Clinical Lab: Carbs, Proteins, Lipids

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Carbohydrates are...: -complex sugars
-metablized into basic sugars
Blood glucose may change d/t...: -inc or dec metabolism of carbs into sugar
-inc or dec rate of consumption of glucose by cells
-hormones help to regulate glucose movement into and out of the cell
What decreased blood sugar?: Insulin
What increased blood sugar?: -glucagon
-cortisol
-epi
-growth hormone
Insulin: -produced in pancreas in islets of langerhans (beta cells)
-controls cells ability to take glucose from the blood stream (increases cells uptake of glucose)
What factor is most important in regulating insulin secretion?: circulating concentration of blood glucose
Diabetes Mellitus: -disruption of insulin relgulation
-deficient beta cell insulin production or release (pancreatic factor)
-insulin receptor dysfcn (extra-pancreatic factor)
Testing/Monitoring Diabetes: -measuring insulin is ideal but difficult and costly
-C-peptide predicts insulin levels
What is c-peptide?: -insulin precursor
-protein connecting alpha chain of pro-insulin
-released into bloodstream when insulin is produced
-CORRELATES WITH INSULIN LEVELS (generally)
Can use c-peptide instead of insulin for..: -diabetics with anti-insulin antibodies
-pt who secretly admin insulin to themselves
-diabetic taking insulin
-pts with insulinoma (excess insulin)
What is more accurate than whole blood glucose for monitoring glucose?: serum glucose
Tube of choice for glucose monitoring: serum separator tube (completely separates cells and serum)
If whole blood glucose is your only option for monitoring glucose, what tube should you use?: -Grey top tube (NaFl) because it blocks glucose metabolsim
-normally whole blood glucose drops 10 mg/dl for each hour it sits
What do most labs used for monitoring glucose?: automated glucose oxidase methodology
CLIA approved procedures for monitoring glucose include...: -glucose oxidase
-orthotoludidine
What may interfere with glucose reading?: -increased HCT can increase glucose
-ascorbic acid or lipemia
Fasting Glucose: Adult Neonate Gestational Diabetes Non gestational Diabetes: Adult: 70-115 mg/dl
Neonate: 30-40 mg/dl
Gestational Diabetes: >105 mg/dl
Non-gestational Diabetes: >140 mg/dl
Glucose Tolerance Tests:: -3 hr procedure used to rule out DM in border line cases
-prep includes 150 gm carb diet for 3 days, followed by 12 hour fast
Glucose Tolerance Test: Expecected reactions: Fasting: 70-100 mg/dl
Peak (30 min -1 hour): 120-170 mg/dl
1 Hour: 120-170 mg/dl
2 Hours: 70-120
3 hours: 70-120
**ALL VALUES MUST BE IN RANGE TO BE CONSIDERED NORMAL
*If you extend it for 5 hours, it can detect hypoglcemia (values will drop below 70 and stay down for a long time)
how do test results differ with diabetics?: -after the peak, there is a slow decrease
Under normal circumstances, glucose attached to ....: Beta chain of hemoglobin A
glucose + hemoglobin A produces...: hemoglobin A1C
What is the link between glycosylation of hemoglobin and blood glucose levels?: Glucosylation will increase with sustained levels of blood glucose

(increase in blood glucose levels leads to increases glycosylation)
Hb A1C values indicate glucose levels over what amount of time?: over the past 3 months

Because of RBCs lifespan (110-120 days)
High glycosylated hemoglobin levels indicates...: poor control in a diabetic
What is the Normal non-diabetic glycosylated Hb level?: <6%
How is glycosylated Hb test used?: -to monitor diabetic therapy
-differentiate short term hyperglycemia from a diabetic condition
-eliminate ficticous report by pt
Causes of hyperglycemia:: -diabetes
-states of stress (MI, CVA, trauma, general anesthesia)
-acute panreatitis
-drugs (corticosteroids, some dieretics, beta blockers)
-IV fluids with dextrose
Causes of hypoglycemia:: -excess inslun
-sulfonylurea (drugs that cause pancreas to produce insulin)
-insulinoma (excess insulin)
-hypothyroidism
-starvation
Plasma lipoproteins carries most of the ..... and ...... in the blood: carries most of the cholesterol and esterified lipids in the blood
4 major lipoprotein classes:: -chylomicrons
-very low density lipoproteins (VLDL)
-low density lipoproteins (LDL)
-high density lipoproteins (HDL)
Major fucntion of the lipoproteins is...: transport of trigylceride and cholesterol from sites of origin (intestine and liver) to sites of energy storage and utilization
Normal Triglycerides: Male: 40-160
Female: 35-135
Normal Total Cholesteral: <200 mg/dl
Normal HDL: >40 mg/dl
Normal LDL: <100 mg/dl
Normal Chol:HDL ratio: <5

10 = double the risk
20 = triple the risk
Which lipid values change with fasting state? Which do not?: Triglycerides change with a fasting state

Total cholesterol does not
Cholesterol is the main lipid associated with....?: arteriosclerotic vascular disease
Is cholesteral a good indicator of CAD?: by, itself, cholesterol is NOT an accurate predictor of CAD (it fluctuates daily)
What is a better measure of CAD?: Total cholesteral:HDL ratio
What is cholesterol used for?: required for production of sex hormones, steroids, etc.
What percentages of cholesteral are bound to LDL and HDL?: 75% to LDL

25% to HDL
Causes of increased cholesterol?: -lifestyle
-familial hyperlipidemia
-pregnancy
-uncontrolled diabetes
Causes of decreased cholesterol?: -severe liver disease
-malnutrition
-MI (levels falls 24-48 hours, reach low point at 7-10 days at ~30-40% lower than normal)
Where are tricglycerides produced,transported, etc.?: -Produced in the liver and tranported by LDL
-Incorporated into the chylomicrons (protein shell)
-gives blood a milky appearance if too high
Triglycerides are hydrolyzed by .... into ....: hydrolyzed by pancreatic lipase into FFA and monoglycerides
Triglycerides can be measured as an assessment of...: Coronary risk
Causes of increased triglycerides:: -glycogen storage disease
-familial hyperlipidemia
-chornic renal disease
Causes of decreased triglcyerides:: -malabsoprtion
-hyperthyroidism
Where and how is LDL produced?: Produced in the liver by combingin Tg and cholestereol with apoproteins
LDL consists of...: 35% protein
50% cholesterol
10% Tg
What does LDL do?: -carries Tg to peripheral tissue to be used by cells
-contributes to deposition of cholesterol in the artery walls
LDL values:: <100 desirable (<70 if hx of MI)

100-160 borderline

>160 high risk
HDL consists of..: 50% protein
20% cholesterol
trace Tg
What does HDL do?: -transports cholesterol from tissue back to liver
-offers some protection from atherosclerosis
HDL values:: Male 35-65 mg/dl (<35 is CAD risk)

Female 35-80 mg/dl (<40 is CAD risk)
What are apolipoproteins?: -polyproteins that make up the protein component of lipoproteins
-involved in the binding of lipoproteins to receptors on the cell surface (facilitates lipid uptake by cells)
What is the major polypeptide component of HDL? of LDL?: HDL: Apolipoprotein A

LDL: Apolipoprotein B
Indication for apolipoproteins labs?: evaluate the risk of atherogenic heart disease or peripheral vascular disease
Factors affecting lipid panel results:: -pt not on usual diet for past 2 weeks
-medications (OCPs, estrogens, BP meds)
-thyroid, hepatic, or kidney dz
-prolonged use of touniquet during blood draw (inc level)
-pregnancy (inc level)
Two main types of proteins:: -Albumin
-Globulin (lipoprotein, glycoprotein, immunoglobulins)
What can be used to separate albumin and globulin?: -protein electrophoresis can be used to separate albumin and globulin and establishes levels of various components that are specific for certain disease states
Electrophoresis is used to ..: -detect gammopathies
-assess severe liver dz
-assess nutritional status
Albumin: -most common protein (2/3 of total)
-smaller and light than globulins
-produced in liver
What does Albumin do?: -maintains serum osmotic pressure
-transports various substances (carrier protein) such as calcium, magnesium, bilirubin, coumadin, etc.
-source of endogenous amino acids
Albumin assays: -assayed by chemical method that react with nitrogen atoms or with a dye that binds to albumin and produces a color change
-ultra-centrifugation has been used to study some groups of globulins
Total serum protein =: albumin + globulins
Normal Total Serum Protein: Adults: 6-8 g/dl
Causes of hyperproteinemia:: -dehydration
-gammopathies
-liver dz
-collage disorders (SLE,RA)
Causes of hypoproteinemia:: -increased protein loss (nephrotic syndrome, burns, etc)
-increased catabolism (inflammation, malignancy)
-decreased synthesis (liver dz, decreased AA intake)
Immunoglobins: -proteins that act as antibodies in the immune system

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