What does a 1% change in glycosylated HgbA1c correspond to?

A 35 mg/dL change in blood glucose

What is the target percentage of glycosylated HgbA1c for a diabetic?

7%

What is the highest percentage of glycosylated HgbA1c that would be considered healthy in a non-diabetic?

6%

What does DM stand for?

Diabetes Mellitus

What are the two forms of diabetes?

Type 1 (juvenile)

Type 2 (adult onset)

Which form of diabetes is insulin dependent?

Type 1

What form of diabetes is insulin independent?

Type 2

What is glycogenesis?

The process of converting glucose to glycogen for storage

What hormones are involved in regulating blood sugar?

Insulin, glucogon, cortisol, epinephrine, thyroxine

What hormone/s downregulate blood sugar?

Insulin

What hormone/s upregulate glucose?

Cortisol, Epinephrine, Thyroxine, Glucogon

Which form of diabetes produces ketosis?

Type 1

Why is ketoacid produced during Type 1 diabetes?

In type 1 diabetes insulin is not produced but glucogon is and there is plenty of glycogen which can be broken down by beta oxidation to produce ketone??

What blood glucose level is associated with diabetes?

Greater than 126 mg/dL when fasting

Greater then 200 mg/dL at random

What causes Type 1 diabetes?

Autoimmune attack of beta cells

(latent autoimmune diabetes)

due to 

Genetic disposition

Environmental factor (virus)

(Insulin not produced or production very impaired)

What happens to insulin in Type 1 diabetes?

It is not produced or its production is impaired

At what stage of life is Type 1 diabetes usually diagnosed?

Childhood

Adolescence

How has the onset of Type 1 diabetes been described?

Abrupt

What testable condition arises in someone with Type 1 diabetes?

Ketoacidosis

(sweet odor to breath, sweet taste to urine, ketones can be detected with chemical tests)

What percentage of Type 1 diabetes sufferers test positive for specific autoimmune antibodies?

85-90%

In type 1 diabetes, what are some possible targets of autoimmune antibodies?

Insulin

Glutamic acid decarboxylase

Tyrosine phosphatase 

1A2 (anti-islets)

1A2B

What is happening to insulin in Type 2 diabetes?

Type diabetes is characterized by resistance to insulin and also by secretion defects

(relative insulin deficiency)

What are some factors that increase the incidence of Type 2 diabetes?

Age

Obesity (especially increased abdominal body fat)

Lack of exercise

(poor diet?)

Genetic predisposition

At what stage of life is Type 2 diabetes usually diagnosed?

Adult

Is there a connection between Type 2 diabetes and autoimmune antibodies?

No

(non-autoimmune in nature)

What is a common complication of Type 2 diabetes?

Hyperosmolar coma

(also people losing their feet occurs too often)

What testing methods can be early detectors of diabetes?

A dipstick won't pick up microalbuminemia

So, nephelometry and immunoassay are the go to methods

What are six laboratory findings for hyperglycemia?

Increased glucose in plasma and urine

Increased urine specific gravity

Increased serum and urine osmolality

Ketones in serum and urine (ketonemia and ketonuria)

Decreased blood and urine pH (acidosis)

Electrolyte imbalance (elevated anion gap)?

Name five pathophysiological problems with diabetes

1. Neuropathy

2. Nephropathy

3. Retinopathy

4. Microvascular problems

5. Cardiac disease (major cause of death)

Ketoacidosis in Type 1 diabetes can lead to what three things?

1. Dehydration

2. Electrolyte disturbance

3. Acidosis

What are three ketones formed?

Acetoacetate

Beta-hydroxybutyrate

Acetone

What two ketones lead to acidosis?

Beta-hydroxybutyrate

and

Acetone

What does a glucose tolerance test involve?

A ten hour fast (not longer than 16 hours)

The test should be done in the am to account for diurnal variation

75 grams of glucose are given

Blood is drawn 2 hours later

What are the expected results of a normal glucose tolerance test?

After 2 hours the plasma glucose should be less than

<140 mg/dL for a normal result

What are the expected results of an impaired glucose tolerance test?

After 2 hours the plasma glucose should be greater than or equal to 140 mg/dL and less than 200 ml/dL for an impairted result

What are the expected results of a provisional diabetes diagnosis in a glucose tolerance test?

After 2 hours the plasma glucose should be greater than or equal to 200 mg/dL for a dignosis of diabetes

Glucose is a ___________ agent

Reducing

When assessing diabetes, what is converted to what to indicate the amount of glucose involved?

(dipstick test for urine or is this serum?)

(is is amount or presence?)

Glucose is a reducing agent that reacts with cupric ions (Cu ²⁺) in an alkaline solution to convert them to cuprous ions (Cu^-1O)

This clinitest is detected chromatically as the color change goes from blue to red

What does Sodium Fluoride have to do with the clinitest glucose assessment?

???

What can be misleading about the clinitest glucose assessment?

It is not specific for glucose - any reducing substance will have a similar effect

What is the glucose oxidate method of glucose measurement?

                          glucose oxidase

Glucose+O₂+H₂O --------------------> gluconic acid+H₂O₂ 

 peroxidase

H₂O₂+reduced chromogen----->oxidizedchromogen+H₂O₂ 

An alternate method of glucose measurement

                    glucose oxidase

dGlucose --------------------> gluconic acid+H₂O₂ 

 peroxidase

H₂O₂+4-aminophenazone ----->quinine complex                                                                    +Hydroxybenzoate

What are the benefits and detractors of using the hexokinase reference method for glucose assessment?

The benefit is that there is less interference

The detractor is that gross hemolysis or increased bilirubin can cause false decreases

What is the hexokinase reference method?

                           hexokinase

Glucose + ATP -----------------> glucose 6-PO₄ + ADP

Glucose6-PO₄+NADP --> NADPH+H⁺+6 phosphogluconate

What are the three methods of glucose measurement discussed in class?

Clinitest with reducing Copper ions

The glucose oxidate/peroxidase enzyme method

The hexokinase/G-6-PD enzyme method

Glucose reacts with the __(1)__ of Hgb to form __(2)__

1. Amino group

2. Ketoamine

RBC are a good marker for glucose levels over the past ___(1)___ because their average lifespan is ___(2)___

1. 2-3 months

2. ~120 days

The measurement of what is used for long-term monitoring of diabetes?

Glycosylated HgbA1c