Hypo + Hyperglycaemia

Question 1

What are the different laboratory diagnostic criteria for Type 2 diabetes?

Answer 1

If symptomatic (polydipsia, polyuria, weight loss, blurred vision ettc. ) then one of the following is diagnostic

• HbA1c >48
• Fasting glucose >7
• Random glucose >11.1
• IGTT >11.1 (glucose tolerance test, rarely used)

If asymptomatic repeat testing (with same test preferrably)

Question 2

What is the laboratory definition of mpaired glucose tolerance?

Answer 2

IGTT >7.8 but under 11.1

Fasting glucose >6.1 but under 7

Question 3

What is the laboratory definition of DKA?

Answer 3

1. pH under 7.3
2. Plasmy glucose >11mM
3. Ketones > 3 mM (or 2+ in urine)

Question 4

When is DKA declared resolved?

Answer 4

If
1. Ketones are under 0.6 and
2. pH >7.3

Question 5

What are the diagnostic criteria of HHS?

Answer 5

1. pH >7.3
2. Osmolarity >320 mOSm
3. Blood Glucose > 30mM

Question 6

In what 2 catergories can hypoglycaemia be classified?

Answer 6

1. Hyperinsulinaemia
2. Hypoinsulinaemic

Question 7

What are the causes of hyperinsulinaemic hypoglycaemia?

Answer 7

1. Insulin overdose
2. Sulfonylurea excess
3. Insulinoma

Question 8

What are the main causes of hypoinsulinaemic hypoglycaemia?

How can they be further sub-devided

Answer 8

Can be devided by Ketones

1. Ketone +ve
   * Alcohol binge no food
   * Pituitary insufficiency
   * Addison’s
   * Liver failure
2. Ketone -ve
   * Non-pancreatic neoplasm (can produce big IGF-2 as paraneoplastic syndrome, that binds to IGF-1 and insulin recepros –> negative feedback without actually doing anything ttherefore everything is low (incl. insulin, glucose, FFA)