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Diabetes Labs

Endocrine

QuestionAnswer
DM dx criteria [A1c ≥6.5% ; FPG ≥ 126 mg/dL; 2 hour GTT ≥ 200 mg/dL (75g load); or RPG ≥ 200 mg/dL] PLUS DM sxs (polyuria, polydipsia, wt loss, blurred vision)
Alert Values: FBS (female) < 40 and > 400 mg/dL
Prediabetes / impaired fasting glucose (IFG) lab value: FPG 100 - 125 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); 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: Urine: Requires: normal renal glucose threshold
Fasting blood glucose (FPG or FBS): lab testing requires: No caloric intake for at least 8 hours
Types of stress that increase glucose trauma, acute illness, general anesthesia, burns
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
Diabetic control correlates highly with: pt education & motivation
HbA1c: In normal people: 3-6% of hemoglobin is glycosylated in the form A1c
HbA1c: Normalizes within: 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
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 / serum protein (1.5-2.4 mmol/L when serum albumin is 5 g/L)
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 utility in pts w/ low serum albumin (nephrotic state or hepatic disease): poss falsely low
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
Test for DM Nephropathy: urine microalbumin; more sensitive than dipstick protein
Urine microalbumin: May use: albumin:creatinine (A:C) ratio
Urine microalbumin: Correlates with: nocturnal systolic blood pressure
T1DM ID’d by: sero autoimmune markers of pancreatic islet dysfn and genetic markers
impaired fasting glucose = FBS = 100 - 125 mg/dL
impaired glucose tolerance (at 2 hrs) = 140-199 mg/dL 2 hrs after OGTT (75 g oral glu)
Polyuria can be caused by what abnormal labs? Hyperglycemia. Hypokalemia
Created by: Abarnard