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Clinical Pathology (JAA)

Blood Glucose Testing


Sometime in December

Introduction o Equivocal fasting or random plasma glucose


• Blood sugars: fructose, galactose, glucose concentrations
• Glucose is the primary source of energy of cells o Diagnosis of impaired glucose tolerance or
• Plasma glucose is maintained within narrow limits gestational diabetes
during fasting and postprandial state by insulin and o Epidemiologic studies to determine DM
counter regulatory hormones such as glucagon prevalence
• Normally 4 – 8 mmol/L (70 – 150 mg/dl) o Px’s w/ clinical features of DM or complications
• High = hyperglycemia w/ normal blood glucose
e.g. impaired glucose tolerance or diabetes mellitus • OGTT prep:
• Low = hypoglycemia o Eat normal diet ~ 150 g CHO/day x 3 days
e.g. fasting, insulinoma o Discontinue meds (diuretics, steroids, oral
contraceptives)
Specimen Considerations o Be ambulatory
• Venous plasma glucose – standard o Fast overnight (8- 14 hrs)
• Serum, whole blood o Conducted between 7 am – 12 pm
• Plasma or serum glucose levels are 15% higher than o Patient is rested, seated
whole blood glucose o No smoking
• Metabolized 7 mg/dL/h at 4oc o Drinking water allowed
• Higher w/ bact contamination, leukocytosis o Collected in gray tube w/ fluoride and
• Serum should be separated w/in 30 min (90 min if anticoagulant
w/o bact contam) • OGTT Procedure
• Stable in ref for 48 hrs o Basal blood sample
o Give 75 gm glucose in 250-300 ml water orally
Methods o Blood sample taken at 120 min
• Enzymatic methods o >200 mg/dL (11.1 mmol/L) or higher, diagnostic
o Glucose dehydrogenase of DM
o Glucose oxidase • OGTT
o Hexokinase – reference method o BUT: fasting below 126 mg/dL (7.0 mmol/L) and
• Electric current is produced proportional to initial 2 hr value > 140 mg/dL (7.8 mmol/L)
glucose concentration but < 200 mg/dL (11.1 mmol/L)
• Product measured spectrophotometrically = IMPAIRED GLUCOSE TOLERANCE
o Fasting glucose >110 mg/dL (6.1 mmol/L) but <
Diabetes Mellitus 126 mg/dL (7.0 mmol/L)
• Chronic disorder of carbohydrate, fat, protein = IMPAIRED FASTING GLUCOSE
metabolism due to absolute or relative deficiency of
insulin Diagnosis of Pre-Diabetes and Diabetes Mellitus
• Complications - blindness, kidney disease, gangrene, Fasting Plasma 2-h Plasma Glucose
Glucose Level (after 76g
heart disease, stroke
glucose load)
• Fasting plasma glucose level > 126 mg/dl (7.0 mg/dL mmol/L mg/dL mol/L
mmol/L) on at least 2 occasions; 8 hr fast Normal <100 <5.6 <140 <7.8
Prediabetes
• Symptoms of hyperglycemia (e.g. polyuria, Impaired fasting 100-125 5.6-6.9
polydipsia, polyphagia, unexplained wt loss) w/ glucose
casual plasma glucose level of > 200 mg/dL (11.1 Impaired glucose 140-199 7.8-
mmol/L) tolerance 11.0
Daibetes mellitus ≥126 ≥7.0 ≥200 ≥11.1
• 2-hr plasma glucose value 200 mg/dl or higher
following a 75-g oral glucose tolerance test (OGTT) Gestational Diabetes
• OGTT not recommended for routine clinical use • Do screening test
• Indicated: o Between 24 and 38 wk of pregnancy

MR*, Eisa, Mel (di ko na alam kung ano ittrans) 1 of 3


Clincal Pathology – Blood Glucose Testing by JAA Page 2 of 3

o All women except < 25 y.o. , normal body wt, no


family history of DM, not members of
ethnic/racial group w/ high prevalence of DM
(e.g. Hispanics, Native American, Asian, African,
African American) • Causes of Hypoglycemia
• Procedure for screening Reactive hypoglycemia
o 50 gm of oral glucose o Drug-induced
o Plasma glucose obtained 1 hr  Insulin
o >140 mg/dL (7.8 mmol/L) → 3 hour glucose  Sulfonylureas
tolerance test  Salicylates
o 100 gm glucose load  Pentamidine
 Plasma glucose values obtained at baseline o Post prandial
and 1, 2 and 3 hrs following glucose  Gastric surgery
challenge  Early diabetes
 Diagnosis is made if 2 or more meet or  Essential (idiopathic) reactive hypoglycemia
exceed values o Alcohol induced
o Inherited metabolic disorders
Diagnosis of Gestational Diabetes Mellitus  Galactosemia
Oral Glucose Tolerance Tests (OGTT) for High-Risk Women and  Hereditary fructose intolerance
Average-Risk Women with Abnormal Screening Test Results Fasting hypoglycemia
100-g OGTT Plasma 75-g OGTT Plasma o Endocrine disease
Glucose Glucose
mg/dL mmol/L mg/dL mol/L  Adrenocortical insufficiency
Fasting ≥95 ≥5.3 ≥95 ≥5.3  Hypopituitarism
1 hr ≥180 ≥10.0 ≥180 ≥10.0 o Inherited Metabolic disorder
2 hr ≥155 ≥8.6 ≥155 ≥8.6
 Glycogen storage disease type I
3 hr ≥140 ≥7.8
Gestational diabetes mellitus diagnosed if > 2 plasma glucose o Hyperinsulinism
levels are exceeded (American Diabetes Association, 2004b)  Insulinoma
 Nesidioblastosis
• The laboratory plays a useful role in monitoring o Non pancreatic neoplasms
glycemic control in the management of diabetes  Fibrosarcoma
• Glycated hemoglobin assay is the best measure of  Hepatoma
long-term diabetes control o Alcohol induced fasting hypoglycemia
• Hemoglobin A1c - major form o Various forms of neonatal hypoglycemia
o Liver and renal failure
• Methods:
o Autoimmune hypoglycemia (insulin and insulin
o Cation-exchange column chromatography
receptor antibodies)
o High-pressure liquid chromatography
o Most important cause of hypoglycemia is
• Index of ave blood glucose level over 2-4 months
excessive and inappropriate secretion of insulin
• Normal: 4-6%
by pancreatic β-cell tumors – INSULINOMAS
o Confirmed by insulin radioimmunoassay
Hypoglycemia
• Clinical syndrome that results in levels of plasma
Insulinoma
glucose low enough to lead to symptoms related to
Diagnostic criteria:
inc catecholamine secretion and/or impaired function
• presence of signs and symptoms of hypoglycemia
of CNS
with plasma glucose level of ≤ 45 mg/dL (2.5
• Plasma glucose < 45 mg/dL (2.5 mmol/L)
mmol/L)
• Sweating, tremor, hunger, palpitations, headache,
• an inappropriately elevated insulin level ≥ 6 μU/mL
personality disorders, seizures
(by radioimmunoassay) or ≥ 3 μU/mL (by
• Whipple’s triad:
immunochemiluminometric assay)
o Symptoms of hypoglycemia
• C-peptide ≥ 0.2 pmol/L
o Plasma glucose values in hypoglycemic range
• proinsulin ≥ 5 pmol/L
o Amelioration of symptoms by treatment with
• beta-hydroxybutyrate ≤ 2.7 mmol/L
glucose
Clincal Pathology – Blood Glucose Testing by JAA Page 3 of 3

• a ≥ 25 mg/dL change in plasma glucose in response


to a 1 mg glucagon injection given intravenously
• a negative sulfonylurea/meglitinide blood/urine
screen

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