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Clinical Chemistry
Exam 1
Lecture 2/5
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Cards (22)
Gestational
Diabetes - resembles
type II DM
presentation - symptoms of
hyperglycemia
occurs during
pregnancy
onset - diagnosed during
pregnancy
resolution -
disappears
after
birth
; however, mother is more prone to developing
type II DM
later in life
babies of mothers with
gestational
diabetes that are not treated are more likely to develop
hypoglycemia
,
hypocalcemia
respiratory distress syndrome
pathophysiology of DM
common
hyperglycemia
spillover
of
180
mg/dl
plateaus
at
300-500
mg/dL because spillover occurs at 180 mg/dL
pathophysiology of DM
type 1
tendency to generate
ketones
-
metabolism
of
triglycerides
results in _____
low
insulin/
high
glucagon promotes
lipolysis
low
or
absent
C-peptide
(proinsulin by pancreas is not being cleaved)
acidosis
and
hyperosmolality
due to
hyperventilation
and
ketosis
ketosis
puts patient in
metabolic acidosis
; body tries to resolve this by getting rid of
CO2
to drive buffer to
neutral
side
Pathophysiology of DM type II
rarely generates
ketones
- some
glucose
is being utilized
normal
insulin
levels suppress
glycogenolysis
and
lypolysis
normal
C-peptide
levels as insulin is being
secreted
hyperosmolality without
ketosis
(from elevated
glucose
and
insulin
increases concentration)
hypoglycemia
decreased
plasma glucose levels
true hypoglycemia is
rare
islet hyperplasia
or
insulinoma
(
beta cell tumor
) - secrete too much
insulin
and cause
glucose level
to
lower
too much
usually
drug
induced - if transient
hyperplasia
- growth in
number
of cells
hypertrophy
- growth in cell
size
Hypoglycemia
symptoms appear at
50-55
mg/dL
symptoms of early hypoglycemia -
hunger
,
diaphoresis
,
nausea
/
vomiting
,
dizziness
symptoms of hypoglycemia:
mental confusion
,
blurred vision
,
slurred speech
,
nervousness
and
shaking
hypoglycemia
see secretion of
glucagon
,
epinephrine
,
cortison
, and
GH
(
growth hormone
)
hypoglycemia can be induced by
alcohol
, as it mimics
insulin
if
hypoglycemia
continues and gets too
low
, patient can
die
Carbohydrate
intolerance
enzyme deficiency
-
lactose
not manufactured
lactose
is the most common
lactose intolerance test
-
pt comes in
fasting
; lactose solution given, blood drawn every
30
minutes; if glucose doesn't
increase
above
25
mg/dL, patient is
lactose intolerant
patient is not metabolizing
lactose
to
glucose
and
galactose
patient blows
balloon
;
H2
gas produced by bacteria metabolizing glucose will be present
blows up balloon every
15
minutes for
2
hours
galactosemia
galactose accumulates in the body when patient lacks enzyme to convert it to
glucose
if galactose not removed from diet, patient can get
cataracts
,
CNS dysfunction
,
short
lifespan
inherited
condition, occurs in
1
out of
62,000
people
increased
liver enzymes
in blood, as well as
bilirubin
urine will be
positive
for
reducing sugars
G6PD -
glucose 6 phosphate dehydrogenase
(takes H)
phosphogluconolactone
or
phosphogluconate
monitoring
self-monitoring
- most common; record on notebook
serum glucose
- drawn at checkups
urinalysis
- way to alert doctor something isn't right; patient isn't compliant with dietary restrictions
Glycosylated hemoglobin
normal is
4-7
%; some texts say up to
8
% is normal
Some type
II
diabetics, if they do not follow doctor orders, pancreas
stops
secreting
insulin
, becoming type
I