S.SUNITHA THENDRAL ‘06

URINE "GLUCOSE"◦ lacks sensitivity = positivity in disease◦ poor specificity = negativity in health

Problems◦ renal threshold variable 6 to 15 mmol/L◦ interferences : Clinitest / Glucose oxidase strips

IF URINE TEST POSITIVE A CONFIRMATORY BLOOD TEST

IS NEEDED

Diagnosis◦ Patient is symptomatic plus

Casual plasma glucose (non-fasting) is 200 mg/dl OR

Fasting plasma glucose of 126 mg/dl or higher OR

Two hour plasma glucose level of 200 mg/dl or greater during an oral glucose tolerance test

A venous blood sample will be collected for the determination of fasting glucose

Load of 75g of glucose is ingested within 5 min

Blood samples will be collected at timed intervals (30min, 60min, 120min) for the determination of glucose

Plasma glucose (mmol/L) 0 min

120 min

Non diabetic < 6.1 < 7.8

Impaired glucose tolerance 6.1 - 6.9 >7.8 - 11.1

Diabetic > 7.0 > 11.1

HbA1c is stable glycosylated

hemoglobin Its percentage concentration

indicates cumulative glucose exposure

A good indicator of blood glucose control. Gives a % that indicates control over the

preceding 2-3 months. Performed 2 times a year. A hemoglobin of 6% indicates good control

and level >8% indicates action is needed.

Lowering HbA1C Reduces Risk of Complications

TO PREVENT TIMELY EMERGENCIES

OF HYPO AND HYPER GLYCEMIA

AMOUNT OF INSULIN TO BE USED BEFORE MEALS

EFFECT OF DIET AND EXERCISE ON BLD GLUCOSE

NEW GLUCOMETER ARE ATACHED WITH INSULIN PUMPS TO

MONITER THE AMOUNT OF INSULIN TO BE RELEASED

COMPLICATIONS; INFECTIONS IF FINGERS NOT CLEANED

PROPERLY

HARDENING OF SKIN IF REPEATEDLY

PRICKED

MICRO ALBUMINURIA

SERUM CREATININE (NORMAL <_ 1)

RELATIVE :

24 HR PROTEIN IN URINE

Blood levels of phosphorus, calcium, bicarbonate, and potassium

Hemoglobin

Hematocrit

Protein electrophoresis - urine

Red blood cell (RBC) count

HIGH BLOOD PRESSURE

Visual acuity testing;ABILITY OF EYE TO FOCUS

SLIT LAMP EXAMINATION; CATARACT AND

CHANGES IN ETINA

GONIOSCOPY;DRAIN ANGLE - GLAUCOMA

FLUORESCEIN ANGIOGRAM; LEAKING BLD VESSEL

IN RETINA(DISTORTED VISION)

People with type 1 diabetes who are age 10 and older

should have an eye exam within 3 to 5 years after diabetes

is diagnosed and then every year

People with type 2 diabetes should have an exam as soon

as diabetes is diagnosed and then every year

Assess symptoms - muscle weakness, muscle cramps, prickling, numbness or pain, vomiting, diarrhea, poor bladder control

Comprehensive foot exam ◦ Skin sensation and skin integrity◦ Quantitative Sensory Testing (QST)◦ X-ray

Nerve conduction studies Electromyographic examination (EMG) Ultrasound

NORMAL RANGE

ANALYTE NORMAL VALUE (MG/DL)

TOTAL PLAMA LIPID 400 – 600

TOTL CHOLESTROL 150 – 200

HDL 30 – 75

LDL 80 -175

TRIGLYCERIDE 40 -150

PHOSPHOLIPID 150 -200

FREE FATTY ACID 10 - 20

SERUM CHOLESTROL <220 MG/DL LDL >160MG/DL HDL<35 MG/DL

WHY DM HAS HIGH RISK FOR MI? LACK OF INSULIN ACTIVATES LIPASE GLYCATION OF LDL INCREASES ITS HALF

LIFE