Lecture Carbohydrates Part 2 (Student Copy) PDF

Carbohydrates Part 2 Signs and Symptoms of DM ⚫ Polydipsia (excessive thirst) ⚫ Polyphagia (increased food intake) ⚫ Polyuria (excessive urine production) ⚫ Rapid weight loss ⚫ Hyperventilation ⚫ Mental confusion M. Zaharna Clin. Chem. 2009 Complication...

Carbohydrates Part 2 Signs and Symptoms of DM ⚫ Polydipsia (excessive thirst) ⚫ Polyphagia (increased food intake) ⚫ Polyuria (excessive urine production) ⚫ Rapid weight loss ⚫ Hyperventilation ⚫ Mental confusion M. Zaharna Clin. Chem. 2009 Complications of DM ⚫ Microvascular problems such as: ⚫ nephropathy ⚫ neuropathy ⚫ retinopathy ⚫ Macrovascular problems ⚫ increased heart disease is also found in patients with diabetes. M. Zaharna Clin. Chem. 2009 Pathophysiology of Diabetes Mellitus ⚫ Type 1 and Type 2 diabetes: ⚫ there is an increase in blood glucose levels (hyperglycemic). ⚫ There is also elevation of glucose in urine (glucosuria) if glucose levels in blood exceeds 180 mg/dl. M. Zaharna Clin. Chem. 2009 Ketoacidosis ⚫ The individual with type 1 diabetes has a higher tendency to produce ketones. ⚫ Absence of insulin and with increased glucagon leads to gluconeogenesis and lipolysis. ⚫ The liver thus produces large amounts of ketone bodies, which are moderately strong acids. ⚫ The result is severe acidosis ⚫ the decrease in pH impairs tissue function, most importantly in the central nervous system. M. Zaharna Clin. Chem. 2009 M. Zaharna Clin. Chem. 2009 Hyperosmolar Nonketonic States ⚫ Type 2: have very little ketone production, but have a greater tendency to develop hyperosmolar nonketonic states. ⚫ This disorder is caused by elevated blood sugar levels and is usually brought on by a coexisting condition, such as an illness or infection. ⚫ can be a life-threatening emergency M. Zaharna Clin. Chem. 2009 Hyperosmolar Nonketonic States ⚫ Criteria for hyperosmolar nonketonic states include: ⚫ serum osmolality of 320 mOsm/kg (275-299) ⚫ plasma glucose level greater than 600 mg/dL, ⚫ intense dehydration, ⚫ no ketoacidosis, ⚫ Hyperglycemia and the rise in concentration of plasma proteins that follow intravascular water loss cause a hyperosmolar state. M. Zaharna Clin. Chem. 2009 Hyperosmolar Nonketonic States ⚫ In the presence of a hyperglycemic, hyperosmolar state, if the renal water loss is not compensated by oral water intake, then hypovolemia follows dehydration. ⚫ Hypovolemia, in turn, leads to hypotension, and hypotension results in impaired tissue perfusion. ⚫ Coma is the end stage of this hyperglycemic process, when severe electrolyte disturbances occur in association with hypotension. ⚫ Ketones are not observed because glucagon is not able to stimulate lipolysis. M. Zaharna Clin. Chem. 2009 Criteria for Testing for Prediabetes and Diabetes ⚫ Forms of impaired glucose metabolism that do not meet the criteria for diabetes mellitus include impaired fasting glucose and impaired glucose tolerance. ⚫ These have a relatively high risk for the development of diabetes ⚫ First, those patients with: ⚫ fasting glucose levels ≥100 mg/dL but 140/90 ⚫ Low HDL cholesterol (< 35mg/dl) ⚫ Elevated triglycerides (> 250 mg/dl)  Criteria For Diagnosis Of DM 1. Random plasma glucose (RBS) ≥ 200 mg/dL (≥11.1 mmol/L), + symptoms of diabetes 2. Fasting plasma glucose (FPG) ≥ 126 mg/dL (≥7.0 mmol/L) 3. Two-hour plasma glucose (2hr-OGTT) ≥ 200 mg/dL (≥11.1 mmol/L) during an OGTT Each of which must be confirmed on a subsequent day by any one of the three methods N.B. To convert mmol/l of glucose to mg/dl, multiply by 18  Categories of Fasting Plasma Glucose (FPG) FPG