cc carbs part 2

serum or plasma

most commonly used specimen

venous plasma

standard clinical specimen

capillary blood

specimen collected when bedside (poct) is applied

11%

glucose concentration in whole blood is — lower than in plasma

• room temperature

• 7 mg/mg/dl/hour

• 4C

• 2 mg/dl/hour

glucose is metabolized at — at a rate of — at —, glucose decreases by approximately —

0.0555

conversion factor of glucose

30 minutes

a serum specimen should be separated from the cells within

sodium flouride

if serum specimen is separated crom the cells longer than 30 minutes, add —

2mg of sodium flouride

If WB is refrigerated, — per milliliter of WB prevents glycolysis for up to 48 hours.

• 48 hours

• -20C

When refrigerated glucose is stable in serum or plasma for —, with long-term specimen storage, even at — glucose, values decrease significantly and progressively

Fasting Blood Sugar (FBS) or Fasting Blood Glucose

• Screening test for DM

• taken after at least 8 hours of fasting

70-99 mg/dl

normal fasting blood glucose value

100-125 mg/dl

impaired fasting glucose value

126 mg/dl above

provisional diabetes diagnosis value

random blood sugar

• Sample is collected at anytime of the day

• Usually used for emergency cases

2-Hour Post Prandial Blood Sugar (PPBS)

75g of glucose load is administered and drawn after 2 hours for sample draw (1 time)

○ After consumption of food

glucose challenge test

multiple blood sugar test

other term for glucose tolerance test

Oral Glucose Tolerance Test (OGTT)

75g glucose load, plasma glucose is drawn 2 hours later and is performed if patient is not pregnant

3 samples

Under gestational DM, the 2-hour OGTT requires — samples if the patient is pregnant

• 75g

• 1.75 g/kg

OGTT

Adult dose is —; children — of glucose

less than or equal to 140 mg/dl

OGTT

normal glucose tolerance test

140-199 mg/dl

OGTT

impaired glucose tolerance

greathan or equal to 200 mg/dl

OGTT

provisional diabetes diagnosis

Intravenous Glucose Tolerance Test

This is done when the patient has Malabsorption Syndrome or altered gastric ohysiology

• invasive

Glycosylated Hemoglobin/Hemoglobin A1c (HbA1c)

Is a more reliable method of monitoring long-term diabetes control over the previous 2-3 month period

35 mg/dL

HbA1c

For every 1% increase in HbA1c, there is a —

whole blood in edta

specimen used for HbA1c

• 4%-6%

• 5.7%-6.4%

• ≥ 6.5%

HbA1c results:

○ Normal: — (Henry’s 21st ed)

○ Increased risk for diabetes:

○ Diabetes:

Fructoseamine

reflects the concentration of glycated albumin

fructoseamine

used for monitoring glycose control over the previous 2-3 weeks

205-285 umol/L

reference value of fructoseamine

enzymatic methods

commonly used method in the laboratory

Alkaline Copper Reduction Method

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

cuprous oxide

alkaline copper reduction method

• In the reaction, glucose reacts with Alkaline Copper

  Tartrate in a hot alkaline solution forming

Folin Wu method

Cuprous oxide reacts with phosphomolybdate to

produce Phosphomolybdic Acid / Phosphomolybdenum Blue

Nelson Somogyi Method

Cuprous oxide reacts with arsenomolybdate to

produce Arsenomolybdic Acid/ Arsenomolybdenum Blue

neucoproine method

Cuprous oxide reacts with neocuproine to produce Cuprous-Neocuproine Complex and produce Yellow/Yellow-Orange Complex

2,9-Dimethyl-1,10-Phenantroline Hydrochloride

reagent of neucoproine method

Benedict’s Method

It is used for the detection and quantitation of reducing substances in body fluids like blood and urine.

Alkaline Ferric Reduction Method

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

inverse colorimetry

end product is colorless

Ortho-toluidine (Dubowski Method)

When the sample contains glucose and upon placing

aromatic amines and glacial HAC, there will be a production of green-colored end product

● glucose dehydrogenase

● glucose oxidase

● hexokinase

Three enzyme systems are commonly used to measure glucose:

enzymatic methods

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

reducing substances

glucose dehydrogenase method

Utilizes: Mutarotase, Glucose dehydrogenase, and Diaphorase

mutarotase

converts a-D-glucose to b-D-glucose

glucose dehydrogenase

converts b-D-glucose + NAD to D-gluconolactone + NADH

diaphorase

MTT + NADH to MTTH (blue color) +NAD (done to detect color)

glucose oxidase

most specific enzyme that reacts only with β-D-glucose

falsely decreased values

glucose oxidase method

caused by increased levels of uric acid, bilirubin, and ascorbic acid

falsely increased values

glucose oxidase method

caused by bleach

glucose oxidase and peroxidase

coupling enzyme in Colorimetric Glucose Oxidase Method or Saifer Gerstenfield method

Colorimetric Glucose Oxidase Method or Saifer Gerstenfield method

Glucose concentration is proportional to the intensity of the color produced in the 2nd reaction

Polarographic Glucose Oxidase

Glucose concentration is proportional to the rate of oxygen consumption in the 1st reaction

catalase

H2O2 + ethanol to acetaldehyde

molybdate

H2O2 + iodide to iodine

hexokinase method

• MOST SPECIFIC generally accepted reference method for glucose determination

• rate of production of NADPH is measured spectrophotometrically

G-6-PD

coupling enzyme in hexokinase method

ketones

The liver produces ketones through the metabolism of

fatty acids

○ Acetone (2%)

○ acetoacetic acid (20%)

○ 3-β-hydroxybutyric acid (78%)

Ketone bodies:

ketonemia

accumulation of ketones in blood

ketonuria

accumulation of ketones in the urine

Gerhardt’s test

ferric chloride reacted with acetoacetic acid to produce a red color

sodium nitroprusside test

sodium nitroprusside reacts with acetoacetic acid to produce a purple color

enzymatic test

• using 3-hydroxybutyrate dehydrogenase

• detects 3-β-hydroxybutyric acid or acetoacetic acid

microalbuminuria

• defined as persistent albuminuria in two out of three urine collections of 30 to 300 mg/24 h, 20 to 200 μg/min, or an albumin – creatinine ratio of 30 to 300 μg/mg creatinine

• useful to assist in diagnosis at an early stage and before the development of proteinuria

microalbuminuria

marker used to detect earky kidney damage caused by long-term high blood glucose