fkg sept 2012 lecture

7/29/2019 Fkg Sept 2012 Lecture

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DIABETES MELLITUS

NINA TRISTINA

DEPARTEMEN PATOLOGI KLINIK

FKUP/RSHS BANDUNG

2012


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CARBOHYDRATE METABOLISM

CARBOHYDRATE

BLOOD

GLUCOSE

GLYCOGEN FFA TRIGLYCERIDE

AMINO ACID

PYRUVATE - LACTATE

ENERGY ATP + H2O + CO2


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NORMAL BLOOD SUGAR CONTROLE

BY HORMONAL REGULATION

BLOOD SUGAR (CONC.)

1. INSULIN

2. GLUCAGON

3. THYROXINE

4. GROWTH HORMONE

5. A.C.T.H

6. CORTICOSTEROID

7. EPINEPHRINE


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NORMAL BLOOD SUGAR CONTROL BY INTER-

MEDIARY REGULATION:

1. GLYCOGENESIS

2. GLYCOGENOLYSIS3. GLUCONEOGENESIS

4. GLUCOLYSIS


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BLOOD GLUCOSE CONCENTRATION

NORMAL DM

1. FASTING 70-100mg/dl 126 mg/dl

2. POST PRAN


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DIABETES MELLITUS

: IS CHARACTERIZED BY CHANGES IN THE

METABOLISM OF EACH OF THE MAJOR BODY

FUELS (CARBOHYDRATE - FAT AND PROTEIN)

AND IS ASSOCIATED BY DISTURBANCES OF A

VARIETY OF HORMONES.


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1. URINE GLUCOSE2. BLOOD GLUCOSE (diagnostic)

3. ORAL GLUCOSE TOLERANCE TEST (confirmatory test)

4. IV- GLUCOSE TOLERANCE TEST (confirmatory test)

5. HbA1C TEST (follow-up)

6. FRUCTOSAMIN TEST (follow-up)

7. C-PEPTIDE CONC (confirmatory test)

8. URINARY KETON (complication)9. BLOOD KETON (complication)

10. MICROALBUMIN IN URINE (complication)

LABORATORY EXAMINATIONS


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*Fasting plasma glucose(FPG)

ADA- the screening test of choice

*Random plasma glucose(RPG)

(measuring plasma glucose without regard to the last food intake).

RPG (8.9 mmol/L) or above to be abnormal

*Oral glucose tolerance test(OGTT)(2 hours after ingestion of a glucose load of 75 g a plasma glucose value of 11.1

mmol/L) or more is abnormal

*Glycosylated hemoglobin(HbA1c)

6,5%

Urinalysis and fingerstick glucose not to be used in screening!!!

SCREENING FOR TYPE II DIABETES


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ORAL GLUCOSE TOLERANCE TEST

(OGTT)

100

200

300

100

200

300

1 2 30 1 2 30Hours Hours

BG mg/dlNORMAL DM

SEVERE

MILD


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PRE-ANALYTIC STEPS(contd.)

Specimens handling :

Glycolysis 7 mg/dl/h in WB w/o inhibitors

At 4C 2 mg/dl/h will lost Bacterial contamination will decrease glucose

level

Delay time in serum containing blood clot :< 90 minutes


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BLOOD GLUCOSE

PRE-ANALYTIC STEPS (contd.)

OGTT

Diet : must consists of > 150g of carbohy-

drate/day, over a period of 3 days

Discontinue any drugs that can affect glucose

plasma level 3 days before the test

Fasting : 12 hours


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BLOOD GLUCOSE

PRE-ANALYTIC STEPS (contd.)OGTT A parallel urine sample must be taken for

fasting glucose and ketone. A positive test strip

results is a contraindication for OGTT


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POST-ANALYTICAL STEPS

INTERPRETATION :

Normoglycemia

Hyperglycemia

Hypoglycemia


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INTERFERING FACTORS :

Falsely high : dextrose iv-infusion, steroids,

stress, infection, caffeine, nicotine, -blockers,

adrenal gland infection, total parenteralnutrition (TPN), diuretics, estrogen, phenytoin

Falsely low : insulin, alcohol, anabolic steroids,OAD


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Glycohemoglobin =Glycated Hemoglobin

= Hb A1C = A1c

- Not recomended for D/ of DM

- 2011: ADA, D/ if 6.5%


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RESULTS: HbA1c

GOOD 2,5-6,0%

FAIR 6,1-8,0%POOR > 8%


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Criteria for testing for diabetes in asymptomatic

adult individuals

1. Testing should be considered in all adults

who are overweight (BMI 25 kg/m2*)

and have additional risk factors:

physical inactivity

first-degree relative with diabetes

high-risk race/ethnicity (e.g., African American,Latino, Native American, Asian American, Pacific

Islander)


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A1C 5.7%, IGT, or IFG on previous testing

other clinical conditions associated with insulin

resistance (e.g., severe obesity, acanthosis

nigricans)

history of CVD


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2. In the absence of the above criteria, testingfor diabetes should begin at age 45years.

3. If results are normal, testing should be repeatedat least at 3-year intervals, with consideration of

more frequent testing depending on initial results

and risk status.

fkg sept 2012 lecture

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