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Glycogen
- The storage form of glucose and is a polysaccharide.
- *saccharide is a single sugar unit*
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Glycogenesis
The formation of glycogen from glucose.
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Glycogenolysis
The breakdown of glycogen to glucose.
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Glycolysis
Glucose changed to give energy.
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Gluconeogenesis
Glucose formed from fats or proteins.
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Where is glycogen made and stored?
- It is made in the liver.
- It is stored in the liver and muscle.
- *the liver is carbohydrate or metabolism central*
- *the liver removes or adds glucose to the blood*
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Where is insulin made?
It is made in the beta cells of Islets of Langerhans in the pancreas.
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What does insulin do?
- Insulin transports glucose through the cell membrane into the cell.
- Insulin must be present for glucose to enter cells.
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How does insulin affect the blood glucose level?
It lowers the blood glucose level.
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Where is glucagon made?
It is made in the alpha cells of the pancreas.
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What does glucagon do?
It stimulates glycogenolysis.
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How does glucagon affect the blood glucose level?
It is going to increase the blood glucose levels.
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Where are ketone bodies made?
They are made in the liver.
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What are ketone bodies made from?
- Ketone bodies are made from excess fatty acids that are partially metabolized into energy.
- *when your body burns fatty acids the waste product is ketone bodies*
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Ketonuria
Ketone bodies in the urine.
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Ketonemia
Ketone bodies in the blood
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Ketoacidosis
- Blood ph <7.35 due to ketones in the blood
- (acid builds up in blood)
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Hyperglycemia
High blood glucose
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Hypoglycemia
Low blood glucose
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Glucosuria/Glycosuria
Glucose in the urine
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Renal threshold
- The blood level above which glucose spills into the urine
- *there shouldn't be any glucose in urine*
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IDDM is also known as
- Insulin Dependent Diabetic Mellitus
- polyuria, polyclipsia, ployphagia
- TypeI
- Juvenille 5 to 10% of all diabetics are TypeI
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The Age of onset of IDDM
- At any age
- More common in youth younger that 20 years old
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Symptoms of IDDM
- Weight lost
- Polyuria (increased urine)
- Polydipsia (increased thirst)
- Polyphagia (increased hunger)
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IDDM and Endogenous insulin
None
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Oral agents used if you have IDDM
No cannot take pills
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Cause of IDDM (type I)
- Distruction of beta cells
- Autoimmune genetic susceptibility, attacks it's own pancreas
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NIDDM also known as
- Non Insulin Dependent Diabetic Mellitus
- Tpye II - adult diabeties
- 90% of diabetics are Type II
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The Age of onset of NIDDM
- Any age
- More common in adults over 30
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NIDDM type of onset
Gradual
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Symptoms of NIDDM
Sometimes none
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NIDDM and Endogenous insulin
Some
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NIDDM using Oral agents
- Yes useful 1/3 of the time
- 1/3 can be managed by diet and exercise
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Causes of NIDDM
- Beta cell exhaustion or insulin resistant
- Also runs in family
- could be obese or more than normal body weight
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What type of diabetes has a tendency to get ketoacidosis?
Type I (Juvenile Diabetes)
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Which type of diabetes may be controlled by diet alone?
Type II (Adult diabetes)
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What do diabetics metabolize instead of glucose?
- Lipids (fats)
- 95% of fats in the body are triglycerides or fatty acids
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What is retinopathy?
- It is a complication seen in both Type I & II diabetes.
- It is the Sclerosis (hardening) of the minute or tiny blood vessels of the eye.
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What are some of the complications of diabetes?
- A. Atherosclerosis- lipid deposits within arterial walls
- B. CAD- Coronary Artery Disease
- C. Peripheral Vascular Disease- poor circulation to the extremities (fingers&toes)
- D. Poor Wound Healing
- E. Susceptibility to Infections (white blood cells not functioning)
- F. Neuropathy- damage of the nerver, especially in the extremities (feet)
- G. Nephropathy- disease of the kidney
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Diabetic Coma Untreated diabetic
(blood sugar too high)
Insulin Level
Low
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Diabetic Coma - Blood glucose level
High
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Diabetic Coma - Urine glucose
Present or positive
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Diabetic Coma - Onset
Over hours or Days
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Diabetic Coma - Symptoms
- Deep breathing
- Dry tongue & skin dehydrated
- Fruity breath or acetone breath
- Patient is drowsy and lethargic
- Coma
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Diabetic Coma - Treat pt. with
Insulin, fluids and eletrolytes
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Insulin Shock Too Much Insulin
(Low blood sugar)
Insulin Level
High
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Insulin Shock - Blood glucose level
Low
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Insulin Shock - Urine glucose
Not present
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Insulin Shock - Onset
Sudden - in a matter of minutes
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Insulin Shock - Symptoms
- Shallow breathing
- Rapid heart action & perspiration
- Normal breath (not sweet)
- Light headed or faint
- intoxicated, thick speech
- unsteady walking
- Coma
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Insulin Shock - Treat pt. with
- 15g of readily available sugar
- ex. raisins, 7 to 8 lifesavers, 3 to 4 teaspoons of sugar, half of cup of regular pop
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What are the symptoms of hypoglycemia?
(blood sugar low)
- Same as Insulin Shock
- Shallow breathing
- Rapid heart action & perspiration
- Normal breath (not sweet)
- Light headed or faint
- intoxicated, thick speech
- unsteady walking
- Coma
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What is a fasting blood glucose sample?
One with no food or beverage within 12 hours
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What does OGTT stand for?
Oral Glucose Tolerance Test
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What samples are taken for the OGTT?
- Blood samples
- Sugar solution * must drink within 5 mins.*
- FBS(fasting blood sugar) 1, 2, 3 hours
- Test taken 1 hour after drinking solution
- 2nd hour the blood sugar should being going down
- 3rd hour blood sugar should be normal
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What samples are taken for the OGTT if hypoglycemia is suspected?
The test will continue and blood samples will be taken at hours 4 & 5 after drinking sugar solution.
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Given the renal threshold and a patient's blood glucose level, how would you determine if glucose will be in the urine?
- Renal threshold 170mg/dL
- <170 no sugar present (less than)
- >170 sugar present (greater than)
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How is the hours postprandial (after meal) glucose test done?
Fasting level and 2 hours after a meal
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What is a normal result for the 2-hour postprandial (after meal) glucose test?
<140mg/dL is normal result
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What does the Hb-A1c test measure?
- It test HbA1, combined with glucose
- hemoglobin combined with glucose
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What is the advantage of the Hb-A1c/glycosylated hemoglobin test?
- It reflects the blood glucose over a 3 month period.
- normal is 4 to 6%
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