Chemistry-Carbohydrates/Diabetes
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Created by:
summerlindsay on April 23, 2011
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75 terms
Terms | Definitions |
|---|---|
 What is insulin synthesized as? | Pro-insulin |
| What is a single amino acid chain, 51 AA long | Pro-insulin |
| What is the amino terminus of the proinsulin chain called? | B chain |
| What is the middle of the proinsulin chain called? | C-peptide |
| What is the carboxy-terminal amino acid part of the proinsulin chain? | A chain |
| What chains make up insulin? | A and B |
| When beta cells are induced to secrete what do they secrete? | insulin (A-B chains) and C-peptide simultaneously |
| Which part of the proinsulin chain is proteolytically cleaved post-translationally to make insulin? | C-peptide |
| What is the ratio of C:peptide to insulin? | 5-15:1 |
| Which is metabolized faster C peptide or insulin? | Insulin |
| If blood is left in a test tube what can occur? | glycolysis |
| How fast does glycolysis reduce glucose in a test tube? | 5-10mg/dL/hour depending on temp and WBC |
| what do you need to add to the test tube to stop glycolysis for 24hrs? | Fluoride |
| What process involves a Schiff base undergoing Amadori rearrangement? | glycosylated hb (HbA1c) |
| What type of reaction is glycosylation of Hb? | nonenzymatic |
| If the RBC has a shortened lifespan what happens to HbA1c? | decreases |
| What is the time frame that HbA1c measures? | past 2-3months |
| What is the % of norm HbA1c? | <6% |
| What is the % of well controlled DM HbA1c? | 7-9% |
| Which hormone in preg has anti-insulin effects similar to GH and causes glc intol in preg? | hPL |
| What are the 2 phenomena that show sxs of hypoglycemia? | Neurologic: brain needs glc, get altered MS Adrenergic: sweat, palpitations, tachy, nervous |
| Which type of responses do you see in fasting hypoglycemia? | slow, gradual onset altered MS |
| Which type of response is seen in reactive hypoglycemia? | adrenergic |
| What does insulin, sufonylurea, alcohol and quinine cause? | drug-induced hypoglycemia |
| What type of hypoglycemia is caused by prolonged fast or exercise? | Fasting |
| What type of hypoglycemia is caused by prolif of islet beta cells, sarcomas, inherited metabolic defects, and end stage liver dz? | fasting |
| What is the term used when you have hypoglycemia sxs, plasma glc<45 mg/dL, and resolution of sxs when given glc? | Whipple's triad |
| What is the entity when the insulin: glc ratio >189 mg/dL? | insulinoma |
| What type of hypoglycemia is caused by hereditary fructose intol, galactosemia, post-vagotomy (dumping synd)? | reactive |
| What is the dx for gestational DM with the 50g OGTT? | =>140 mg/dL |
| What is the dx for gestational DM with the 100g (75g) OGTT fasting? | =>95 |
| What is the dx for gestational DM with the 100g (75g) OGTT 1hr? | =>180 |
| What is the dx for gestational DM with the 100g (75g) OGTT 2hr? | => 155 |
| What is the dx for gestational DM with the 100g OGTT 3hr (75g OGTT doesn't have)? | =>140 |
| What is the fasting plasma glc for impaired glc tolerance? | 110-126 mg/dL |
| What is the 75g OGTT with 2h plasma glc for impaired glc tolerance? | 140-199 mg/dL |
| What is considered to be pre diabetes? | 140-199 mg/dL |
| What is the best screening test to dx DM? | fasting plasma glc |
| What is the fasting plasma glc to dx DM? | >= 126 mg/dL |
| What is the 75g OGTT with 2h plasma glc that is dx of DM? | >= 200 mg/dL |
| What type of DM does DKA occur most often? | Type 1 |
| What occurs in insulin-deficient pts after some sort of provocation like infxn, trauma or not taking their insulin? | DKA |
| What are the early sxs of DKA? | polyuria polydipsia nausea, abdominal pain |
| What is the altered breathing pattern seen in late DKA? | Kussmaul respiration |
| What happens if you don't tx DKA? | altered MS, coma then death |
| What 3 things do you need to dx DKA? | Hyperglycemia Ketosis Metabolic acidosis |
| What dx can sometimes be made on the clinical sxs and urine dipstick findings of glycosuria and ketonuria? | DKA |
| What technique measures the serum ketones acetoacetic acid and acetone but NOT beta-hydroxybutyrate? | Nitroprusside test |
| Why do you get an apparent initial increase in ketones when you tx DKA? | because more betahydroxybutyrate is being broken down to acetoacetic acid and acetone as the total serum ketones decrease |
| What is the intial level of glucose in DKA? | >300 mg/dL |
| Are pH, bicarb and sodium up or down in DKA? | decreased and there is an anion gap |
| What is increased in DKA due to severe vol depletion resulting in prerenal azotemia? | BUN |
| Why is K tricky in DKA? | initially increased, then transcellular shifts and urinary loss and insulin admin, total K down, get profound HYPOkalemia |
| What is crucial to give DKA patients when you treat them? | K |
| What type of DM do you see hyperglycemic hyperosmolar nonketotic coma? | DM 2 |
| What presents with altered MS, profound hyperglycemia, hyperosmolarity, dehydration and norm pH? | HHNC |
| What are common features of HHNC? | seizures and localizing neurologic deficits like hemiplegia |
| What is the mortality rate of HHNC? | >50% |
| What is the glc level of HHNC? | >1000 mg/dL |
| What is the osmolarity of HHNC? | >300 mOsm/L |
| Are pH, HCO3, Na, and K norm in HHNC? | yes |
| Where does A1c get added? | glucose added to N-term valine in beta chain |
| In pts who don't have HbA (ie sickle cell) how do you monitor diabetic control? | fructosamine |
| What is the most sensitive early lab marker of diabetic nephropathy? | microalbuminuria, measure T2DM q yr and T1DM q yr after 5y |
| Which type of DM has anti-islet autoAb? | Type 1 |
| What type of DM has HLA-DR3 and DR4? | Type 1 |
| What syndrome is DM2 frequently a part of? | Metabolic syndrome |
| What is the syndrome that has insulin resistance, dyslipidemia, dysglycemia, non alcoholic fatty liver? | Metabolic syndrome |
| What type of infants have inc risk of neonatal hypoglycemia, hyperbilirubinemia, hypocalcemia, and higher risk for RDS? | babies of moms with gestational DM |
| how do you confirm hypoglycemia? | 72h fast w periodic glc measurement |
| How do you determine specific cause of hyperinsulinemia? | C-peptide (marker for endogenous insulin) |
| If C-peptide is low or absent in pt with hyperinsulin what is cause? | exogeneous hyperinsulinism: insulin injection |
| What syndrome do you see insulinomas in? | Wermer synd (MEN I): 3 Ps: pituitary, parathyroid, pancreas |
| What are the 2 fast acting anti-insulin hormones? | Glucagon and epinephrine |
| What are the 2 slow acting anti-insulin hormones? | cortisol and GH |
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