Criteria for Diagnosis of DM to other types of DM Flashcards
Requested during insulin shock and hyperglycemic ketonic coma
Random Plasma Glucose/ Random Blood
Sugar/RBS
Reference value for RBS
<160 mg/dL
T/F: If RBS is ≥160 mg/dL → perform FBS/ HbA1c/ 2-hr OGTT for confirmation
TRUE
Measure of overall glucose homeostasis
It is affected by Diurnal Variation (higher in the morning than in the afternoon)
Fasting Plasma Glucose
Reference value for FPG
70-99 mg/dL
If FBG is done in the afternoon, the result will
falsely decrease
FBG increase with age for how many per decade?
2mg/dL (per decade)
o Uses standardized Glucose Load (75g equivalent complete meal)
o After the 2-hour after meal, the patient must not eat anything
2nd hour Post Prandial Blood Glucose
Reference value for 2hr Post prandial Glucose
60-140 mg/dL
Diabetic value for 2hr PPG
≥200 mg/dL
2hr PPG increase with age for how many mg per decade
4 mg
Called “glycosylated/glycated” because glucose is non-enzymatically attached to one or both beta chain of the hemoglobin
Glycosylated (Glycated) Hemoglobin (HbA1c)
- referred test to assess long-term glycemic control
- Reflects the average glucose level over the past 2-3 months
Glycosylated (Glycated) Hemoglobin (HbA1c)
Decrease RBC life span in hemolytic anemia or hemoglobinopathies will cause
False decrease HbA1c
Substitute test for patient with hemolytic anemia and hemoglobinopathies
Fructosamine
Reference value: HbA1C
Adult: 4.0-6.0 % (American Diabetes Association: <5.7%) ▪ Pediatrics:<7.5%
Diabetic value for HbA1C
≥6.5%
Prediabetes value for HbA1c
5.7-6.4%(normal but at risk)
- Most widely used to assess short-term glycemic control (3-6 weeks)
- Specimen: Serum with or without fasting
Fructosamine/Glycosylated/Glycated albumin/Plasma Protein Ketoamine
Methods used for fructosamine
HPLC, Affinity chromatography, photometric assay
Interference for fructosamine
High uric acid, triglyceride and bilirubin levels, heparin, hemolysis
You cannot perform this if the patient has
hypoalbuminemia (albumin less than or equal 30 g/dL because
It will cause false decrease fructosamine
Reference value for Fructosamine
205-285 umol/L
- It is used to determine how well the body metabolizes glucose over a required period of time
- Recommended for diagnosis of GDM
Not routinely performed in patient with DM
Glucose Tolerance Test (Multiple Sugar test)
Recommended method for Non-pregnant patients
Oral Glucose Tolerance Test
Reference value for OGTT
2hr - 60-140 mg/dL
Diabetic value for OGTT
2hr, ≥ 200 mg/dL
Value of impaired glucose tolerance for OGTT
140-199 mg/dL
Requirement for OGTT
- Patient should be ambulatory/able to walk (the only test in clinical chemistry that requires ambulatory patient and not performed on bedridden patients)
- Unrestricted diet of 150g carbohydrate/day for 3 days prior to test
- Restrictions: Exercise, food intake, drinking (only water), smoking
- Fasting for at least 10 hours
- Must be performed in the morning
Smoking and alcohol can __ blood glucose
Increase
Glucose load standards
▪ 75 grams – WHO standard glucose load
▪ 100grams–pregnant; as requested
▪ 1.75 grams of glucose/KBW - children (max. 75g)
- Performed on patients with gastrointestinal disorders (malabsorption syndrome)
- Glucose load: 0.5 g/KBW (administer within 3 mins)
Intravenous Glucose Tolerance Test
Janney-Isaacson Method also known as
Single-Dose method
Steps for Janney-Isaacson Method
Steps:
a. Extract first blood sample (FBS)
b. Administer standard glucose load (75g)
c. Collect 1 hour, 2 hour, and 3 hour blood samples after glucose loading
- Total of 4 blood samples (including FBS)
d. Patient is not allowed to eat before collecting all four blood samples (he or she can only after collection of the 3 hour blood sample)
Called double-dose because it uses 100g glucose load then, divide into 2
Exton Rose Method (Double-Dose/Divided Oral Dose Method)
Exton Rose Method (Double-Dose/Divided Oral Dose Method) steps
- Extract first blood sample (FBS)
- Administer 1st half of the glucose load (50g)
- Collect blood sample; 30 minutes after the first glucose load Administer remaining 2nd half of glucose load (50g)
- Collect blood again 30 minutes after the 2nd glucose load
- Total of 3 blood samples including FBS
- Recommended by International Association of Diabetes and Pregnant Study Groups (IADPSG)
- Type of OGTT performed among pregnant women 24-28 weeks age of gestation who are not previously diagnosed with diabetes mellitus (can be used as screening method)
One-step Method
In one step method, this is the ff criteria to diagnose GDM
Patient has GDM if one of the following criteria is met:
o FBS: ≥92 mg/dL
o 1hr: ≥180 mg/dL
o 2nd hr: ≥153 mg/dL
Recommended by the National Institute of Health (NIH)
Two-step method
In two-step method, this criteria is used fi diagnose GDM
Patient has GDM if the patient met 2 out of 4 criteria
▪ FBS:>95mg/dL
▪ 1st hour: ≥180 mg/dL ▪ 2nd hour: ≥155 mg/dL ▪ 3rd hour: ≥140 mg/dL
Removal of pancreas or any disorder can alter the normal production of insulin which may lead to hyperglycemia then, Type 1 DM
Pancreatic Disorders/Pancreatectomy
Increase cortisol
Cushing’s Syndrome
Increased catecholamines
Pheochromocytoma
Increased in Growth hormones
Acromegaly
Increase in Thyroid hormone (T3 and T4)
Hyperthyroidism
Drugs or chemical inducer of Beta Cell dysfunction
- Dilantin
- Pentamidine
Drugs or chemical causing impairment of Insulin action
- Thiazides
- Glucocorticoids
It can cause Type 1 DM due to immune defect
Down Syndrome (Trisomy 21)
Causes immune defect
Klinefelter’s (XXY)
Shows severe insulin resistance – Type 2 DM
Rabson-Mendengall and Leprechaunism
Death of brain cells
Causes DM
Huntington’s chorea
- Occurs among females
- Partial or complete depletion of one X chromosomes
Turner’s Syndrome
