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Glucose Testing


CM complications: chronic hyperglycemia leads to: nonenzymatic glycation of proteins & produces tissue damage
DM dx criteria 1 of these (A1c ≥6.5% ; FPG ≥ 126 mg/dL; 2 hour GTT ≥ 200 mg/dL (75g load); RPG ≥ 200 mg/dL PLUS DM sx (polyuria, polydipsia, wt loss, blurred vision), w/ confirmation of other criterion on another day (required for first 3)
Alert Values: FBS (female) < 40 and > 400 mg/dL (DUMC = <50 and >350)
Prediabetes / IFG lab FPG 100 - 125 mg/dL
Impaired glucose tolerance 2 hr plasma glucose (75g GTT) 140 – 199 mg/dL
Values assoc w/ diabetic retinopathy FBS 126 mg/dL; 2 hr GTT 200 mg/dL; HgbA1c of 7%
Created when proinsulin splits into insulin & this product C-peptide (connecting peptide)
C-peptide: used mostly in: newly diagnosed diabetics
C-peptide: Type 1 diabetes: decreased levels
C-peptide: Type 2 diabetes: normal or high levels
C-peptide: can be used to identify: gastrinoma spread or malingering (low C-peptide with hypoglycemia may reflect abuse of insulin)
Glucose Testing: Venous serum: benefits / reflects Benefit of independence from hematocrit
Glucose Testing: Venous serum: reflects: reflects tissue glucose
Glucose Testing: Capillary: benefits Rapid, no centrifugation required, home monitoring
Glucose Testing: Urine: Requires: normal renal glucose threshold
Random plasma glucose (RPG or RBS): Any time of day without regard to last meal
Fasting blood glucose (FPG or FBS): No caloric intake for at least 8 hours
Oral glucose tolerance testing (OGTT or GTT): Timed blood draw after oral load of a specific amount of glucose
Meds that increase glucose diuretics, estrogens, beta blockers, corticosteroids
Meds that decrease glucose: acetaminophen, alcohol, propanolol, anabolic steroids
Factors affecting Glucose & Glucose Tolerance Meds; Activity level; stress; Liver dz; Hormonal tumors; Pancreatic disorders; PG
Types of stress that increase glucose trauma, acute illness, general anesthesia, burns
O’Sullivan or 1 hour GTT 50g oral glucose with blood draw in 1 hour (normal < 140 mg/dL)
2 hour GTT 75g oral glucose with blood draw in 2 hours
3 hour GTT 100g oral glucose with blood draw just prior to oral load (fasting) and then at 1, 2 & 3 hours
2 hour GTT Interp: FPG (mg/dL) Normal GTT <100; Impaired Glucose Tolerance 100-125; DM ≥ 126
2 hour GTT Interp: 2 hrs after glucose load Normal GTT <140; Impaired Glucose Tolerance 140-199; DM ≥ 200
3 hour GTT Interp: Normal Fasting <95 mg/dL ; 1 hr <180 mg/dL; 2 hr <155 mg/dL; 3 hr <140 mg/dL
3 hour GTT Interp: Abnormal = 2 or more values above reference range
3 hour GTT Interp: Equivocal = 1 value above reference range
Diabetic control correlates highly with: pt education & motivation
Monitoring Diabetic Ctrl: Urine testing (downside): Delayed information
Monitoring Diabetic Ctrl: Blood glucose testing Current status; Self-monitoring recommended by ADA; Continuous monitoring systems available
Monitoring Diabetic Ctrl: Glycosylated hemoglobin (A1c): upside: Long term control
Monitoring Diabetic Ctrl: Fructosamine Good for some populations
Home Blood Glucose Monitoring: most common = Fingerstick; Other sites (forearm/thigh) used, but may have 20 min lag time compared to finger
Home Blood Glucose Monitoring: Helps guide self mgmt of: exercise, diet & meds
Home Blood Glucose Monitoring: upside: Improves blood glucose control through immediate patient feedback
HbA1c: In normal people: 3-6% of hemoglobin is glycosylated in the form A1c
HbA1c: Provides info: that spot blood checks may miss; info about LT glycemic ctrl (previous 8-12 wks)
HbA1c: Normalizes: within 3 weeks of normoglycemic levels
HbA1c & RBCs: Older RBCs have higher HbA1c levels; pts w/ episodic or chronic hemolysis who have larger proportion of young RBCs might have spuriously low levels
HbA1c monitoring Does not require fasting; Goal < 7% HbA1c; Lowering by any amount will improve health outcomes
If HbA1c if > 7% : adjust therapy
HbA1c: If good DM control: check HbA1c 1-2 times yearly
HbA1c: If suboptimal DM control: check HbA1c every 3 months
Fructosamine = = glycated albumin or glycated serum protein
Fructosamine reflects: hyperglycemic period within the last few weeks
Fructosamine gives info about: short term glycemic control
Fructosamine: useful for: patients with chronic hemolytic anemias that cause shortened RBC life span; Limited use in pts w/ low serum albumin (nephrotic state or hepatic disease)
Fructosamine: Normal values: vary in relation to serum albumin (1.5-2.4 mmol/L when serum albumin is 5 g/L)
Acute Complications of Diabetes Diabetic coma; DKA
Diabetic ketoacidosis = Pronounced hyperglycemia with insulin deficiency
DKA: lab values Hyperglycemia > 250 mg/dL or glycosuria 4+ ; Acidosis with blood pH < 7.3; Serum bicarb < 15 mEq/L; Serum positive for ketones
Screening for Chronic Complications of Diabetes Ocular comps; Nephropathy; Peripheral neuropathy; CVD (Heart dz; PVD)
Pronounced hyperglycemia with insulin deficiency = DKA
DM: Ocular Complications Retinopathy; Cataracts; Glaucoma; pts w/ DM need an annual ophthalmologic exam
Diabetic Retinopathy: microaneurysms = Small blow-out swellings of blood vessels
DM Retinopathy: Exudates = Small leaks of fluid from damaged blood vessels
DM Retinopathy: hemorrhages Small bleeds from damaged blood vessels
DM Retinopathy: Blood vessels: may become blocked, causing reduced blood & oxygen supply to small sections of the retina; New abnml vessels may grow from damaged vessels (AKA proliferative retinopathy); new vessels are delicate & bleed easily
Test for DM Nephropathy: urine microalbumin
Urine microalbumin: more sensitive than: dipstick protein
Urine microalbumin: May use: albumin:creatinine (A:C) ratio
Urine microalbumin: Correlates with: nocturnal systolic blood pressure
Treatment of renal failure due to DM: renal transplant more promising than dialysis (if patient eligible)
Most common complication of DM: Neuropathy
Characterize DM Neuropathy Distal symmetrical polyneuropathy with loss of motor & sensory function, esp. of long nerves
DM Neuropathy clinical features Painful diabetic neuropathy with hypersensitivity to light touch; Diabetic gastroparesis; Erectile dysfunction
Diabetic Foot Ulcer Painless due to peripheral neuropathy; pt unaware unless vigilant with & able to do self exams; Prone to infection & enlargement
Test for Diabetic Foot Ulcer with: 10g monofilament test ; Comprehensive foot exam
Screening for Complications of Diabetes: Eye Funduscopic exam by optometrist or ophthalmologist for retinopathy
Diabetes Screening: USPSTF Guidelines (2008) No need to screen asymptomatic adults with BP ≤135/80; Should screen adults with HTN (sustained BP >135/80)
Created by: Abarnard