disease states in glucose metabolism
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Questions and Answers

What happens to glucose levels in plasma and urine as a result of hyperglycemia?

  • They increase (correct)
  • They remain the same
  • They decrease
  • They fluctuate

    • refers to the presence of ketones in the urine, a characteristic of hyperglycemia

  • Ketonuria (correct)
  • Hyperglycemia
  • Ketosis
  • Acidosis

    • What happens to the pH of blood and urine as a result of hyperglycemia?

  • It remains the same
  • It increases
  • It decreases (correct)
  • It fluctuates

    • What is affected by the increased osmolality in hyperglycemia?

    <p>Electrolyte balance</p> Signup and view all the answers

    What is the term for the presence of ketones in the serum?

    <p>Ketonemia</p> Signup and view all the answers

    What percentage of diabetes mellitus cases are accounted for by Type 1 diabetes?

    <p>5-10%</p> Signup and view all the answers

    What is the primary reason for ketosis in Type 1 diabetes?

    <p>Lack of insulin to use fat as a glucose source</p> Signup and view all the answers

    What is characteristic of Type 2 diabetes?

    <p>Seldom ketosis</p> Signup and view all the answers

    What is the primary defect in diabetes mellitus?

    <p>Either or both insulin action and secretion</p> Signup and view all the answers

    What is the reason for seldomly seen ketosis in Type 2 diabetes?

    <p>Hyperosmolar state of glucose inhibiting glucagon stimulation of lipolysis</p> Signup and view all the answers

    What is the primary characteristic of diabetes mellitus?

    <p>Hyperglycemia</p> Signup and view all the answers

    What is the approximate percentage of diabetes mellitus cases accounted for by Type 2 diabetes?

    <p>90%</p> Signup and view all the answers

    What is the primary reason for the presence of ketosis in Type 1 diabetes?

    <p>Insulin underproduction</p> Signup and view all the answers

    What is the term for diabetes that requires exogenous insulin for life?

    <p>IDDM</p> Signup and view all the answers

    What is the age range when Type 1 diabetes is often diagnosed?

    <p>Children and adolescents</p> Signup and view all the answers

    What is the characteristic of Type 1 diabetes in children?

    <p>Faster progression</p> Signup and view all the answers

    What is the effect of hyperglycemia on the body?

    <p>Causes metabolic disorder</p> Signup and view all the answers

    What is the primary defect in diabetes mellitus?

    <p>Defect in insulin action and secretion</p> Signup and view all the answers

    What is a common symptom of diabetes due to the body's attempt to compensate for a hyperglycemic state?

    <p>Excessive urination</p> Signup and view all the answers

    What is a consequence of the body using up more water due to hyperglycemia?

    <p>Excessive thirst</p> Signup and view all the answers

    What are the factors that contribute to the development of Type 1 diabetes?

    <p>Environmental and genetic factors</p> Signup and view all the answers

    What is a characteristic of patients with diabetes?

    <p>Frequent urination at night</p> Signup and view all the answers

    What is a consequence of hyperglycemia in the body?

    <p>The body tries to dilute high glucose levels</p> Signup and view all the answers

    What is the primary reason why insulin cannot be recognized by the cell in NIDDM?

    <p>The receptors where insulin binds are broken</p> Signup and view all the answers

    What is the result of the receptor breaking in NIDDM?

    <p>The cell won't allow glucose inside its system</p> Signup and view all the answers

    What is the relationship between old age and NIDDM?

    <p>Old age increases the risk of NIDDM due to wear and tear of the body</p> Signup and view all the answers

    Which of the following is a characteristic of NIDDM?

    <p>Seldom ketosis tendency</p> Signup and view all the answers

    What are the three Ps symptomatic of NIDDM?

    <p>Polyuria, Polyphagia, Polydipsia</p> Signup and view all the answers

    What is gestational diabetes specific to?

    <p>Pregnant women</p> Signup and view all the answers

    At what period of pregnancy should women be screened for Gestational DM?

    <p>24-28 weeks</p> Signup and view all the answers

    What happens to gestational diabetes in most women after delivery?

    <p>It goes away</p> Signup and view all the answers

    How long does it take for gestational diabetes to potentially develop into Type 2 diabetes?

    <p>At least 5 years</p> Signup and view all the answers

    What causes insulin resistance in pregnant women with gestational diabetes?

    <p>The placenta</p> Signup and view all the answers

    What is a complication of diabetes that affects the kidneys?

    <p>Nephropathy</p> Signup and view all the answers

    What is not a potential complication of diabetes to babies during pregnancy?

    <p>Gestational diabetes</p> Signup and view all the answers

    What is the process of filtering blood through a machine for people with kidney failure?

    <p>Dialysis</p> Signup and view all the answers

    What is a common effect of high glucose levels on the body?

    <p>All of the above</p> Signup and view all the answers

    What is a potential problem for babies born to mothers with glucose intolerance?

    <p>All of the above</p> Signup and view all the answers

    complication of diabetes

    <p>neuropathy = most commonly affecting the nerves of the hands and the feet. It can also affect nerves controlling autonomic functions of the body, such as digestion, or nerves in the hips and thighs retinopathy = disease of the retina which results in impairment or loss of vision pangulo = wala nephropathy = damage to your kidneys caused by diabetes. In severe cases it can lead to kidney failure. But not everyone with diabetes has kidney damage</p> Signup and view all the answers

    What does a fasting glucose level of ≥ 100 mg/dL but ≤ 126 mg/dL indicate?

    <p>Impaired Fasting Glucose</p> Signup and view all the answers

    What is the term for the percentage of glucose attached to hemoglobin in the blood?

    <p>Glycated Hemoglobin (HbA1c)</p> Signup and view all the answers

    What is the range of HbA1c levels that indicates pre-diabetes?

    <p>5.7% - 6.4%</p> Signup and view all the answers

    What is the significance of the 2-hour Oral Glucose Tolerance Test (OGTT)?

    <p>Detecting impaired glucose tolerance</p> Signup and view all the answers

    How often should women be screened for gestational diabetes during pregnancy?

    <p>Between 24-28 weeks of pregnancy</p> Signup and view all the answers

    what does a 2-hr OGTT ≥ 140 mg/dL but ≤ 200 mg/dL indicate?

    <p>Impaired Glucose Tolerance</p> Signup and view all the answers

    SAMPLE -Plasma -Whole blood

    <p>HbA1c (glycated hemoglobin)</p> Signup and view all the answers

    SAMPLE -Plasma -Serum

    <p>b and c</p> Signup and view all the answers

    EDTA (violet)

    <p>2-hour (75g) OGTT (oral glucose tolerance test)</p> Signup and view all the answers

    -Sodium fluoride (gray)

    <p>FPG (fasting plasma glucose)</p> Signup and view all the answers

    -Sodium fluoride (gray) -Serum (red)

    <p>2-hour (75g) OGTT (oral glucose tolerance test)</p> Signup and view all the answers

    What is the random plasma glucose level that indicates diabetes?

    <p>≥200 mg/dL</p> Signup and view all the answers

    What is the HbA1c level that indicates diabetes?

    <p>≥6.5%</p> Signup and view all the answers

    What is the FPG level that indicates diabetes?

    <p>≥126 mg/dL</p> Signup and view all the answers

    What is the 2-hour PG level that indicates impaired glucose tolerance?

    <p>140-199 mg/dL</p> Signup and view all the answers

    What is the 2-hour PG level that indicates provisional diabetes diagnosis?

    <p>≥200 mg/dL</p> Signup and view all the answers

    What is the cutoff for normal glucose tolerance in a 2-hour OGTT?

    <p>≤140 mg/dL</p> Signup and view all the answers

    What is the amount of glucose used in a standard 2-hour OGTT?

    <p>75g</p> Signup and view all the answers

    What is the diagnosis if a 2-hour PG is ≥200 mg/dL?

    <p>Diabetes</p> Signup and view all the answers

    What is the duration of a 75g OGTT?

    <p>2 hours</p> Signup and view all the answers

    What is the unit of measurement for glucose levels in the blood?

    <p>mg/dL</p> Signup and view all the answers

    What is the range of fasting plasma glucose (FPG) for impaired fasting glucose?

    <p>100-125 mg/dL</p> Signup and view all the answers

    What is the term for decreased plasma glucose?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is released when there is a low glucose level in the blood?

    <p>Glucagon</p> Signup and view all the answers

    What is the range of fasting plasma glucose (FPG) for provisional fasting glucose?

    <p>≥126 mg/dL</p> Signup and view all the answers

    What is the diagnostic criterion for gestational diabetes in terms of 1-hour plasma glucose?

    <p>≥180 mg/dL</p> Signup and view all the answers

    What is the range of fasting plasma glucose (FPG) for normal fasting glucose?

    <p>70-99 mg/dL</p> Signup and view all the answers

    What is released in response to hypoglycemia, in addition to glucagon?

    <p>Epinephrine</p> Signup and view all the answers

    What is the diagnostic criterion for gestational diabetes in terms of 2-hour plasma glucose?

    <p>≥153 mg/dL</p> Signup and view all the answers

    What is the diagnostic criterion for gestational diabetes in terms of Fasting plasma glucose ?

    <p>≥92 mg/dL</p> Signup and view all the answers

    What is a characteristic of Von Gierke Disease?

    <p>Severe hypoglycemia and metabolic acidosis</p> Signup and view all the answers

    What happens to glycogen in the liver in Von Gierke Disease?

    <p>It builds up in the liver</p> Signup and view all the answers

    What is the mode of inheritance of Von Gierke Disease?

    <p>Autosomal recessive</p> Signup and view all the answers

    What is a consequence of glycogen accumulation in the liver in Von Gierke Disease?

    <p>Hepatomegaly (enlarged liver)</p> Signup and view all the answers

    What is a metabolic abnormality associated with Von Gierke Disease?

    <p>Hyperuricemia (high uric acid levels)</p> Signup and view all the answers

    Glycogen cannot be converted back (lyze) to glucose via hepatic glycogenolysis

    <p>True</p> Signup and view all the answers

    What is the primary cause of hypoglycemia in galactosemia?

    <p>Decreased metabolism of galactose</p> Signup and view all the answers

    What is the diagnostic test for galactosemia?

    <p>Measuring erythrocyte Galactose 1-phosphate-uridyltransferase activity</p> Signup and view all the answers

    What is not the characteristic feature of galactosemia?

    <p>Hyperglycemia</p> Signup and view all the answers

    What is the result of the lack of galactose metabolism in galactosemia?

    <p>Build-up of galactose in the blood</p> Signup and view all the answers

    What is galactosemia classified as?

    <p>Inborn error of amino acid metabolism</p> Signup and view all the answers

    Study Notes

    Hyperglycemia (in the blood) Increased: ○ glucose in plasma and urine ○ urine-specific gravity ○ serum and urine osmolality Ketones in serum and urine (ketonemia and ketonuria) Decreased blood and urine pH (acidosis) Electrolyte imbalance (from increased osmolality)

    Diabetes Mellitus Types

    • IDDM (Type 1) accounts for 5-10% of all diabetes cases and often presents with ketosis.
    • IDDM typically has an early onset, often in juveniles, and is influenced by environmental, genetic, and viral factors.
    • Insulin is still produced in IDDM, but its action or secretion is defective.

    Characteristics of DM Type 1 vs. Type 2

    • DM Type 1: often presents with ketosis due to the lack of insulin, which forces the body to use fat as a glucose source.
    • DM Type 2: seldom presents with ketosis due to the hyperosmolar state of glucose, which inhibits glucagon's ability to stimulate lipolysis (glucagon attenuation).

    Diabetes Mellitus Definition

    • Diabetes mellitus is a metabolic disorder characterized by hyperglycemia resulting from a significant defect in either insulin action, insulin secretion, or both.

    Diabetes Mellitus (DM)

    • A metabolic disorder characterized by hyperglycemia due to a defect in insulin action and/or secretion.

    Types of Diabetes Mellitus

    • DM Type 1: IDDM, Juvenile Onset (5-10% of all cases)
      • Insulin is still produced, but in insufficient amounts.
      • Often associated with ketosis.
      • Caused by environmental factors, genetics, and previous viral encounters.
    • DM Type 2: NIDDM, Adult Onset (90% of all cases)
      • Seldom associated with ketosis.
      • Caused by broken insulin receptors.

    Ketosis in DM

    • Ketosis is often seen in Type 1 DM due to the absence of insulin, leading to the use of fat as a glucose source.
    • Ketosis is seldom seen in Type 2 DM due to the hyperosmolar state of glucose, which inhibits glucagon's ability to stimulate lipolysis (glucagon attenuation).

    Characteristics of DM Type 1: IDDM

    • Insulin-dependent diabetes mellitus, requiring exogenous insulin for life.
    • Juvenile onset, which can be diagnosed early, often from birth.
    • Caused by the presence of autoantibodies that destroy B-cells, leading to a deficiency in insulin secretion.
    • Pancreas becomes dysfunctional over time, with complete destruction of B-cells by puberty.
    • Symptoms include:
      • Tendency for ketosis.
      • 3 Ps: Polyuria (excessive urination), Polyphagia (excessive eating), Polydipsia (excessive thirst).
      • Microvascular problems.

    Causes of DM Type 1: IDDM

    • Pancreatic B-cell destruction.
    • No or low insulin production.
    • Presence of autoantibodies.
    • Excess glucagon.

    Diabetes Mellitus Symptoms

    • Polyuria (excessive urination) occurs in patients with diabetes as the body tries to compensate for the hyperglycemic state by diluting or neutralizing it with high water consumption, often leading to frequent nighttime urination.

    Diabetes Mellitus Symptoms (continued)

    • Polydipsia (excessive thirst) is a consequence of the body's increased water usage, resulting in patients drinking large amounts of water to compensate.

    Causes of Diabetes Mellitus Type 1

    • Environmental factors contribute to the development of DM type 1, likely triggered by an individual's genetic predisposition.
    • Viral infections can initiate DM type 1, with research suggesting a link to the presence of autoantibodies in the body.
    • Genetic predisposition plays a role in the development of DM type 1, making individuals more susceptible to the disease.

    Type 2 Diabetes (NIDDM)

    • Accounts for 90% of all diabetes cases, also known as Adult Onset Diabetes.
    • Characterized by insulin production, but cells are unable to recognize it.

    Insulin Receptors and Glucose Uptake

    • Insulin binds to receptors on the cell surface to allow glucose entry.
    • When receptors are damaged, glucose cannot enter the cell.
    • Insulin needs to bind to receptors to facilitate glucose uptake.

    Causes of Type 2 Diabetes

    • Defects in receptors that prevent insulin binding.
    • Insulin resistance, where cells become less responsive to insulin.
    • Presence of insulin, but cells are unable to utilize it.
    • Glucagon attenuation, which disrupts glucose regulation.

    Symptoms of Type 2 Diabetes

    • Polyuria (excessive urination), polyphagia (excessive eating), and polydipsia (excessive thirst).
    • Seldom ketosis tendency, and hyperosmolar states.
    • Symptoms may be mild and often develop gradually.

    Gestational Diabetes Mellitus (GDM)

    • Occurs only in pregnant women, typically between 24-48 weeks of gestation.
    • In most cases, GDM resolves on its own after delivery.
    • If left untreated for at least 5 years, women with GDM are at risk of developing Type 2 Diabetes.
    • Screening for GDM should begin between 24-28 weeks of gestation.
    • The placenta produces substances that simulate insulin resistance during pregnancy, contributing to the development of GDM.

    Complications of Diabetes During Pregnancy

    • Glucose intolerance can occur during pregnancy due to metabolic and hormonal changes
    • Babies born to diabetic mothers are at risk of respiratory distress, hypocalcemia, and hyperbilirubinemia

    Neuropathy

    • Neuropathy is a complication of diabetes that commonly affects the nerves of the hands and feet
    • It can also affect nerves controlling autonomic functions of the body, such as digestion
    • Additionally, it can affect nerves in the hips and thighs

    Nephropathy

    • Nephropathy is a complication of diabetes that causes damage to the kidneys
    • In severe cases, it can lead to kidney failure
    • Not everyone with diabetes develops kidney damage

    Retinopathy

    • Retinopathy is a complication of diabetes that causes disease of the retina
    • It can result in impairment or loss of vision

    Kidney Damage and Dialysis

    • High glucose levels can damage the kidneys
    • Those who have kidney failure may undergo dialysis
    • Dialysis is a process of filtering blood through a machine, which is then returned to the body of the patient

    Impaired Fasting Glucose

    • Fasting glucose level of ≥ 100 mg/dL but ≤ 126 mg/dL
    • Not considered diabetes, but borderline between diabetes and impaired fasting glucose
    • Indicates problems with glucose metabolism

    Impaired Glucose Tolerance

    • 2-hr OGTT ≥ 140 mg/dL but ≤ 200 mg/dL
    • Discovered through a 2-hour Oral Glucose Tolerance Test (OGTT)
    • Worse than impaired fasting glucose

    Pre-diabetes

    • HbA1c of 5.7% - 6.4%
    • Indicates progression to pre-diabetes stage
    • Glycated hemoglobin (HbA1c) represents average glucose levels over 90-120 days

    Glycated Hemoglobin (HbA1c)

    • Glucose attaches to hemoglobin (Hb) in RBCs
    • Primarily bonds with HbA1
    • High sugar levels in the blood detected through HbA1c
    • Used as a screening test for diabetes

    Impaired Fasting Glucose

    • Fasting glucose level of ≥ 100 mg/dL but ≤ 126 mg/dL
    • Not considered diabetes, but borderline between diabetes and impaired fasting glucose
    • Indicates problems with glucose metabolism

    Impaired Glucose Tolerance

    • 2-hr OGTT ≥ 140 mg/dL but ≤ 200 mg/dL
    • Discovered through a 2-hour Oral Glucose Tolerance Test (OGTT)
    • Worse than impaired fasting glucose

    Pre-diabetes

    • HbA1c of 5.7% - 6.4%
    • Indicates progression to pre-diabetes stage
    • Glycated hemoglobin (HbA1c) represents average glucose levels over 90-120 days

    Glycated Hemoglobin (HbA1c)

    • Glucose attaches to hemoglobin (Hb) in RBCs
    • Primarily bonds with HbA1
    • High sugar levels in the blood detected through HbA1c
    • Used as a screening test for diabetes

    Diagnosis of Diabetes Mellitus

    • Symptoms of DM require 3Ps: polyuria, polydipsia, and polyphagia
    • Random plasma glucose level ≥200 mg/dL at any time of day without fasting, which needs to be confirmed by one of the tests below

    Diagnostic Tests for Diabetes Mellitus

    • HbA1c (NGSP-certified method) ≥6.5%
    • FPG (Fasting Plasma Glucose) ≥126 mg/dL
    • OGTT (Oral Glucose Tolerance Test) ≥200 mg/dL (2-hour post load 75g)

    Categories for Oral Glucose Tolerance

    • Normal glucose tolerance: 2-hour PG ≤140 mg/dL (≤7.8 mmol/L)
    • Impaired glucose tolerance: 2-hour PG 140-199 mg/dL (7.8-11.1 mmol/L)
    • Provisional diabetes diagnosis (must be confirmed): 2-hour PG ≥200 mg/dL (≥11.1 mmol/L)

    Standard Glucose Solutions for OGCT and OGTT

    • OGCT (Oral Glucose Challenge Test) for gestational diabetes: 50g
    • Standard OGTT: 75g
    • 3-hour OGTT: 100g

    Glucose Solutions for OGCT (Oral Glucose Challenge Test)

    • Standard glucose solution for OGCT to diagnose gestational diabetes: 50g
    • Standard glucose solution for 2-hour OGTT (Oral Glucose Tolerance Test): 75g
    • Standard glucose solution for 3-hour OGTT: 100g

    Interpretation of OGTT Results

    • Normal glucose tolerance: 2-hour plasma glucose (PG) ≤140 mg/dL or ≤7.8 mmol/L
    • Diagnosis of gestational diabetes: 2-hour PG ≥200 mg/dL after a 75g OGTT

    Categories of Fasting Plasma Glucose

    • Normal fasting glucose: FPG 70-99 mg/dL (3.9-5.5 mmol/L)
    • Impaired fasting glucose: FPG 100-125 mg/dL (5.6-6.9 mmol/L)
    • Provisional fasting glucose: FPG ≥126 mg/dL (≥7.0 mmol/L)

    Diagnostic Criteria for Gestational Diabetes

    • Fasting plasma glucose: ≥92 mg/dL (5.1 mmol/L)
    • 1-hour plasma glucose: ≥180 mg/dL (10 mmol/L)
    • 2-hour plasma glucose: ≥153 mg/dL (8.5 mmol/L)

    Hypoglycemia

    • Hypoglycemia: decreased plasma glucose
    • Glucagon: released when there is low glucose level in the blood, inhibits insulin and releases epinephrine

    Von Gierke Disease (G-6-Phos Deficiency Type 1)

    • Autosomal recessive inheritance pattern
    • Characterized by severe hypoglycemia, metabolic acidosis, ketonemia, elevated lactate and alanine levels
    • Associated with hyperlipidemia, uricemia, and growth retardation
    • Impaired glycogenolysis in the liver, preventing glycogen conversion back to glucose
    • Resulting glycogen accumulation in the liver causes hepatomegaly (enlarged liver)

    Galactosemia

    • Congenital deficiency of one of three enzymes involved in galactose metabolism, leading to increased plasma galactose levels
    • Diagnosed by measuring erythrocyte Galactose 1-phosphate-uridyltransferase activity
    • Failure to metabolize galactose leads to hypoglycemia
    • Characterized by hypoglycemia, hyperbilirubinemia, and elevated galactose levels in the blood

    Inborn Errors of Metabolism

    • Includes galactosemia, inborn errors of amino acid metabolism, alimentary hypoglycemia, and idiopathic hypoglycemia
    • Caused by genetic defects

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    Description

    This quiz covers the symptoms and effects of hyperglycemia, including increased glucose levels, ketones in serum and urine, acidosis, and electrolyte imbalance. Test your knowledge of the signs and consequences of uncontrolled blood sugar.

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