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CP2 Carbs
Basic Carb questions
| Question | Answer |
|---|---|
| How is normal blood glucose maintained during a fasting state? | Liver stores of glycogen are drawn upon. |
| Why doesn't skeletal muscle directly contribute to blood glucose levels? | It lacks Glucose 6 phosphatase. |
| What two pathways of carbohydrate metabolism are flipped as blood glucose levels increase? | Glycogenolysis is replaced by glycogenesis |
| What hormone promotes glycogenesis and lipogenesis? | Insulin |
| What hormone increases permeability of cells to glucose? | Insulin |
| What hormone's production is heavily increased by an islet cell tumor? | Insulin |
| What hormone is linked to Diabetes Mellitus? | Insulin |
| What hormones have an antagonistic action to insulin and tend to raise blood glucose? | GH and ACTH |
| What hormone stimulates gluconeogenesis? | Hydrocortisone |
| An increase in what hormone leads to Cushing's disease? | Hydrocortisone |
| A decrease in what hormone leads to Addison's disease? | Hydrocortisone |
| What hormone stimulates glycogenolysis with a resultant increase in blood glucose levels? | Epinepherine |
| An increase in what hormone results from a pheochromocytoma? | Epinepherine |
| What hormone is released in response to short term stress? | Epinepherine |
| What hormone stimulates hepatic glycogenolysis? | Glucagon |
| What hormone stimulates glycogenolysis? | Thyroxine |
| What hormone increases the rate of glucose absorption in the intestine? | Thyroxine |
| An excess of what hormone leads to Thyrotoxicosis? | Thyroxine |
| Where is insulin produced? | Beta cells of Pancreas |
| Where is GH and ACTH produced? | Anterior Pituitary |
| Where is Hydrocortisone produced? | Adrenal Cortex |
| Where is Epinepherine produced? | Adrenal Medulla |
| Where is Glucagon produced? | Alpha cells of Pancreas |
| Where is Thyroxine produced? | Thyroid |
| What are the critical values of blood glucose in an adult male? | <50 and >400 mg/dl |
| What are the critical values of blood glucose in an adult female? | <40 and >400 mg/dl |
| What are the critical values of blood glucose in an infant? | <40 mg/dl |
| What are the critical values of blood glucose in a newborn? | <30 and >300 mg/dl |
| What is the normal value for blood glucose? | 65-99 mg/dl |
| What should a casual blood glucose be evaluated at? | <200 mg/dl |
| Fasting blood glucose levels over __________ are considered prediabetes. | 100 mg/dl |
| This type of Diabetes has an onset <25 years of age. | Type I |
| This type of Diabetes has a leaner body type. | Type I |
| This type of Diabetes is prone to Ketosis. | Type I |
| This type of Diabetes has Insulinopenia. | Type I |
| This type of Diabetes has Microangiopathy. | Type I |
| This type of Diabetes has HLA present. | Type I |
| This type of Diabetes has a minor family history of the condition. | Type I |
| This type of Diabetes has a low concordance with twins. | Type I |
| This type of Diabetes has a loss of islet cell morphology. | Type I |
| This type of Diabetes has a more obese body type. | Type II |
| This type of Diabetes is not prone to Ketosis. | Type II |
| This type of Diabetes has variable insulin levels. | Type II |
| This type of Diabetes is prone to atherosclerosis. | Type II |
| This type of Diabetes has no HLA present. | Type II |
| This type of Diabetes can have a marked family history. | Type II |
| This type of Diabetes has a high concordance with twins. | Type II |
| This type of Diabetes has hyperplasia of islet cells. | Type II |
| Name the 4 primary conditions or symptoms that diabetes is associated with. | 1. Pancratitis 2. Drug related Endocrinopathies 3. Infection related Endocrinopathies 4. Malnourishment |
| In reference to Gestational Diabetes, what percentage of mothers keep the diabetes after the baby is carried to term? | 5% |
| In reference to Gestational Diabetes, what percentage of mothers does the diabetes disappear after the baby is carried to term? | 95% |
| In reference to Gestational Diabetes, what is the 1 hour blood glucose value for glucose tolerance testing that suggests a need for a full NDDG gestational OGTT? | 140 mg/100 ml |
| Persons with what blood glucose levels are considered to be diagnosed as impaired glucose tolerance post blood glucose challege? | >140 mg/dl and <200 mg/dl or 140-200 mg/dl |
| What is the probability of outcomes for people that are diagnosed with impaired glucose tolerance? | 1/3 progress to diabetes 1/3 remain in the range of IGT 1/3 return to normal |
| What blood glucose level is considered prediabetes? | >100 mg/dl but less than that required for diagnosis of diabetes |
| What are the 3 P's of Diabetes Mellitus? | 1. Polydipsia 2.Polyuria 3.Polyphagia |
| What chronic infection can indicate a possible case of Dibetes Mellitus? | Chronic Yeast infection |
| What do IDDM and NIDDM stand for? | Insulin Dependent Diabetes Mellitus Non-Insulin Dependent Diabetes Mellitus |
| What are two major concerns for a person with Diabetes Mellitus? Why/How? | Renal Failure- microangiopathy leading to kidneys inability to properly clean the blood---> salt and water retention---> weight gain and ankle swelling Visual loss- microangiopathy of small vessels in retina of eye |
| What are some of the nueropathy signs/symptoms of Diabetes Mellitus? | 1. Bilateral symmetrical distal polyneuropathy 2. Loss of position and vibration sense 3. Decreased deep tendon reflexes 4. CN III and VI most commonly affected 5. Bilateral Carpal Tunnel Syndrome 6. Sexual Impotence |
| What percentage of the population may have diabetes Mellitus? What portion of that is diagnosed? | 5-6% of the population Approximately half (2.5-3% of the population) |
| What is the gold standard for diabetes Mellitus diagnosis? | hyperglycemia |
| Glycosuria associated with ___________ is almost always pathognomonic of Diabetes Mellitus. | Ketonuria |
| Name the possible criteria for diagnosis of Diabetes Mellitus. (5 points) see notes for expansion on point 5 (topic D point 8 roughly page 3) | 1. classical symptoms plus casual plasma glucose >or= to 200 mg/dl 2. fasting plasma glucose >= to 126 mg/dl 3. 2 hour plasma glucose >= to 200 mg/dl following an oral glucose challenge of 75g 4. HbA1C >6.4% 5. in absence...repeat testing on diff day |
| What is the ADA screening procedure for Diabetes Mellitus in healthy adults? | begin at age 45 and repeat every 3 years with routine blood test after an 8 hour fast |
| What is the ADA screening procedure for Diabetes Mellitus in children? | screen at 8 years and annually thereafter with presence of risk factors. |
| What do you do if there is a blood glucose that is >= 126 mg/dl? | redo test |
| When should Diabetes Mellitus testing begin before the age of 40? (5 points) Part 1 of 2 | 1. patient is obese (BMI >25) 2. have an immediate family member with DM 3. members of a high risk population 4. have gestational diabetes or delivered a baby weighing more than 9 lbs 5. are hypertensive |
| When should Diabetes Mellitus testing begin before the age of 40? (4 points) Part 2 of 2 | 6. have HDLc <35 mg/dl or triglyceride >250 mg/dl 7. who had a previous abnormal glucose measurement 8. exercise for fewer than 20 mins three times a week 9. have polycystic ovary syndrome |
| What is used to test urine glucose? | clinistix |
| What fasting values of blood glucose are indicative of prediabetes? | 100-125 mg/dl |
| Is a normal FBG indicative reliable in ruling out possible Diabetes Mellitus? | No |
| Values higher than _________ are highly indicative of Diabetes Mellitus. | 180 mg/dl |
| Values lower than _________ are highly indicative of hypoglycemia. | 50 mg/dl |
| Most patients with mild diabetes or adult onset diabetes will have a fasting blood glucose which falls _________. | within the normal range. |
| What are the three limitations of the 2 hour post challenge blood glucose test? | 1. slow absorption delaying the peak level 2. rapid absorption with early hyperglycemia, rapid fall in concentration of blood glucose and then a second hyperglycemic peak due to effects of counter regulatory responses 3. errors in timing of collection |
| Under what conditions should a Oral Glucose Tolerance Test be performed? | patients with fasting or 2 hour postprandial hyperglycemia or type I Diabetes Mellitus |
| When are urine and whole blood samples taken after an OGTT? Are they all at a fasting state? | 30 mins, 1 hour, 1.5 hours, 2 hours, 3 hours, and 4 hours after ingestion of carbohydrate meal Yes |
| What does Hemoglobin A1c (glycohemoglobin) measure? | chronic blood sugar control in a patient with Diabetes Mellitus. Its levels reflect the mean glycemia and level of control in the previous 2-3 months |
| What percentage of HbA consists of molecules that have been partially modified by attachment of a glucose molecule? | 6-7% |
| HbA1C and total glycohemoglobin levels are found to be _________ times greater in persons with Diabetes Mellitus. | 2-3 times |
| When patients are carefully and optimally regulating their blood sugar the HbA1C levels begin to drop toward normal in ________ weeks. | 3-5 weeks |
| A measurable increase in glycosylated hemoglobin begins about _______ weeks after a sustained increase in the average blood glucose level. | 2-3 weeks |
| What is a normal A1C value/range? | <5.7% |
| What is a pre-diabetic A1C value/range? | 5.7-6.4% |
| What is a diabetic A1C value/range? | >6.4% |
| What is the goal of therapy for persons with Diabetes in relation to their A1C value? | To be lower than 7% |
| At what A1C value does the ADA recommend reevaluation of treatment? | Consistently above 8% |
| What does a 1% change in A1C equate to in reference of change in average blood glucose? | A change of about 30-35 mg/dL |
| What relationship does the A1C test attempt to correlate? | The relationship between chronically high blood glucose and the pathological complications of diabetes |
| What are 3 items that can interfere with the A1C test? (7 total, 5 with specific outcomes of inc/dec/false/invalid) | 1. Inc Hb F 2.Hemolysis 3.Hemoglobinopathies---> invalid results 4. Splenectomy---> inc A1C 5. Pregnancy---> inc A1C 6. Renal failure---> dec A1C 7. Aspirin, alcoholism, and lead poisoning---> false increases |
| What are the 5 parts of the body that do not require insulin to absorb glucose? | 1. Retina 2. Lens 3. Kidney 4. Peripheral Nerves 5. Blood Vessels |
| Besides HbA what is another structure that undergoes non-enzymatic glycosylation? | Albumin or various globulins |
| What assay results indicate average glycosylation within the preceding 2 weeks? | Serum Fructosamine |
| What are the 3 routes of management of a person with Type I diabetes? | 1. Refer to a pediatric endocrinologist 2. Inject-able Insulin 3. Support groups |
| Name a few routes of management for a person with Type II diabetes. (13 listed in notes) Part 1 of 2 | 1. Use A1C to determine appropriate management 2. measure urine protein for micro-albuminuria/ketones/electrolytes 3. ADA exchange list diet 4. weight loss 5. exercise 6. Fructose>Sucrose>Glucose 7. high complex carb/low fat diet |
| Name a few routes of management for a person with Type II diabetes. (13 listed in notes) Part 2 of 2 | 8. low or mixed glycemic index CHOs 9. eat foods in whole form 10. six small mixed meals a day 11. Chromium supplement 12. Cinnamon 13. ABC management (A1C, BP, and Cholesterol) |
| What is the best way to manage a patient with IGT/IFG? | weight loss and watch diet |
| At what blood glucose level is someone considered chemically hypoglycemic? | <50 mg/dl |
| What distinguishes Chemical from Clinical Hypoglycemia? | Symptoms that are neuroglycopenia or adrenergic in nature |
| What are the two clinical categories of Hypoglycemia? | Fasting Hypoglycemia (symptoms after fasting) and Reactive/postprandial Hypoglycemia (symptoms after a meal) |
| If blood glucose levels drop rapidly symptoms tend to be similar to that associated with the release of _________. | Epinepherine |
| If hypoglycemia persists, CNS glucose deprivation occurs and symptoms resemble those of ___________. | Cerebral Hypoxia |
| What are the three most likely etiologies of a person that is found to have an insulinoma that contributes to a case of fasting hypoglycemia? | Single adenomas--->80% Multiple adenomas--->10% Carcinomas--->10% |
| What are three causes of fasting hypoglycemia (not insulinoma)? | Insulin overdose Prolonged CHO deprivation alcoholic hypoglycemia non-pancreatic tumor deficiency of counteracting hormones (pituitary and adrenal insufficiency) |
| What is the main category of symptoms associated with fasting hypoglycemia? Give 3 examples from that category. | CNS neuroglycopenia lethargy, headache, confusion, bizzare behavior, visual disturbances, personality changes, convulsions, loss of consciousness |
| What is Whipple's triad for diagnosing an insulinoma? | 1. symptoms are compatable with hypoglycemia while fasting 2. a fasting BG level of 10 mg/100 ml or more below FBG normal lower limits 3. relief of symptoms by ingestion of glucose |
| In reference to Reactive hypoglycemia, how does "dumping syndrome" affect BG? | Most often associated with gastric surgery. Results with an unusually swift or complete gastric emptying of ingested CHO into the duodenum, leading to an abnormally high BG level with temporary hypoglycemia after hastily produced insulin |
| How can Type II diabetes cause hypoglycemia? | some people with NIDDM may develop mild and transitory hypoglycemia 3-5 hrs after eating. Believed to be an early manifestation of their disease which disappears with progression. |
| How many hours after a meal does a person with Idiopathic postprandial syndrome develop hypoglycemic symptoms? | 3-4 hours |
| What type of derivation of symptoms does a person with idiopathic postprandial syndrome have? | Adrenergic with abrupt onset and self-limiting Anxiety, sweating, palpitation, tremor, and hunger |
Created by:
okeywan
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