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How is Type 1 diabetes mellitus characterized?
What is the term for a deficiency of insulin?
How do individuals live with Type 1 diabetes melliuts?
Require treatment with insulin to sustain life
How does Type 1 diabetes mellitus manifest?
Most exhibit it as an autoimmune disorder when beta cells of the islets of Langerhans are destroyed by their own body
What condition has the primary symptoms:
Type 1 diabetes melitus
Produce excess ketones
Results in diabetic ketoacidosis
Ketosis-prone Type 1 diabetes mellitus
What condition is characterized by:
Defect in insulin secretion
Cellular resistance to insulin
Associated with obesity and sedentary lifestyle
Type 2 diabetes mellitus
How are individuals with Type 2 diabetes mellitus treated?
- Individuals are NOT dependent on treatment with insulin
- Generally respond to dietary intervention and oral hypoglycemic agents
- Some require insulin therapy
With which type of diabetes is prone to diabetic ketoacidosis?
Type 1 diabetes mellitus
When is the onset of gestational diabetes mellitus (GDM) occur?
What happens after pregnancy, with those who get gestational diabetes mellitus?
- Individual generally returns to normal metabolism
- There is an increased chance that type 2 diabetes mellitus may develop later in life
What type of deficiency is caused by von Gierke, type I?
What disease is the result of a glucose-6-phosphatase deficiency?
von Gierke, type I
What type of deficiency is caused by Pompe, type II?
What disease is the result of an alpha-1,4-glucosidase deficiency?
Pompe, type II
What type of deficiency is caused by Cori, type III?
What disease is the result of an Amylo-1,6-glucosidase deficiency?
Cori, type III
Deficiency or absence of galactokinase, galactose 1-phosphate uridyl transferase, or uridyl diphosphate glucose-4-epimerase
Enzyme defect prevents metabolism of galactose
Galactose 1-phophate uridyl transferase deficiency
Excessive galactose in blood and excretion in urine
How are glucose levels regulated when a person is fasting?
- Blood glucose levels are kept constant by mobilizing the glycogen stores in the liver (which will only last 24-48 hours)
- During long fasts, glucogenesis is required to maintain blood glucose levels
What is the reference range for someone who is considered hyperglycemic?
Fasting glucose >100 mg/dL
What reference range is considered for someone who is considered hypoglycemic?
Fasting glucose of <50 mg/dL
What hormone is produced by the beta cells of the pancreatic islets of Langerhans, promotes the entry of glucose into the liver, muscle, and adipose tissue to be stored as glycogen and fat?
What hormone inhibits the release of glucose from the liver?
What hormone is synthesized by the delta cells of the pancreatic islets of Langerhans and inhibits secretion of insulin, glucagon, and growth hormone?
What hormone results in an increase in plasma glucose levels?
What hormones are secreted by the anterior pituitary that raises the blood glucose levels?
- Growth hormone
- Adrenocorticotropic hormone (ACTH)
What hormone is secreted by the adrenal glands and stimulates glycogenolysis, lipolysis, and gluconeogenesis?
What hormone is secreted by the medulla of the adrenal glands, stimulates glycogenolysis and lipolysis, and inhibits secretion of insulin?
What hormone is stimulated to secrete when physical or emotional stress is involved and causes an immediate increase in blood glucose levels?
What hormone is secreted by the alpha cells of the pancreatic islets of Langerhans and increases blood glucose by stimulating glycogenolysis and gluconeogenesis?
What hormone is secreted by the thyroid gland and stimulates glycogenolysis and gluconeogenesis?
What hormone increases glucose absorption from the intestines?
How is glucose regulated?
Glucose is filtered by the glomeruli, reabsorbed by the tubules, and normally NOT present in the urine
What is the term if glucose appears in the urine?
What is an individuals renal threshold?
- Between 160-180 mg/dL
- Once it is over this level, the renal tubular transport mechanism becomes saturated which causes glucose to be excreted into the urine
What is the range for an Impaired fasting glucose (IFG)?
When is a provisional diagnosis of diabetes mellitus made?
Fasting glucose is >/=126 mg/dL
How is the diagnosis of diabetes mellitus performed?
- Any one of the following results is diagnostic:
- Physical symptoms AND causal plasma glucose >/=200 mg/dL
- Fasting plasma glucose >/=126 mg/dL
- Plasma glucose level >/=200 mg/dL at 2 hr point of OGTT (not recommended by the Am. Diabetes Association)
When should women get tested for GDM (gestational diabetes mellitus)?
- 24-28 weeks (for average risk)
- High risk should be screened during the initial screening then retested at 24-28 weeks
Describe the 2-step approach in the initial screening of GDM
- 50g oral glucose load
- Plasma is tested at 1 hour
- If >/=140 mg/dL, an OGTT is performed
Describe the OGTT when diagnosing GDM
- 100g oral glucose
- Must meet or exceed 2 or more of:
- Fasting glucose >95 mg/dL
- 1 hour >180 mg/dL
- 2 hour >155 mg/dL
- 3 hour >140 mg/dL
- A 75g dose can be used for a 2 hour period
What are the 3 forms of hemoglobin A?
Which form of Hgb A is referred to glycated or glycosylated hemoglobin?
- Hgb A1a
- Hgb A1b
- Hgb A1c - main form
What is glycated hemoglobin formed from?
Nonenzymatic, irreversible attachment of glucose to hemoglobin A1
What does the measurement of glycated hemoglobin reflect and why is it measured?
- Blood glucose levels for the past 2-3 months
- Useful in montoring effectiveness of treatment and compliance of diabetic individual to treatment protocol
What specimen is collected for the measurement glycated hemoglobin?
Nonfasting blood drawn in EDTA tube
What is the reference range of Hgb A1c?
- 4-6% Hgb A1c
- Effective treatment range <7%
What is the clinical significance of fructosamine?
Blood glucose levels for 2-3 weeks
What is the reference range of fructosamine?
What is the measurement of albumin excretion is useful in patients with what complication?
Renal complications of diabetes mellitus
What is the clinical significance of an increase in blood glucose level?
- Diabetes mellitus
- Cushing disease
What is the normal end product of glucose metabolism?
What is the end product of glucose metabolism when oxygen is deficient?
What does the measurement of lactate indicate?
Used to assess the degree of oxygen deprivation that is occurring
Where is lactate metabolized?
Liver via gluconeogenesis
What is the reference range of an adult fasting glucose?
What is Type A lactic acidosis caused by?
Depressed oxygen levels that may occur in acute myocardial infarction, congestive heart failure, shock, pulmonary edema...
What is Type B lactic acidosis caused by?
Metabolic process that may occur in diabetes mellitus, renal disorders, liver disease, ingestiong of toxins (salicylate overdose and excess ethanol)...
What is special about the specimen with lactate?
- Avoid using tourniquet
- Place specimen on ice
- Immediately spin and run
What is the reference range for lactate?
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