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Unit 3
Diabetes Mellitus resulting from lack or underproduction of insulin
has nothing to do with sugar and not serious.
Diabetes Insipidus Due to underproduction of the pituitary
hormone
majority of patients are under 20 at the onset of
disease
10% of all diabetics
Diabetes Mellitus Destruction of Beta cells (insulin producing) in
Type 1 ( IDDM) pancreas
Blood and urine glucose levels Without medical intervention, death will occur within
Blood and urine ketone levels days.
Blood pH a. Blood and urine glucose levels - panic values
Blood Insulin levels b. Blood and urine ketone levels – extremely high
c. Blood pH – very low, severe acidosis
d. Blood Insulin levels – absolute deficiency of
insulin,
majority over age 20 on onset
Diabetes Mellitus Insulin resistance and obesity-most common cause
Type 2 ( NIDDM) a. Blood and urine glucose levels – high, but not
Blood and urine glucose levels panic levels
Blood and urine ketone levels b. Blood and urine ketone levels - high, but not
Blood pH panic levels
Blood Insulin levels c. Blood pH - mild acidosis
d. Blood Insulin levels normal or elevated
OGTT The OGTT requires fasting for at least 12 hours before
Preparation the test.
Coffee, tea, gum, cigarettes, etc. interfere with results
Small amounts of water are allowed.
recommended glucose loads for: Children – 1.75 grams drink per Kg body
Children weight, up to 75 grams
Non-pregnant adults Non-pregnant adults - 75 grams
Pregnant adults Pregnant adults - 100 grams
Used to detect increased urine excretion
Several random measurements may be taken
throughout the day.
Random testing is useful because glucose
levels in healthy people do not vary widely
Random urine glucose test.
throughout the day.
Test not specific for DM
Blood glucose levels that vary widely may
Procedure – collect urine
indicate a problem.
Normal 160 – 180 md/dL
Result that indicates a problem?
Blood glucose <160, no glucose should be
found in urine.
Adv. – no preparation
measures blood glucose regardless of when
you last ate.
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Unit 3
blood test after 12 hour fast
Fasting Blood glucose Useful screening test for all carbohydrate
disorders
Diagnosis can be made (ADA/WHO)
If FBS < 126 mb/dL, a follow up test needed
1. A FBS is obtained in green heparin tube. No
smoking or eating is permitted during the test.
2. Patient must during standardized load of
OGTT
glucose within a 5 minute period. Someone
Procedure
must observer patient actually drink glucose
load. If patient vomits, discontinue test.
Urine test?
3. At exactly 30 minutes, blood and urine
specimen.
4. At one hour, another blood specimen.
• Do not administer glucose load to anyone
5. Each additional hour, blood specimens
with elevated fasting glucose level.
obtained, up to 5 hours. All blood glucose
specimens are measured as a batch.
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Unit 3
Used for glucose intolerance, give 2 hours after
glucose drink.
ADA recommends a FBS be included a part of
test to establish fasting baseline
If 2 hour blood glucose is >200mg/dL,
2-Hour Oral Post-challenge blood glucose
diagnostic for DM.
the rationale for, the advantages of, and the
Recommended for DM diagnosis if FBS but
procedures
<126ml/dL.
Normal – normal blood glucose after 2 hours.
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Unit 3
blood urea nitrogen test reveals that your urea
nitrogen levels are higher than normal, it
probably indicates that your kidneys aren't
BUN test working properly. Or it could point to high
protein intake, inadequate fluid intake or poor
circulation.
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Unit 3
Hepatic disease – liver can’t store enough glycogen
Myxedema – thyroid does not produce hormone
Hashimoto’s disease – autoimmune destroys thyroid
Addison’s disease – failure of adrenal to produce
Hypoglycemia diseases aldosterone and cortisol
VonGeirke’s disease – liver cannot produce G6PP and
chop off phosphate so glucose can’t leave liver cell
(Epinephrine tolerance test is diagnostic)Positive if
epinephrine does not raise blood glucose level
CNS neuropathy PNS neuropathy
Cataracts Renal hemorrhage
Complications of Blindness(degeneration) Renal failure
Diabetes Mellitus Atherosclerosis MI and strokes
Loss of feeling loss of circulation
Non-healing wounds amputations
Type 1 = No insulin or C-Peptide
Type 2 = Low to Normal insulin and C-Peptide
Measure C-Peptide because insulin has a short half-life.
True definitive test for DM type
C-Peptide last 4 times longer – test how much patient is
producing, does not measure added insulin.
FBS>126 mg/dL on more than one occasion
Most severe
All of a sudden, you cannot produce insulin
Insulin undetectable, glucose levels extremely high
Severe ketoacidosis
Type 1 (juvenile or IDDM) 15% Insulin Shock - comas from hyperglycemia or severe
hypoglycemia
Must be treated with insulin
Caused by a virus triggering an autoimmune
response against the beta cells that produce insulin.
Most common
Insulin produced, but is low or doesn’t work correctly
managed by diet or oral insulin-stimulation drugs that
Type 2 (Adult onset or NIDDM) 85%
make the pancreas produce insulin
Obesity can be sole cause.
adipose cells enlarge, insulin receptors change position
Urine Glucose
Negative if blood glucose < 165 mg/dL
Glucose Tests Does not rule out DM, based on renal threshold
5-hour glucose tolerance test
Gold standard - 5th hour for hypoglycemia
Fasting – no urine sugar - ½ hour – no urine sugar
5HGTT
1 hour – none to trace urine sugar
What to expect - Normal After that, back to normal
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Unit 3
Test urine and FBS before drink
***If urine has no glucose, you are safe.
If FBS>126mg/dL, don’t do test, contact Dr.
5HGTT ½ hour after glucose load – blood and urine
Take blood at 1, 2, 3, 4, 5 hour
Graph results for interpretation
For Hypoglycemia – hours 3-5 results
Fasting – above 126mg/dL or lower
5HGTT ½ hour – FBS > 170, positive urine sugar
What to expect – Diagnostic Criteria 1 hour –FBS >200, positive urine sugar
After that, FBS >200, variable urine sugar
Used when the glucose test is abnormal but
does not meet DM criteria
Impaired Glucose Tolerance (IGT)
FBS = <126 mg/dL
OGTT(2Hr) = <200 mg/dL
Used when fasting glucose is abnormally high,
but below126mb/dL. Rest of test is normal
Impaired Fasting Glucose (IFG)
FBS = Elevated, <126 mg/dl
OGTT(2Hr) = Normal Range
Get fasting specimen
If > 140 don’t give glucose load
GDM screening test
50 gms glucose, then get 1 hr. specimen
If >140, continue with confirmatory test
GDM screening test Get fasting specimen
(3HGTT) 100 gms glucose, get 1, 2, 3 hr. specimens
Fasting > 105 mg/dL
GDM screening test 1-Hr > 190 mg.dL
(3HGTT)confirmed if any 2 are exceeded 2-Hr > 165 mg.dL
3-Hr > 145 mg.dL
Global use test for both
5HGTT
Hyper and hypoglycemia
2HPP Take fasting sample
No standardization of glucose load Patient goes out for a meal
For geriatric patients Take 2 hr specimen
2HGTT Check FBS, If FBS>126mg/dL, don’t do test
Take blood at 2 hour
Accepted by ADA/WHO as cost effective If > 200 mg/dL, patient had DM
Normal 5 – 9%
Glycosylated Hemoglobin
> hyperglycemic <hypoglycemic
Any changes do not show for at least 4 weeks
Hemoglobins separated based on charge
Xylose test for malabsorption Normal – 25 grams ingested, eliminate at least 4.1 gms
Urine Xylose * Urine Volume If Urine Xylose = 128 mg/dL+ Urine Volume -= 470 mL (4.7 dL)
No malabsorption if > 4.1 gms 123mg/dL x 4.7 dL = .602 grams = abnormal
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Unit 3
Like oral 2HGTT, but lactose load
Lactose tolerance test
blood glucose, not intolerant
Viral meningitis – normal CSF glucose and lactate
CSF glucose and lactic acid
Bacterial meningitis - CSF glucose, lactate levels
40 – 70 mg/dL
CSF glucose normal
Use 2/3 of plasma glucose
Patients in shock =Anaerobic glycolysis = lactic acid
CSF handling Process as STAT – glucose and lactate
Keep sample cool
Glucose is not stable for very long
Oxalate/Fl (gray)
Heparinized (least problems of anticoags)
Venous glucose handling
(green) second best
Centrifuge, ASAP, remove plasma from cells
Serum ok, but centrifuse as soon as blood clots
and remove serum from cells
clear liquid that can be separated from clotted
Serum
blood
obtained from centrifuged whole blood that has
been prevented from clotting by the addition of
plasma
anticoagulants such as citrate, oxalate, or
heparin.
Collect in Oxalate/Fl (gray) tube
Assay STAT
Lactic acid collection Fluoride is a glycolysis inhibitor
Otherwise, RBC and WBCs will catabolize
glucose anaerobically, lactic acid.
Whole blood is ??? in glucose than serum or
10 – 12% lower
plasma
Arterial blood(or capillary) is ??? in glucose 5% higher
than normal venous
Above normal range, ??? 10 mg/dL higher
sweat glands do not reabsorb salt from sweat.
If the sweat has NaCl and KCl, osmolarity will be
Cystic fibrosis – sweat is saltier than normal
Sweat is assayed for osmolality, chloride, sodium,
potassium
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Unit 3
Uses high heat (stinky)
O-Toluidine method Can measure xylose and galactose
Use standards for what you are measuring
Glucose Oxidase Method
The specificity of the method for glucose. – step 1, Second step is non-specific
Interfering substances
anything that can be oxidized will cause falsely low glucose – billirubin, creatinine, uric acid, etc.
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