Reference values - Own notes! Flashcards
According to American Diabetic Association (ADA) diagnostic criteria for DM,
what is the cut-off value of
1. Fasting plasma glucose
2. 2-hourpost-oral glucose tolerance test plasma glucose
3. HbA1c
4. Random plasma glucose
? (please provide unit)
- <7.0 mmol/L
- <11.1 mmol/L
- <6.5 %
- > 11.1 mmol/L
What is the fasting plasma glucose range that accounts for impaired fasting glucose level?
- 6-7 mmol/L
normal: <5.6
What is the plasma glucose range that accounts for impaired glucose tolerance after OGTT?
7.8 - 11.1 mmol/L
notmal <7.8
How do we differentiate Gestational DM and DM in pregnancy?
OFTT performed at 6-12 weeks postpartum:
- at 0 min, normal <5.1
- Gestational DM: 5.1-6.9; DM in pregnancy: >7 - at 60 minutes (1 hour), normal <10.0
- Gestational DM: >10; DM in pregnancy: – - at 120 minutes: normal <8.5
- Gestational DM: 8.5-11; DM in pregnancy: >11.1
DM in pregnancy should be diagnosed one or more of OGTT criteria are met
What are the therapeutic goals of ADA in diabetes patients?
- Glycemic control (3)
- BP
- Lipid profile (3)
- Glycemic control
- HbA1c <7%
- Pre-prandial BG 5.0-7.2
- Post-prandial BG <10.0 - BP <130/80
- Lipid profile
- TG: <1.7
- LDL-C <1.8 (<2.6 in normal)
- HDL-C >1.1 in M, > 1.3 in female
How is serum osmolality calculated?
Calculated osmolality = 2 x [Na+]+ glucose + urea
What is the definition of hypoglycaemia?
Plasma glycose <2.5 mmol/L by laboratory method
In normal circumstances in normal patient, how should the body respond to a short synacthen test? (correct unit please!)
Cortisol level should rise to >450 nmol/L
In patients with
i) primary adrenal insufficiency
ii) secondary adrenal insufficiency,
how would they react to the short synacthen test?
i) no increase in cortisol, with increased baseline ACTH level
ii) sluggish response in cortisol level, with undetectable ACTH level
What is a glucagon stimulation test?
How would a normal individual respond to a glucagon stimulation test? (2)
- Induce hyperglycaemia thus reactive hypoglycaemia and stress > test both adrenocortical and GH-IGF axis
1. Cortisol during hypoglycaemic attack should increase to >450 nmol/L
2. GH during hypoglycaemic attack should increase to >20 ng/mL
What is the definition of neonate hypoglycaemia?
- Full-term baby
- Pre-term infant
- Full-term baby: plasma glucose <2.0mmol/L
2. Pre-term infant: plasma glucose <1.1 mmol/L
What are the differential diagnosis for hypercortisolism?
- Cushing’s disease - pituitary adenoma secreting ACTH
- Adrenal adenoma (primary)
- Ectopic source of ACTH - e.g. SCLC
- Iatrogenic: treatment with exogenous glucocorticoids
What are the investigations for hypercortisolism?
Describe.
- Overnight dexamethasone depression test
- dexamethasone 1mg at 23:00, then measure cortisol in the next morning - High dose dexamethasone depression test
- 2mg Q6h x 2 days
If the hypercortisolism is due to
- Adrenal cause (primary)
- Pituitary adenoma secreting ACTH
- Ectopic ACTH secretion
, what would you expect in the 2 investigations respectively?
- Primary adrenal cause
ONDST - unchanged
HDDST - unchanged - Pituitary adenoma secreting ACTH
ONDST - unchanged
HDDST - decreased >50% - Ectopic ACTH secretion
ONDST - unchanged
HDDST - unchanged
What test is used to confirm primary hyperaldosteronism? What are the expected results in normal individuals and abnormal?
Salt loading test
- 5 days of NaCl tablet, measure 24 hour urine aldosterone and Na
- 24h urine Na >200 mmol/24h = adequate salt loading
- 24h urine aldosterone >38 mol/24h = lack of aldosterone suppression with intravascular expansion
