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Give a comparative description of the two types of diabetes by the following criteria:

- age of the patient

- beginning acute or gradual

- the presence of excess body weight

- insulin content in blood plasma

- state of insulin receptors

- concentration of C-peptide

- effect of insulin administration

- plasma glucose concentration.

What is the significance of determining the type of diabetes for choosing the optimal treatment regimen?

Literature:

1) В.В. Долгов, А.С. Аметов, К.А. Щетникович, А.П. Ройтман,

Т.Ю. Демидова. Лабораторная диагностика нарушений обмена углеводов, сахарный диабет. М., ЛАХЕМА, 2000 г. 63 с.

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 580, 592-597, 2011. -С. 568, 580-585

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Problem 7

Patient A., 17 years old. Complaints: menstrual irregularities, pustular rashes on the skin, overweight; history of furunculosis. Objectively: II degree obesity, pyoderma. To assess the condition of the patient, the following laboratory tests were performed:

Glucose-tolerant Test (GTT): fasting serum glucose: 5.6 mmol / l, after 1 hour, 12.4 mmol / l; after 2 hours, 6.1 mmol / l.

Urine glucose under GTT conditions, i.e. 1 hour after a load 2.8 g / day.

What pathology can you think of in this case? Explain symptoms and abnormalities in laboratory tests.

Literature:

1) В.В. Долгов, А.С. Аметов, К.А. Щетникович, А.П. Ройтман,

Т.Ю. Демидова. Лабораторная диагностика нарушений обмена углеводов, сахарный диабет. М., ЛАХЕМА, 2000 г. 63 с.

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 580, 592-597, 2011. -С. 568, 580- 585.
Problem 8

Patient B., 40 years old. Complaints: skin itching, thirst, dry mouth, decreased performance periodically. Objectively: III degree obesity.

GTT: serum glucose on an empty stomach 6.0 mmol/l, after 1 hour 13 mmol/l, after 2 hours, 9.1 mmol/l.

Urine glucose during Test 3.5 g / day.

Explain clinical symptoms and abnormalities in the laboratory tests.

When examined after 5 years during the annual medical examination, the patient revealed: GTT: serum glucose on an empty stomach 6.8 mmol/l, after 1 hour 15 mmol/l, after 2 hours 12.1 mmol/l.,

glucosuria after 1 and 2 hours after loading test.

In addition, the following was discovered:

C-peptide on an empty stomach is 1801 pmol / l, 2 hours after glucose loading 4667 pmol / l (normal - 298 - 1324 before and after loading),

total cholesterol 7.0 mmol / l (normal - 3.1-5.2 mmol / l),

TAG level 3.27 mmol / l (normal - 0.4-1.53 mmol / l).

What pathology developed in patient B? Explain data from laboratory tests.

References:

1) В.В. Долгов, А.С. Аметов, К.А. Щетникович, А.П. Ройтман,

Т.Ю. Демидова. Лабораторная диагностика нарушений обмена углеводов, сахарный диабет. М., ЛАХЕМА, 2000 г. 63 с.

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 580, 592-597, 2011. -С. 568, 580- 585.
Problem 9.

Patient A, 53 years old, complains of poor health, muscle weakness, headaches, tinnitus, swelling. Objectively: obesity, fat is unevenly distributed, with predominant localization in the face and trunk and disproportionately thin limbs, BP 175/95.

To assess the condition of the patient, the following laboratory tests were performed:

ACTH –1.06 pmol / l (norm 1.1 –10.1 pmol / l),

cortisol 1466 nmol / l (norm 182-690 nmol / l),

aldosterone 780 pmol / l (normal 80–400 pmol / l),

total cholesterol 7.5 mmol / l (normal - 3.1-5.2 mmol / l),

TAG level 3.27 mmol / l (normal - 0.4-1.53 mmol / l).

Glucose-tolerant Test (GTT): fasting serum glucose: 7.0 mmol / l, after 1 hour, 9.4 mmol / l, after 2 hours 5.5 mmol / l .

No glucose in urine

What pathology can you think of in this case?

Explain clinical symptoms and abnormalities in the laboratory tests.

References:

1)Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003, стр. 572-577, 2011- С. 560-566.

2) Учебно-методическое пособие к практическим занятиям по биологической химии

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, часть 2, Санкт-Петербург, - 2013, стр. 74-76
Problem 10.

In a child (1.5 years), the liver is enlarged, there is a delay in growth and development. During the examination, the following indicators were found in the blood:

Glucose - 2.75 mmol / l

PVA - 1.38 mmol / l (norm 0 -0, 11 mmol / l)

Bilirubin 28 μmol / l (norm 3.4-22 μmol / l)

triglycerides 2.5 (norm 0.4-1.53 mmol / l).

During the test with glucagon, there was no increase in blood glucose (test positive)

Evaluate these indicators and tell what kind of pathology is involved. What process of carbohydrate metabolism is impaired? What is the cause of this disorder ?

(Write the process of carbohydrate metabolism, in the normal course of which there are no indicated deviations and indicate any violations in this process).

References:

1) Березов Т.Т., Коровкин Б.Ф. Биологическая химия,М.,Медицина, 1998.,С.359-362, 324-327.

2) В.В. Долгов, А.С. Аметов, К.А. Щетникович, А.П. Ройтман,

Т.Ю. Демидова. Лабораторная диагностика нарушений обмена углеводов, сахарный диабет. М., ЛАХЕМА, 2000 г. 63 с.

3) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 330-333, 2011. -С. 325-328.
Problem 11.

In the manufacture of some dyes in the manufacture of wood impregnation agents, 2,4-dinitrophenol (2,4-DNF) is used. In the production process, 2,4-DNF can enter the human body in the form of dust, fog, fumes, pass through the respiratory tract, through the skin. When 2,4-DNF poisoning is observed, an increase in body temperature, increased heart rate, weakness, increased breathing. Hyperglycemia and glucosuria are observed.

Describe the mechanism of biochemical disturbances of the action of this reagent on the human body. What disorders of carbohydrate metabolism are observed?

References:

1. 
   Березов Т.Т., Коровкин Б.Ф. Биологическая химия,
   

М., Медицина, 1998., С.305-314.

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 264-281, 2011. -С. 262-279
Problem 12.

Acetonitrile (СН₃СN)

It is used as a selective solvent for hydrocarbons and is used in organic synthesis. The toxic effect of acetonitrile in the body is associated with the formation of cyanide anion

- CN^-

In case of poisoning by acetonitrile of chemical workers as a result of a violation of the technological regime the victims found an increase in glucose and lactic acid in the blood. Victims complained of weakness, nausea, headaches.

What processes of carbohydrate metabolism were disrupted and why?

References:

1) Березов Т.Т., Коровкин Б.Ф. Биологическая химия, М., Медицина, 1998., С. 305-314.

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 362-364, 2011. -С. 358-380.
Problem 13.

During prolonged treatment with an antibiotic with the properties of an oxidizing agent, the patient developed anemia and hematuria due to intravascular hemolysis of red blood cells. The basis of the complex of symptoms of the poisoning occurred is, apparently, the blockade of the SH-groups of the components of the antioxidant system, which protect the membranes of red blood cells and pulmonary epithelial cells from peroxidation.

What processes of carbohydrate metabolism are related to the resistance of erythrocyte membranes to the action of oxidizing agents?

Activity of what enzyme should be determined before prescribing drugs with oxidizing properties? What preventive measures should be considered?

Reference:

1) Березов Т.Т., Коровкин Б.Ф. Биологическая химия , М., Медицина,

1998., С. 353-359.

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 358-364 , 2011. -С.352-358
Problem 14.

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In the diet of workers at the hot shop of the metallurgical plant, the carbohydrate content was 300 g per day, mainly due to the consumption of pasta, bakery products, potatoes, with a sufficient amount of fat. During a preventive examination, the content of PVA in the daily urine of some workers was above 30 mg.

What carbohydrate metabolism disorders occur? How to eliminate them?

References:

1. 
   Березов Т.Т., Коровкин Б.Ф. Биологическая химия, М., Медицина, 1998 г., С. 327-352.
   
2. 
   Петровский К.С., Ванханен В.Д. Гигиена питания М., С. 43-45, 59, 383-384.
   

Problem 15.

Patient A, 33 years old, complains of poor health, weakness, headaches. Objectively: muscle mass is reduced, BP 100/60.

To assess the patient’s condition, the following laboratory tests were performed:

Fasting plasma glucose of 3.3 mmol / l,

Urine glucose is 1.9 mmol / day. 1 hour after a meal, the blood glucose is 5.5 mmol / l, the glucose in the urine is 2.1 mmol / day

Other laboratory tests:

ACTH –7.66 pmol / l (norm 1.1 –10.1 pmol / l),

cortisol 666 nmol / l (norm 182-690 nmol / l),

total cholesterol 3.5 mmol / l (normal - 3.1-5.2 mmol / l),

TAG 0.97 mmol / l (normal - 0.4-1.53 mmol / l).

What pathology can you think of in this case? Explain the symptoms and abnormalities in the laboratory tests.

References:

Lecture "Regulation of carbohydrate metabolism"
Supplement for self-study «Disorders of carbohydrate metabolism»
According to 1999 WHO recommendations, the glucose tolerance test (GTT) - test for resistance to glucose load is carried out with the determination of glucose level at two points: before the load and 2 hours after the load. TSH is performed if the diagnosis is unclear.

After loading, the measurement after 60 minutes is used to interpret the results in cases when after 120 minutes boundary figures are obtained. When diagnosing acromegaly and ascertaining the cause of glucosuria, blood samples can be taken at 30 min intervals.

However, in clinical practice, GTT is continued at three points: before the load, 1 hour and 2 hours after the load (the “sugar curve”) in most cases, and not only when the border figures are obtained after 2 hours.

TSH performance

The patient should follow a normal diet with at least 250 g of carbohydrates for 3 days. Do not eat up at night. The test is performed in the morning on an empty stomach, it starts with determining the initial glucose level, then the patient is given an average of 75 g of glucose (based on 1 g per kg of weight) dissolved in tea with lemon, then blood samples are taken to determine glucose after 60 and 120 minutes.

Normal values of glycemia (glucose) in the serum of venous blood, urine glucose and "C" peptide:

Fasting 3.4-6.1 mmol / l

After 1 hour 6.7-9.4 mmol / l

After 2 hours 3.9-6.7 mmol / l  7.8 mmol / l - according to V. Dolgov.

Urine Glucose 0

"C" peptide 298 ­ 1324 pmol / l (before and after loading)

GTT can detect the following disorders of carbohydrate metabolism:

1. 
   Impaired glucose absorption (fasting glucose and after 1 hour, slightly-smoothed “sugar curve”)
   
2. 
   Impaired fasting glycemia (the fasting glucose level is higher than normal, but there are no signs of diabetes; during GTT after 2 hours, the glucose level is normal).
   

Impaired fasting glycemia can be observed with excessive stimulation of gluconeogenesis at night by glucocorticoids (Itsenko-Cushing's disease and syndrome, prolonged use of drugs containing corticosteroid analogues). In response to the load (GTT, food containing carbohydrates), insulin production increases significantly, so for a long time, normal glucose levels can be observed 2 hours after the load.

Increased glucose utilization contributes to the development of obesity and hypercholesterolemia. Without correction, this condition can be complicated by the development of so-called "steroid diabetes", the cause of which can be either depletion of the insular apparatus or the development of insulin resistance.

3. The conclusion "Violation of glucose tolerance" is made if the fasting glucose level is normal or slightly above it, and after 1 hour exceeds the "renal threshold" and after 2 hours 7.8 mmol / l -11 mmol / l. Many patients with impaired tolerance are characterized by obesity and hypercholesterolemia. Due to the fact that in these patients some clinical signs of diabetes are periodically observed, with a normal fasting blood glucose level, this condition was called “latent”, “latent” diabetes mellitus; Now they have abandoned this term. This condition requires mandatory correction due to the high risk of developing true diabetes, and the risk of developing myocardial infarction, stroke, and other complications of atherosclerosis also increases.

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An impaired tolerance should also be considered a condition in which the fasting glucose level is normal, after one hour exceeds the norm, goes beyond the "renal threshold" for glucose during GTT, glucose appears in the urine), and after two hours it is normal. When analyzing the results only on an empty stomach glucose level and after 2 hours, these patients remain undiagnosed. Such patients, as a rule, do not actively complain. However, many of them are characterized by obesity of the I-II degree, pyoderma, furunculosis, impaired reproductive function, etc., in connection with which they are observed by a dermatologist, surgeon, gynecologist, etc., and not by an endocrinologist. In such cases, in order to detect a violation of carbohydrate metabolism, it is necessary to carry out GTT with the obligatory determination of the glucose level at three points. In the absence of correction, this condition can progress with the development of a more severe glucose tolerance disorder, which is discussed above.

GTT can be used:

For dynamic monitoring of patients with diabetes in order to control the adequacy of treatment. It should be remembered that the Test is carried out only if the fasting glucose level against the background of diet and drug treatment is normal, or moderately elevated (but not more than 7.8 mmol / l), because when it is held above this blood glucose level, there is a risk of hyperglycemic shock. For the same reason, in patients whose diagnosis of diabetes is not in doubt (severe fasting glucose  7.8 mmol / l) and other clinical signs of diabetes), TSH is not indicated and dangerous because of the possible development of hyperglycemic shock.
Тests for the topic «CARBOHYDRATE EXCHANGE»

Тest 1

CHOOSE THE CORRECT ANSWER:

Disorders in the digestion of carbohydrates in the small intestine can be detected using a load test with

а) glucose

b) glucagon

c) disaccharide

d) dexamethasone

e) ischemic load

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