It is the rise of blood glucose Level above 140 Causes Insulin in: Diabetes mellitus (commonest cause) surgical pancreatectomy (removalof pancreas) Streptozotcin.

WAAD ALOTIBI

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It is the rise of blood glucose Level above 140

CausesInsulin in:

Diabetes mellitus (commonest cause) surgical pancreatectomy

(removalof pancreas)Streptozotcin injection that destroy b-cells

pancreatitis and pancreatic cancer

HYPRERGLYCEMIA

1-ACTH and glucocorticoids: as in adrenal cortical tumors and cushing’s syndrome (b c reduce senstivity of tissues (me adipose tissue) to the offect of insulin on glucose uptake and utilization +

rate of gluconeogensis)

2-Adrenaline :as in emotionsstress and pheochromocytoma glycogenolysis in ms&liver+lipolvsis+inhibit insulin secretion)

3-TSHand thyroxine as in hyperthyroidism(b c thyroid H has diabetogenic action ( absorption of gluconse+gluconeogensis)

4- Pituitary growth hormone : as in acromegaly (b c chronic administrationof GH> glucose uptake in ms +fat tissue glucose > production by liver > insulin secrtion >>exhaustion of B

cell )

Dietary or alimentary high cardohydrate diet rich in simpl sugars drug-induced e g chronic use of corticosteroids

INCREAS ANTI-INSULIN HORMONES:

Normal:70-110mg/dl

Dm:>= 126mg/dl [%] on at least two occasion s

Impiared fasting glucose: fasting glucose(110-125)mg/dl

A risk factor for future diabetes

Normal:<180mg/dl

Dm: >200mg/dl in more than one occasion

1-FASTING BLOOD GLUCOSE(FBS) LEVEL:

2-random blood glucose level(RBS):

Normal:<140mg/dl

Dm:>200mg/dl even at one occasion

3-TWO HOUR POSTPRANDIAL TEST(PPS)

It measures the ability of body to utilize oral glucose dose

Measuring FBS [aftar 8-12h fasting ] and blood Glucose levels five times (every 30 min) over a period of 3 hours after ingestion of 75 grams glucose [1-1.5 gm/dl]of glucose. Urineis also

collected and glucose is estimated

4-THE ORAL GLUCOSE TOLERANCE TEST:

Normal FBS [70-110mg/dl]

Peak within 1h [not> renal threeshold [180mg/dl] The normal FBS isreached after 2-2.5 h [<140mg/dl]

No glucose or KB inany urine specimen In renal glycosuria,OGTT is normal

A- NORMAL RESPONSE

FBS is >110 and <126 2-hour glucose is >=140 but <200mg/dl

This is also considereda risk factor for future diabetes

B-IMPAIRED GLUCSE TOLERANCE [IGT}

A pregnant woman has any two of the dfollowing

AFBS>110mg/dl A1-hour glucose level< ;190mg/dl A2 hour glucose level <;165mg/dl

Or a 3hour glucose level of< ;145mg/dl

C- GESTATIONAL DIABETES :

FBG>=126mg/dl The peak is >180mg/dl

FBG is not reached after 2-3h[200mg/dl] Urine samples Always+ve for glucose whil

KB are+ve or –ve depending on the condition

D- DIABETIC GTT:

Normal FBS peak aftar 0.5-1 h and is 180mg/dl returns to normal aftar 2-2 5h. As in alimentary glucosuria

E-LAG CURVE

Easy inexpensive rabid and noninvasive below renal threshold 180mg/dl

HBA1c will tell ehat the diabetic’s blood sugar levels have been running for the past 2-3 months [life span of

RBCs normal HB A1c is 4-6,5

5.MEASUREMENT OF GLUCOSE IN URINE

6-measurement of glycoseylated hemoglobin glycated hb or hb a1c

Condensation product of glucose with serum albumin Estimate plasma glucose levels over (2-3 weeks) (half life

of alb ) Normal range (205-285 mmol/l)

7- MEASUREMENT OF SERUM FRUCTOSAMINE:

Detection in serum and urine : using (nitroprusside test ) acetone or acetoacetate nitroprusside to from violet color)

Acetest tablets or ketostix (strips)

:

It is an indicator of B-cell function and insulin secetory capacity in diabetic patients on insulin (doesnot cross react

with exogenous insulin)

-C-peptide is 0,9-4,2 ng/ml

Normal serum insulin 29-181 pm/l

8- MEASUREMENT OF KETONE BODIES :

9- measurement of c-peptide

10- measurement of insulin : by ELIZA

ANY QUSTION …???