Podcast
Questions and Answers
The HbA1c test provides information about blood glucose control over the past 2-3 weeks.
The HbA1c test provides information about blood glucose control over the past 2-3 weeks.
False
Microalbuminuria is defined as a daily loss of albumin in urine ranging between 30-300 mg.
Microalbuminuria is defined as a daily loss of albumin in urine ranging between 30-300 mg.
True
A blood sugar series is typically performed before and after meals to assess glycemic control during pregnancy.
A blood sugar series is typically performed before and after meals to assess glycemic control during pregnancy.
True
Fructosamine testing is a reliable indicator of average glucose level over the past 3 months.
Fructosamine testing is a reliable indicator of average glucose level over the past 3 months.
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C-peptide testing is commonly used to directly measure blood glucose levels in diabetic patients.
C-peptide testing is commonly used to directly measure blood glucose levels in diabetic patients.
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Impaired Glucose Tolerance (IGT) is indicated by an OGTT result of 150 mg/dl.
Impaired Glucose Tolerance (IGT) is indicated by an OGTT result of 150 mg/dl.
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HbA1c levels of 5.5% are classified as normal for diabetes diagnosis.
HbA1c levels of 5.5% are classified as normal for diabetes diagnosis.
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C-peptide levels can be used to assess insulin production in the body.
C-peptide levels can be used to assess insulin production in the body.
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The renal threshold for glucose means that glucose will appear in urine at normal blood glucose levels.
The renal threshold for glucose means that glucose will appear in urine at normal blood glucose levels.
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Fasting blood sugar (FBS) levels of 130 mg/dl are indicative of prediabetes.
Fasting blood sugar (FBS) levels of 130 mg/dl are indicative of prediabetes.
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A glucose tolerance test (OGTT) during pregnancy is performed with a 50g glucose load.
A glucose tolerance test (OGTT) during pregnancy is performed with a 50g glucose load.
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Antibody testing can be useful in diagnosing Type II Diabetes Mellitus.
Antibody testing can be useful in diagnosing Type II Diabetes Mellitus.
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Urine testing for glucose is considered a reliable diagnostic test for diabetes.
Urine testing for glucose is considered a reliable diagnostic test for diabetes.
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The normal threshold for fasting blood glucose level is less than 126 mg/dl.
The normal threshold for fasting blood glucose level is less than 126 mg/dl.
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An Oral Glucose Tolerance Test (OGTT) is performed by measuring blood glucose levels after consuming a fixed glucose load.
An Oral Glucose Tolerance Test (OGTT) is performed by measuring blood glucose levels after consuming a fixed glucose load.
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A diagnosis of Diabetes Mellitus can be made based on clinical features and one abnormal lab result.
A diagnosis of Diabetes Mellitus can be made based on clinical features and one abnormal lab result.
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Post-prandial blood glucose levels are considered normal if they are less than 160 mg/dl.
Post-prandial blood glucose levels are considered normal if they are less than 160 mg/dl.
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The HbA1c test measures the percentage of glycated Hb as an indirect measure of average blood glucose levels.
The HbA1c test measures the percentage of glycated Hb as an indirect measure of average blood glucose levels.
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Diabetic ketoacidosis is a condition that is primarily related to impaired fasting glucose.
Diabetic ketoacidosis is a condition that is primarily related to impaired fasting glucose.
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The random blood glucose level for diabetes diagnosis is indicated as greater than or equal to 180 mg/dl.
The random blood glucose level for diabetes diagnosis is indicated as greater than or equal to 180 mg/dl.
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C-peptide testing is important for assessing insulin production in individuals with diabetes.
C-peptide testing is important for assessing insulin production in individuals with diabetes.
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Study Notes
Glucose Homeostasis Derangement - III
- Students should be able to define and explain impaired glucose tolerance, impaired fasting glucose, diabetes, and diabetic ketoacidosis after the lecture and practical demonstrations.
- Students should be able to describe the laboratory diagnosis of these conditions.
- Students should be able to describe the oral glucose tolerance test (OGTT).
- Students should be able to describe the significance of glycated Hb in blood and microalbumin in urine analysis.
Outline
- Tests for diagnosing diabetes mellitus (DM)
- Tests for monitoring DM control
- Tests for detecting DM complications
Diagnosis of Diabetes Mellitus
- Diagnosis is based on clinical features of long-standing or acute hyperglycemia.
- Evidence of hyperglycemia through laboratory testing (or a directly related effect of it).
- Clinical features + one abnormal lab result, or abnormal lab results at two separate occasions.
Normal Blood Glucose Curve
- Presents a graph of normal blood glucose levels over time after glucose ingestion.
Random Blood Glucose Level (RBS)
- Venous blood glucose is measured without considering the last meal.
- Normal: < 100 mg/dL or ≤ 5.6 mmol/L
- Diabetes: ≥ 200 mg/dL or ≥ 11.1 mmol/L
Fasting Blood Glucose Level (FBS)
- Venous blood glucose is measured at a fixed time after the last meal (no caloric intake for 8 hours).
- Normal: < 100 mg/dL or ≤ 5.6 mmol/L
- Diabetes: ≥ 126 mg/dL or ≥ 7.0 mmol/L
Post-prandial Blood Glucose Level (PPBS)
- Venous blood glucose is measured at a fixed time after a meal (usually 2 hours).
- Normal: < 140 mg/dL or < 7.8 mmol/L
- Diabetes: ≥ 200 mg/dL or ≥ 11.1 mmol/L
Oral Glucose Tolerance Test (OGTT)
- Venous blood glucose is measured at a fixed time after a fixed glucose load (1 hour and 2 hours).
- Normal OGTT 2hr: < 140 mg/dL or < 7.8 mmol/L
- Diabetes OGTT 2hr: ≥ 200 mg/dL or ≥ 11.1 mmol/L
- OGTT involves fasting for 8–12 hours, collecting a fasting blood glucose sample, ingesting 75g of glucose, and measuring blood glucose at fixed times, mostly at 2 hours.
HbA1c Test (Glycated Hb Levels)
- Glycation is the non-enzymatic binding of glucose to other substrates, directly proportional to glucose concentration in the blood.
- HbA1c, about 80% of glycated Hb, is used as an indirect measure of blood glucose levels.
- Normal: < 5.7%
- Diabetes: ≥ 6.5%
- Advantages of HbA1c: no need for fasting or timed samples, measures average blood glucose over 2-3 months, used to monitor control.
- Disadvantages of HbA1c: standardized only for adults, not reliable in increased red cell turnover or hemoglobinopathies, or pregnancy.
Fructosamine Test
- Measures glycated proteins/albumin levels in serum.
- Indicates average glucose levels over 2–3 weeks.
- Can be used when HbA1c isn't reliable, but depends on serum albumin levels.
Blood Sugar Series
- Often done during pregnancy to determine sugar control.
- Tests before and after breakfast, lunch, and dinner.
Detection of DM Complications
- Diabetic Nephropathy: Albumin loss in urine is a feature. <30mg/day is normal. Early kidney damage causes gradual increase above 30mg/day called Microalbuminuria, (30-300mg/day)
- Microalbuminuria can be tested in different urine samples (24-hour, less than 24-hour, or spot sample).
- Ketoacidosis (DKA):
- Arterial blood gas testing for pH, pCO2, HCO3 and base excess.
- Urine testing for ketone bodies.
- Plasma osmolality.
Prediabetes
- A category for those whose blood sugar or HbA1c test results are neither diabetic nor normal.
- Not a disease, but a high-risk group for developing DM.
- Impaired Fasting Glucose (IFG): FBS 100–125 mg/dL or 5.6–6.9 mmol/L
- Impaired Glucose Tolerance (IGT): OGTT 140–199 mg/dL or 7.8–11.0 mmol/L
WHO Criteria for Diagnosis of DM
- A summary table of normal, prediabetes, and diabetes values for RBS, FBS, OGTT, and HbA1c.
Urine Testing for Glucose
- Glucose appears in urine when blood glucose levels exceed the renal threshold.
- Not a diagnostic test, but used as a screening test.
- Benedict test is used to test for reducing substances, one of which is glucose.
OGTT in Pregnancy
- 75g OGTT, venous blood tested before, 1-hour, and 2-hour after.
- GDM (gestational diabetes mellitus) is diagnosed with any of fasting ≥92 mg/dL (5.1 mmol/L), 1-hour ≥ 180 mg/dL (10.0 mmol/L), or 2-hour ≥ 153 mg/dL (8.5 mmol/L).
C-peptide Levels
- A by-product of insulin synthesis, used to measure insulin production (beta cell function).
- Can be tested in a fasting state or after a standard meal
Antibody Testing
- Specific antibodies, like islet-cell antibodies (IA2), antibodies against glutamic acid decarboxylase (Anti-GAD65), and anti-insulin antibodies, can be detected in Type 1 DM, especially during early stages.
Monitoring Control of DM
- HbA1c is best for monitoring blood glucose control in DM patients.
- Other tests for blood glucose control include RBS, FBS, and OGTT
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