabetes that occurs when your body produces high levels of blood acid called ketones.

Diabetic ketoacidosis

It develops when your body is unable to produce enough insulin

DM - increase specific gravity of urine


DI - decrease specific gravity of urine

Differentiate DM and DI based on urine specific gravity

Vasopressin (antidiuretic hormone)

DI lacks what hormone????

Diabetes insipidus

A rare form of diabetes caused by a deficiency of the pituitary hormone vasopressin, which regulated the kidney function.

Carbohydrates - without nitrogen (CHO)


Protein - with nitrogen (CHON)

Differentiate carbohydrates from proteins

GTT

It is a multiple blood sugar test