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Pancreas
INSULIN
GLUCAGON
2. Cathecolamines
It is released from the chromaffin cells of the adrenal
medulla
Inhibits insulin secretions and promotes glycogenolysis
and lipolysis.
3. Growth hormones(Somatotrophic)
Secreted by the anterior pituitary gland
Decreases entry of glucose into the cell
It promotes glycogenolysis and glycolysis.
4. Thyroid hormones
Secreted by the thyroid gland.
Promotes glycogenolysis, gluconeogenesis and intestinal
absorption of glucose.
6. Somatostatin
Produced by the delta cells of the islets of langerhans of
the pancreas
It is primarily inhibits the action of insulin and glucagon.
2. Hypoglycemia
Involves decreased glucose levels and can have many
causes.
Warning signs and symptoms of hypoglycemia are all
related to CNS.
80 mg/dl to 5mg/dl (2.8-3.0 mmol/L) observable
symptoms of hypoglycemia occur.
CLASSIFICATION:
1. Drug administration- insulin alcohol, salicylates,
sulfonamides, pentamidine. Etc.
2. Critical illnesses- hepatic failure, sepsis, renal failure, cardiac
failure, malnutrition
3. Hormonal deficiency- epinephrine, glucagons, cortisol,
growth hormone
4. Endogenous hyperinsulinism- pancreatic beta cell disorder
5. Autoimmune hypoglycemia- insulin antibodies
6. Non beta cell tumors- leukemia, hepatoma,
pheochromocytoma, lymphoma etc.
7. Hypoglycemia if infancy and childhood- galactosemia, GSD,
Reyes syndrome
8. Alimentary (reactive) hypoglycemia- post-gastric surgery 9.
Idiopathic (functional) postprandial hypoglycemia
Diabetes Mellitus(DM)
A group of metabolic disorders characterized by
hyperglycemia resulting from defects in insulin secretion,
insulin or both.
Fasting plasma glucose concentrations > 26 mg/dL on more
than one testing are diagnostic DM.
Glucosuria occurs when the plasma glucose levels exceeds
180 mg/dL (9.99mmol/L) with normal renal function
In severe DM, the ratio of beta-hydroxybutyrate to
acetoacetate is 6:1
Classification of DM:
A. Type 1 DM
Formerly known as:
Insulin Dependent Diabetes Mellitus (IDDM)
Juvenile Onset Diabetes Mellitus
Brittle Diabetes Ketosis-Prone Diabetes
Is a result of cellular-mediated autoimmune destruction of the
beta cells of the pancreas.
Diabetic individuals have insulinopenia (absolute insulin
deficiency) because of loss of pancreatic beta-cells and depend
on insulin to sustain life and prevent ketosis.
80-90% reduction in the vol. of the beta cell is required to
induce symptomatic type 1 DM
Signs and symptoms: polyuria, polydipsia, polyphagia, rapid
wt. loss, hyperventilation, mental confusion and possible loss
of consciousness.
Complications: nephropathy, neuropathy, and retinopathy
microvascular disorders.
Microalbumin of 50-200 mg/24hrs. diabetic nephropathy
Urine albumin excretion rate of 200 g/minute overt diabetic
nephropathy.
B. Type 2 DM
Formerly known as:
Non-insulin Dependent Diabetes Mellitus
Adult Type/maturity Onset Diabetes Mellitus
Stable Diabetes
Ketosis- Resistant Diabetes
Receptor-Deficient Diabetes Mellitus
Risk factors:
obesity
family history
advanced age
hypertension
lack of exercise
impaired glucose metabolism
1. Pancreatic disroders
2. Endocrine disorders Cushings syndrome,
pheochromocytoma, accromegaly and thyrotxicosis
3. Drugs or chemical inducers of beta cells dysfunction
(dilantin and pentamidine)and impair insulin action
(thiazides,glucocorticoids)
4. Genetic syndromes- down syndrome, klinefelters
syndrome, leprechaunism etc.
D.Gestational DM(GDM)
Diabetes Insipidus
Deficiency of anti diuretic hormone released by the posterior
gland.
Glucose Methodologies
Fasting glucose in whole blood is 15% lower than in serum or
plasma.
Serum or plasma must be separated from the cells within one
hour to prevent losses of glucose.
At rm. Temp. (20-25C), glycolysis decreases glucose by 5-
7%/hour (5-10mg/dL) in normal uncentrifuged coagulated
blood.
At refrigerated temp. (4 C) glucose is metabolized at the rate
of about 1-2 mg/dL/hr.
WBC and RBC metabolize glucose resulting to decrease value
in clotted, uncentrifuge blood.
CSF glucose concentration should be approximately 60% (40-
60 mg/dL) of the plasma concentrations.
Plasma glucose levels increase with age fasting 2
mg/dL/decade; postprandial, 4mg/dL/decade; glucose
challenge, 8-13 mg/dL/decade.
I. CHEMICAL METHODS
a. FolinWu Method
b. Nelson Somogyi Method
c. Neocuproine method
d. Benedicts method- used for detection and quantitation of
reducing substances in body fluids like blood and urine.
e. Citrate or tartrate as stabilizing agent
2. Hexokinase Method
Most specific glucose method ; reference method
NOTES TO REMEMBER
3.Dextrostics
Important in establishing correct insulin amount for next
dose
Effective in reducing the rate of development of diabetic
complications
Samples for Glucose Measurement
Requirements:
CHO depletion and inactivity or bed rest impair glucose
tolerance
GTT is unnecessary to do for women under 25 yrs. Old who
have normal body wt. no family history of diabetes and are not
member of an ethnic group with high prevalence of diabetes.
b. Intravenous GTT
> used for DM patients with GI disorders.
>determine glucose by getting blood samples every 10mins.for
one hour
>0.5 g of glucose/kg body wt. (given within 3mins.)
administered intravenously
>fasting sample is also required.
Indications
a. Those who are unable to tolerate a large CHO load.
b. Those with altered gastric physiology
c. Those who had undergone previous operation or surgery in the
intestine.
d. Those with chronic malabsorption syndrome.
5.Glycosytated/glycated hemoglobin
6.Fructosamine
called glycosylated or glycated albumin/plasma protein
ketoamine.
A reflection of short term glucose control (2-3wks)
May be useful for monitoring diabetes individuals w/ chronic
hemolytic anemias and hemoglobin variants.
It should not be measured in cases of low plasma albumin.
1. Galactosemia
> A congenital deficiency; one of three enzymes involved in
galactose metabolism
Cause of failure to thrive syndrome in infants
eficient enzymes: galactose 1-phophate uridyl transferase
galactokinase and uridine diphosphate galastose 4-epimerase
Cllinical features: jauncide, hepatomegally, easy
bruisability,sepsis, cataract, hypotonia and sensory neural
deafness.
Diagnostic test: erythrocyte galactose- 1-PO4 uridyl
transferase activity.
2. Essential fructosuria
An autosomal recessive disorder characterized by
fructokinase deficiency
Diagnostic indicator: (+) fructose in urine
Notes to Remember
1. CSF glucose
It is abt. 60-70% of the blood plasma glucose level
Any changes in blood sugar are reflected in the CSF
approximately one hour later because of the lag in CSF
equilibrium time.
A blood glucose specimen should be collected at least 60
mins. Before the lumbar puncture.
Increased levels: diabetes
Decreased levels: bacterial meningitis, TB, fungal and
amebic meningitis.
Reference value: 40-70 mg/dL (adult)
60-80 mg/dL (child)
Normal CSF to glucose ratio: <0.5
2. C-Peptide test
Formed during the conversion of pro-insulin to insulin.
The amount of circulating C-peptides provides reliable
indicators for pancreatic and insulin secretionS (beta cells
functions)
Used to monitor individual responses to pancreatic
surgery.
To evaluate hypoglycemia
Specimen: fasting blood