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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.