CARBOHYDRATES PART 2

Type 2 diabetes mellitus

Indicates hyperglycemia due to an individual’s resistace to insulin with defective insulin secretion;

Associated with strong genetic disposition and not usually related to an autoimmune disease

Glucagon

Epinephrine

T4

What hormone promotes glycogenolyis (glycogen to glucose)?

Cortisol and t4

What hormone promotes gluconeogenesis (glycogen to glucose)?

Epinephrine

Cortisol

What hormone promotes lipolysis? (TAG-FA to glucose)

Nonketotic hyperosmolar coma

Untreated type 2 DM will result in what?

>300 mg/dL

Severe dehydration

Electrolyte imbalance (low sodium + high potassium_

Increased BUN and creatinine

Untreated type 2 DM will result in nonketotic hyperosmolar coma due to what?

Obesity

Family history

Advanced age

Hypertension

Lack of excercise

GDM

Impaired glucose metabolism

Risks factors of type 2 DM (O, FH, AA, H, LoE, G, IGM)

3 years

It is recommended that adults ages 45 and older be screened for DM every how many years?

B cell destruction

Pathogenesis of Type 1 DM

Insulin resistance

Pathogenesis of Type 2 DM

5-10%

Incidence of Type 1 DM

90-95%

Incidence of Type 2 DM

Childhood/teens (Any age)

Onset of Type 1 DM

Adult (any age)

Onset of Type 2 DM

Genetics

Autoimmune

Risk factor of Type 1 DM

Decreased or undetectable

C-peptide of Type 1 DM

Autoantibodies (+)

Pre-diabetes of Type 1 DM

Abruptly

Symptomatology of Type 1 DM

common; poorly controlled

Ketosis of Type 1 DM

Parenteral insulin

Medication of Type 1 DM

Detectable

C-peptide levels of Type 2 DM

Autoantibodies (-)

Prediabetes of Type 2 DM

Gradually

Symptomatology of Type 2 DM

Rare

Ketosis of Type 2 DM

Hypoglycemic medication

Medication of Type 2 DM

Gestational diabetes mellitus

Due to impaired ability to metabolize carbohydrates usually caused by a deficiency of insulin, metabolic or hormonal changes

Pregnancy

When does gestational DM occur?

Yes

Does GDM disappear after delivery?

24-28 weeks of gestation

GDM screening should be performed when?

2 hour OGTT

Screening and diagnosis of GDM is through what?

One step method

Two step method

Diagnostic test of GDM

One-step method

What diagnostic test is commonly used?

75 grams

How much glucose load does one-step method use?

50 grams

How much glucose load does two-step method use initially?

100 g

How much glucose load does two-step method use as a follow up?

>92 mg/dL

FBS diagnostic criteria for GDM (one-step method)

>180 mg/dl

1-hour sample diagnostic criteria for GDM (one-step method)

>153 mg/dl

2-hour sample diagnostic criteria for GDM (one-step method)

6-12 weeks

After giving birth, women with GDM should be evaluated how long post-partum?

Pancreatogenic DM

Also known as type 3c DM;

Develops as an outcome of a pancreatic disease such as chronic pancreatitis or carcinoma;

Characterized by insulin deficiency and loss of pancreatic polypeptide

Maturity onset diabetes of the youth

Form of monogenic diabetes;

Believed to be caused by damage to the pancreatic beta cells;

Usually asymptomatic, non-ketotic, and hyperglycemia predominantly appears between 20 years to 30 years of age in otherwise normal weight young adults;

Its gene affect secretion via impairment of insulin sensing, glucose metabolism in beta cells or activation of ATP-depndent potassium channels

Absence of specific islet cell autoantibodies;

With residual c-peptide

Distinct featuer of MODY

Neonatal diabetes mellitus

Infantile diabetes or congenital diabetes;

Form of monogenic diabetes that occur in infants less than 6 months of age;

<6 months

NDM occurs in infants of what age?

Persistent hyperglycemia

PFG>250 mg/dL

Pathognomonic feature of NDM

Genetic mutation (KCNJ11 and ABCC8)

Most common cause of permanent of NDM

Serum

Glucose is measured most commonly in what sample?

10-15% lower

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

7 mg/dL lower

Venous blood glucose is what than capillary blood?

60%

CSF glucose concentration should be approximately what of the plasma concentration?

0.5-0.8

CSF/plasma glucose ration normally ranges from what?

7 mg/dL/hour

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

2 mg/dl/hour

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

Leukocytosis

What can lead to excessive glycolysis?

30 minutes

A serum specimen is appropriate for glucose analysis is serum is separated from the cells within how many minutes?

Sodium fluoride

What preservative can inhibit glycolysis?

Alkaline copper reduction method

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

Phosphomolybdenum blue

Folin Wu result

Arsenomolybdenum blue

Nelson-somogyi result

Cuprous-neocuproine complex (yellow or yellow orange)

Neucuproine result

Benedict's method

Used for the detection and quantitation of reducing substances in body fluids like blood and urine

Citrate or tartrate

Stabilizing agent of benedict’s method

Alkaline ferric reduction method (hagedorn-jensen)

Involved reduction of a yellow ferricyanide to a colorless ferrocyanide by glucose

Ortho-toluidine (dubowski method)

Glucose condenses with an aromatic amine, o-toluidine, dissolved in glacial acetic acid when heated, forming a colored N-glycosylamine product

Enzymatic method

Acts on glucose but not on other sugars and not on other reducing substances

Colorimeteric glucose oxidase method (trinder)

One of the commonly used enzymatic measures of plasma glucose;

Measures CSF and urine glucose, and other paracentesis fluids

B-d glucose

Colorimetric glucose oxidase method measures what?

Mutarotase enzyme reagent

Colorimetric glucose oxidase method contains what?

Polarographic glucose oxidase method

Measures the rate of oxygen consumption which is proportional to glucose concentration

Glucose oxidase

Catalyzes the oxidation of glucose by oxygen under first order conditions, forming hydrogen peroxide

Catalase

Inhibits reverse movement of hydrogen peroxide back to the sample chamber that may cause interference in the analysis

Whole blood

Polarographic glucose oxidase method cannot utilize what specimen?

Hexokinase method

Most specific enzymatic method for glucose determination;

routine method for measurement of glucose

Glucose dehydrogenase method

Glucose is reduced to produce a chromophore that is measured spectrophotometrically or with the use of an electrical current

Glucose concentration

In glucose dehydrogenase method, the amount of NADH is proportional to the what?

Dextrostics

Important in establishing correct insulin amount for next dose;

Effective in reducing the rate of development of diabetic complications

Interstitial glucose measuring device

Used for continuous monitoring of glucose levels in persons with DM;

Utilizes electrochemical process to automatically measure glucose levels in the interstitial fluid of dermis of subcutaneous fat tissue

Random blood sugar

Requested during insulin shock and hyperglycemic ketonic coma

Fasting blood sugar

Measure of overall glucose homeostasis;

70-99 mg/dL

FBS non-DM

>126 mg/dL

FBS diabetes mellitus

Impaired fasting glucose

Characterized by fasting blood glucose concentration between normal and diabetic values

70-99 mg/dL

Non-diabetic criteria for fasting plasma glucose/fasting blood sugar

100-125 mg/dL

Impaired plasma glucose criteria for fasting plasma glucose/fasting blood sugar

>126 mg/dL

Diabetes mellitus criteria for fasting plasma glucose/fasting blood sugar

60-100 mg/dL

For children, the plasma glucose concentration for non-diabetic is what?

2-hour post prandial blood sugar

Measures the response of the body to a full meal;

Detemines how the body metabolizes glucose

<140 mg/dL

Non-DM 2-HPPBS

>140 mg/dL

DM or hyperglycemia 2-HPPBS

Glucose tolerance test

Multiple blood sugar test;

Used to determine how well the body metabolizes glucose over a required period of time

Janney-isaacson method

Most common OGTT

30-60 mg/dL

30 minute plasma glucose level after intake of glucose load

20-50 mg/dl

1 hour plasma glucose level after intake of glucose load

5-15 mg/dl

2 hour plasma glucose level after intake of glucose load

Intravenous glucose tolerance test (IVGTT)

Recommended for DM patients with gastrointestinal disorders;

Fasting blood sample is required

0.5 g/kg body weight

Glucose load of IVGTT

2 hr PG <140 mg/dL

Normal/non-DM oral glucose tolerance test result

2 hr PG 140-199 mg/dl

Impaired GTT oral glucose tolerance test result

2 hr PG >200 mg/dl

Diabetes mellitus oral glucose tolerance test result

glycolysated hemoglobin (HbA1c)

Stable ketoamine and a product of a covalent reaction between glucose and the a-amino group of b-chain of hemoglobin;

Largest subfraction of normal hemoglobin A in both diabetic and non-diabetic individuals;

Represents a weighted average of glucose levels, with the youngest RBC contributing to the measurement