vis dis exam 4 BCP

BCP

a group of select tests that can screen for certain conditions - patterns of abnormal values provide data for arriving at a diagnosis - CMP is like the same thing

glucose

primary energy source - blood glucose levels are held within a fairly constant range by regulatory hormones and metabolic activity - disorders of glucose metabolism result in hypoglycemia and hyperglycemia - insulin decreases blood glucose concentrations - levels controlled by feedback mechanism

what things increase blood glucose levels

glucagon (secreted in the fasting state), epinephrine, growth hormone, ACTH, and cortisol

insulin

secreted to drive glucose into the cells to be metabolized to glycogen. amino acids, and fatty acids = reduces glucose

reasons for hyperglycemia

diabetes mellitus, acute stress response, cushing’s syndrome, pheochromocytoma, renal failure, acromegaly, pancreatitis

reasons for hypoglycemia

insulin overdose, pancreatic islet cell tumor, starvation, liver disease, addison’s disease, hypothyroidism

diabetes symptoms

polydipsia (thirsty), polyuria, polyphagia, fatigue, weight loss, blurred vision, slow healing, dizziness, nausea

ranges for fasting blood glucose

normal is under 100 mg/dl (really between 70-99), pre-diabetes is ≥100 mg/dl to <126 mg/dl, diabetes is ≥126 mg/dl

symptoms of hypoglycemia

sweating, hunger, trembling, anxiety, confusion, blurred vision

glucose tolerance test (OGTT)

used if diabetes is suspected - usually a 2hr OGTT (most commonly used) - patient fasts, then a FBS is taken and then is given an oral glucose load (75 g of glucose in 300 ml water) - tested 30 min, 1hr, 2hr, 3hr, and sometimes 4hr - normally there is a rapid insulin increase in response to the glucose load and peaks within the first hour and returns to normal in about 3 hours - 2hr mark should be less than 140

results of OGTT

patient with an appropriate insulin response are able to tolerate the glucose load and glucose does not spill into the urine - patient’s with diabetes will not tolerate the load and serum levels will be greatly elevated from 1 to 5 hours and glucose spills out in the urine

ranges for OGTT

normal is under 140 mg/dl, pre-diabetes is ≥140 mg/dl and <200 mg/dl, diabetes is ≥200 mg/dl

hemoglobin A1c test (HbA1c)

blood test used to determine how well a patient’s diabetes/blood sugar levels are being controlled - provides an average of your blood sugar control over a 6-12 seek period - normal range is 4-6% for those without diabetes - goal for patients with diabetes should be less than 7% (low A1c level means a significantly lower likelihood of experiencing complications from diabetes

what test is being recommended to becoming the new gold standard for diagnosing diabetes?

A1c assay

A1c ranges

normal is <5.6%, pre-diabetes is ≥5.7% to <6.5%, diabetes is ≥6.5%

diabetes mellitus diagnosis

diagnosis is <200 mg/dl or a FBS >126 or a ≥200 mg/dl on OGTT or ≥6.5 A1c - glycosuria is present when glucose levels exceed the renal threshold values (RTV may rise in some diabetics)

diabetes

patients often present with musculoskeletal and neurological complaints - only half of patients are aware of their disorder 0 the leading cause of kidney failure, lower-limb amputations, and adult-onset blindness

type 1 diabetes mellitus

insulin dependent - polyuria, polydipsia, hyperglycemia - most commonly seen in juveniles, circulating insulin is absent and plasma glucagon is elevated - autoimmune destruction of pancreatic islet beta cells, although the etiology is unknown - dependent on exogenous insulin to sustain life

type 2 diabetes mellitus

most common type, most patients are over 40 and obese with a family history - polyuria, polydipsia, hyperglycemia = circulating insulin is present but inadequate in times of increased need - insulin resistance or decreased amounts - may be controlled by diet, lifestyle, exercise, maybe oral hypoglycemic agents

gestational diabetes mellitus

occurs during pregnancy and disappears after delivery - tested between 24th-28th week - imbalance occurs between the mother’s ability to secrete insulin ad the diabetogenic hormones of pregnancy (estrogen and progesterone) which results in insulin resistance and glucose levels ride (hyperglycemia) - extra blood glucose goes through the placenta, giving the baby high blood glucose levels, which causes baby’s pancreas to make extra insulin to get rid of the blood glucose - since baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat

what percent chance do people who had gestational diabetes have of developing diabetes in the next 10-20 years?

35-60%

diabetes mellitus complications

diabetic catarcts, diabetic retinopathy, glaucoma, diabetic nephropathy, diabetic neuropathy, vascular disease, skin lesions, foot gangrene, diabetic coma

diabetic coma/DKA - diabetic ketoacidosis

from a shortage of insulin - glycosuria, ketonuria, hyperglycemia, polyuria, polydipsia, fatigue, vomiting, mental stupor and can progress to coma, rapid breathing, fruity breath odor

hypoglycemia

blood glucose levels below 70 mg/dl - more common in a diabetic patient - anxiety, sweating, palpitations, tremor, hunger - if it persists, CNS glucose deprivation occurs and they may exhibit lethargy, headaches, confusion, visual disturbances convulsions, and coma - symptoms of reactive and fasting hypoglycemia are similar to diabetes-related hypoglycemia

reactive hypoglycemia

occurs within 4 hours after meals - under 70 mg/dl - also called postprandial hypoglycemia - relief of symptoms when glucose returns to normal (eat small meals and snacks about every 3 hours) - high blood sugar can result in excessive insulin secretion and results in lowered glucose levels - exercise regularly

fasting hypoglycemia

often related to underlying disease, various medications, excess insulin or carbohydrate deprivation, tumors like insulinoma, insulin overdose in diabetic, hormonal deficiencies, hepatic or renal disease - under 50 mg/dl - also called postabsorptive hypoglycemia - may need a 5 or 6 hour glucose tolerance test with measurements hourly

whipple’s triad

symptoms known or likely to be caused by hypoglycemia - a low plasma glucose measured at the time of symptoms - relief of symptoms when the glucose is raised

blood urea nitrogen BUN

measures the amount of urea nitrogen in the blood - urea is formed in the liver as an end product of protein metabolism and transported to the kidneys for excretion - this test is related to the metabolic function of the liver and excretory function of the kidneys - nearly all renal disease will elevate this - high protein diet may also elevate and severe liver disease and overhydration will decrease levels

azotemia

elevated blood levels of BUN

what 2 tests are the renal function tests

BUN and creatinine

creatinine

measures the amount of creatinine in the blood - catabolic product of creatine phosphate which is used in muscle contraction - only renal disorders can elevate this (so better indicator of renal disease than BUN) - levels tend to rise later and indicate chronicity

uric acid

nitrogenous compound that is a product of purine catabolism excreted by the kidney and a little by the intestinal tract - hyperuricemia (elevated levels) is associated with gout - may also be elevated in renal disease, metastasis, multiple myeloma, alcoholism, leukemias

radiographic findings of gout

soft tissue swelling, decreased joint space, nonmarginal erosions (overhang sign)

gout of the big toe is called what?

podagra