ADITIONAL DIAGNOSTIC PROCEDURE

 Two hour postprandial plasma glucose

 Hemoglobin AIC:
Valine amino terminal of hemoglobin β – chain (one or both) may be glycosylated
 Although many other protein such as albumin are glycosylated, measurement of
glycosylated Hb are performed routinely to monitor glucose control
 Chromatography (using cation – exchange resin) of human red cells hemolysates
– 3 peaks are eluted, before hemoglobin A peak:
AIa, AIb, AIC, A
 The glycosylation of hemoglobin A depends on the glucose concentration during
the 120-day life span of the cell
 Hb AIC is 3 to 6% of total Hb in healthy individual. It can be double or triple in
hyperglycemia. With good control of diabetes the level is back to the reference
level

AGE protein:
 The diagnosis of diabetes mellitus can be made by measurement of plasma
glucose when the patient is fasting
 A plasma glucose level of >140mg/dl or 7.8mmol/L on 3 or more occasions
confirmed as diabetes mellitus
 Diabetes mellitus is a chronic disease characterized by abnormally high [glucose]
in plasma, glucosuria and thickening of capillary basement membranes
 Diabetic patients have increased risk of blindness, kidney disease, peripheral
vascular disease, peripheral neuropathy and heart disease (myocardial infarction)
 Infection usually occur at foot

Hypoglycemia:
 Syndrome that characterized by low plasma glucose and associated group of
symptoms that are relieved by ingestion of food especially carbohydrates
 Overnight fasting plasma glucose should be result <2.5mmol/L or 45mg/dl
 However this value may be vary from each person

Common cause of hypoglycemia:

 No anatomic lesions
1. Fasting plasma glucose normal
Functional hypoglycemia
Aliment organ hypoglycemia
Diabetic and impaired glucose tolerance
2. Fasting plasma glucose low
Ethanol induced hypoglycemia
Sulfonylurea
Insulin
Salicylates
Combination of the above
 Anatomic lesion present
 Insulinemia
Extrapancreatic neoplasms
Adrenocorticol insufficiency
Hypopituitarism
Massive liver disease

Hypoglycemia and premature infants:

 Premature and small for gestational age neonates have increase susceptibility to
hypoglycemia
 Children are more susceptible than adults
 Children have larger brain / body weight ratio and the brain uses high amounts of
glucose than the rest of the body
 Newborn infants can’t make ketogenesis process. It is because the transport of
long – chain fatty acids into mitochondria is poorly developed
 Brain (in neonates) completely dependent on glucose
So, glycogenolysis makes glucose
Gluconeogenesis makes glucose. This is also limited (especially utilization of
lactate alanine) because the rate limiting enzyme phosphoenolpyruvate
carboxykinase is low in infant (low birth weight) especially during the first few
hours after birth
 Fasting depletes the glycogen stores more rapidly

Hyperglycemia:
 Normal (acceptable) fasting plasma glucose:
50 – 110mg/dl (2.8 – 6.2mmol/L) normal should be 80 – 120mg/dl
 Hyperglycemia may result from primary diabetes mellitus cause or secondary
cause
 Primary:
o Insulin dependent diabetes mellitus
o Non – insulin dependent diabetes mellitus
 Secondary:
o Disease of pancreas:
Acute pancreatitis
Chronic pancreatitis
Pancreatitis due to mumps
Autoimmune disease
Pancreatectomy
Pancreatic infiltration
Hemochromatosis
Tumors, trauma to pancreas
o Related to major disease states:
Chronic renal failure
Chronic liver disease
Infection
o Miscellancous:
 Pregnancy
Related to insulin receptor antibodies
Abnormal insulin
o Related to major endocrine disease:
Acromegaly
Cushing’s syndrome
Thyrotoxicosis
Hyperaldosteronism
Glucagonoma
o Caused by drugs:
Steroids
Thiazide diuretucs, propranolol, phenytoin, diazoxide
Oral contraceptive
Alloxan and streptozotocw

Oral glucose tolerance test (OGTT):

 This is a commonly used glucose load test
 After a load of glucose, plasma glucose value are determined
 It lacks specificity. The glucose tolerance can be abnormal in a variety disease and
diet and other variable such as stress
 For meaningful data, conditions of performing the test must be controlled rigidly
 For 3 days prior to the GTT, a diet of at least 150g/day of carbohydrate is required
 If a person has anorexia – invalidates the test
 Inactivity: low glucose tolerance
 Alcoholism: low glucose tolerance
 Many disease
 Overnight fast (about 12 hours – no coffee, no smoking and no exercise)
 The size of glucose load 50g, 75g, or 100g. for pediatrics (1.75g/kg body weight)
 Blood sample for baseline glucose
 Ingest glucose within 5 minutes
 Draw sample every 30 minutes for blood glucose 2-3 hours