HealthFlex
×
  • Home
  • Immunology Book
  • Lab Tests
    • Hematology
    • Fluid analysis
    • CSF
    • Urine Analysis
    • Chemical pathology
    • Blood banking
    • Fungi
    • Immune system
    • Microbiology
    • Parasitology
    • Pathology
    • Tumor marker
    • Virology
    • Cytology
  • Lectures
    • Bacteriology
    • Liver
    • Lymph node
    • Mycology
    • Virology
  • Blog
    • Economics and technical
    • Fitness health
    • Mental health
    • Nutrition
    • Travel
    • Preventive health
    • Nature and photos
    • General topic
  • Medical Dictionary
  • About Us
  • Contact

Diabetes Mellitus:- Part 2 – Diabetes Mellitus Diagnosis and Management

October 23, 2023Chemical pathologyLab Tests

Table of Contents

Toggle
  • Diabetes Mellitus
      • What Sample for Glucose Estimation is needed?
      • How much is the Stability of the sample for glucose?
      • Indications for Diabetes Mellitus Patients:
      • What Screening indications for Diabetes are advised in individuals?
      • How will you Define Diabetes mellitus?
      • What are the Complications of diabetes mellitus?
  • Diabetes Mellitus
      • What are the Criteria for the Diagnosis of Diabetes Mellitus?
    • Type of Diabetes  Mellitus (classification of the diabetes mellitus):
  • Diabetes Mellitus Type 1
      • Pathogenesis of type 1 diabetes mellitus:
      • How will you define Type 1 Diabetes Mellitus?
      • Signs and symptoms of diabetes mellitus Type 1:
        • What is the Treatment of Diabetes Mellitus Type 1?
  • Diabetes Mellitus Type 2 (NON-Insulin dependent NIDDM)
      • Signs and symptoms of diabetes mellitus type 2:
      • Factors affecting glucose level:
      • What are the American diabetes association recommendations?
      • What are Clinical manifestation and their explanation in Diabetes mellitus?
  • Gestational diabetes mellitus:
      • What are the diagnostic criteria for gestational diabetes mellitus:
  • Impaired glucose tolerance (IGT)
  • Impaired fasting glucose (IFG)
      • What are the Latest classification criteria for Diabetes mellitus?
      • What are the Criteria for the diagnosis of diabetes mellitus?
      • What is the normal fasting glucose level?
          • Source Tietz
      • Various types of diabetes mellitus and glucose values:
      • Glucose values in whole blood child/adult:
      • Diabetes Mellitus classification based on oral 75 G Glucose overload:
      • Critical values of Glucose:
      • What are the causes of raised glucose levels (Hyperglycemia)?
      • What are the causes of decreased glucose levels (Hypoglycemia)?
      • What are the complications of Diabetes Mellitus?
      • Acute complications are:
      • Chronic complications are:
      • How will you monitor the Diabetes mellitus patients?
      • How will you treat the Diabetes mellitus patients?
        • Functions of various Hormones related to glucose produced by the pancreas:
      • Questions and answers:

Diabetes Mellitus

What Sample for Glucose Estimation is needed?

  1. This test can be done on Serum. The Serum should be separated within 30 minutes of collection.
  2. The Serum can be stored at 25° C for 8 hours and 72 hours at 4 °C.
  3. Oxalated blood can also be used. Preservative sodium fluoride may be added.
  4. The plasma can be stored at 25 °C for 24 hours (with preservative sodium fluoride).

How much is the Stability of the sample for glucose?

  1. One ml of blood in anticoagulant will be stable for 3 hours with fluoride.
  2. Oxalate plasma is stable at 2 to 8 °C for 48 hours.
  3. Mostly Serum is used, stable for 8 hours at 25 °C and 72 hours at 4 °C.
  4. A fast of 6 to 8 hours is required for a fasting sample.

Indications for Diabetes Mellitus Patients:

  1. This test is done to diagnose diabetes mellitus.
  2. This test is also done to evaluate and monitor the patient with Diabetes mellitus.

What Screening indications for Diabetes are advised in individuals?

  1. People over the age of 45 years or older at 3-year intervals.
  2. Younger individuals should be screened if they are obese,>120% of the desired weight, or have a body index ≥ 27.
  3. Individuals with H/O first-degree relatives with Diabetes.
  4. In the case of high-risk ethnic groups, afro-American, Hispanic Americans,  Native Americans, and Asian Americans.
  5. Babies delivered >9 Lbs of weight, and there is a previous H/O GDM.
  6. Individuals with hypertension ≥140/90 mm Hg and H/O atherogenic dyslipidemia.
    1. HDH-Cholesterol = ≤35 mg/dL.
    2. Triglycerides         = ≥250 mg/dL.

How will you Define Diabetes mellitus?

  1. Diabetes mellitus is a group of metabolic disorders of carbohydrate metabolism in which glucose is not adequately utilized, leading to hyperglycemia.
  2. This is not a single disease but is a group of disorders with glucose intolerance in common.
  3. Diabetes mellitus describes a syndrome characterized by chronic hyperglycemia and disturbances of carbohydrates, protein, and fat metabolism.
  4. Diabetes Mellitus is a metabolic disorder characterized by hyperglycemia that results from defects in insulin secretion, insulin action, or both.
    1. This condition is also associated with protein and fat metabolism abnormality.
    2. Diagnosis is dependent upon hyperglycemia and glucosuria.
Diabetes mellitus metabolism

Diabetes mellitus metabolism

What are the Complications of diabetes mellitus?

  1. Chronic hyperglycemia leads to:
  2. Changes in the retina and lens of the eye (retinopathy)
  3. Damage to kidneys.
    1. Microalbuminuria.
    2. Nephropathy
  4. The heart, arterial system, and microcirculation are adversely affected.
    1. Increased risk of heart disease problems.
  5. These patients may develop neuropathy.
  6. The foot needs care and may develop gangrene.
  7. These patients may develop hearing problems.
  8. There are chances for Alzheimer’s disease.

Diabetes Mellitus

What are the Criteria for the Diagnosis of Diabetes Mellitus?

  1. Polyuria, polydipsia, and rapid weight loss.
  2. Fasting glucose level is high.
  3. Insulinopenia has decreased insulin due to the loss of β-cells in the pancreas.
  4. Most patients have autoantibody called an autoimmune process.
  5. When no cause is known is called idiopathic Type.
  6. Abnormal Glucose tolerance test.

Type of Diabetes  Mellitus (classification of the diabetes mellitus):

  1. Type 1 diabetes mellitus (Insulin-dependent, IDDM).
    1. There is β-cell destruction, usually leading to absolute insulin deficiency.
    2. This may be immune-mediated.
    3. It may be Idiopathic.
  2. Type 2 diabetes mellitus (Noninsulin dependant, NIDDM).
    1. There is predominantly insulin resistance with relative insulin deficiency. OR
    2. There may be predominantly insulin secretion deficiency with insulin resistance.
  3. Gestational Diabetes Mellitus (Gestational diabetes mellitus, GDM).
    1. It is detected early in pregnancy. This may be type 1 or type 2.
    2. This is detected in the 2nd or 3rd trimester in 4% of pregnant ladies.
  4. Other specific types are:
    1. The genetic defects of β-cell dysfunction.
    2. The genetic defect in insulin action (Type A insulin resistance).
  5. Diseases of the pancreas (exocrine glands).
    1. Pancreatitis.
    2. Trauma or pancreatectomy.
    3. Tumor of the pancreas.
  6. Drugs or chemicals induced.
    1. Thiazide.
    2. Glucocorticoids.
    3. Nicotinic acid.
  7. Infections.
    1. Cytomegalovirus (CMV).
    2. Congenital rubella.
  8. Endocrinopathies.
    1. Glucagonoma.
    2. Cushing’s syndrome.
    3. Acromegaly.
  9. Immune-mediated diabetes.
  10. Genetic syndrome associated with diabetes mellitus are:
    1. Turner syndrome.
    2. Down’s syndrome.
    3. Myotonic dystrophy.
    4. Friedreich ataxia.

Diabetes Mellitus Type 1

Pathogenesis of type 1 diabetes mellitus:

  1. The autoimmune phenomenon may be the cause of  type 1 diabetes mellitus:
    1. Type 1 diabetes mellitus is due to cell-mediated autoimmunity leading to the destruction of the insulin-secreting cells of the pancreatic β- cells.
    2. While other α, δ, and other islet cells are preserved.
    3. The islet cells have mononuclear cells infiltrated, called insulitis.
    4. The autoimmune process for type 1 diabetes begins years before the clinical presentation.
    5. An 80% to 90% reduction in the volume of β- cells is needed before clinical Diabetes appears.
    6. Destruction of the β- cells is more rapid in children than in adults.
Insulin main functions

Insulin main functions

  1. Antibodies that may play a role in type 1 diabetes are:
    1. There is a marker of β-cells autoimmunity where the antibodies in the Serum are detected before Diabetes appears.
      1. Islet cell cytoplasmic antibodies.
      2. Insulin auto-antibodies.
      3. Glutamic acid decarboxylase antibodies.
  2. Genetic  role:
    1. Type 1 diabetes is inherited, but the mode is not clear.
  3. Environmental factors:
    1. There are various factors reported, and one of those is the virus.
    2. Viruses like mumps, Bella, and coxsackievirus B are blamed.
    3. Other factors like cow’s milk and chemicals.
  1. This is because of the severe or absolute absence of insulin caused by the loss of beta cells in the pancreas.
  2. Destruction of the islet cells may be due to the following:
    1. Genetics.
    2. Autoimmunity.
    3. Environmental factors.
  3. In 80% to 90% of the cases, there are islet cell autoantibodies and antibodies to insulin and glutamic acid decarboxylase, which cause damage to the islet cells.
    1. Non-immune type 1 diabetes occurs secondary to other diseases like pancreatitis.
  4. Pathology: Beta-cell abnormalities are present long before the onset of type 1 diabetes mellitus.
    1. Both beta and alpha cell functions are abnormal, with a lack of insulin and a relative excess of glucagon produced by the alpha cells.

How will you define Type 1 Diabetes Mellitus?

  1. This is also called:
    1. Juvenile-onset Diabetes.
    2. Juvenile Diabetes.
    3. Ketosis prone diabetes.
    4. Brittle Diabetes.
    5. Autoimmune Diabetes.
    6. Idiopathic Diabetes.
  2. There is a long preclinical period with abrupt onset of clinical manifestations.
  3. Patients are prone to develop ketoacidosis.
  4. There is a dependency on insulin.
  5. This often affects young people around the age of puberty.
    1. The peak age of onset is 11 to 13 years.
    2. The risk for the sibling is 5 to 10%, while the risk for the offspring is 2 to 5%.
  6. There are several syndromes like autoimmune and genetic origin.

Signs and symptoms of diabetes mellitus Type 1:

  1. Glucose accumulates in the blood (hyperglycemia)  and is excreted in the urine.
    1. There is weight loss due to the breakdown of proteins and fats.
    2. There is polyuria, polyphagia, and polydipsia.
    3. There is a wide fluctuation in the blood glucose level.
    4. There may be ketoacidosis because of the breakdown of protein and fat.
      1. There are increased ketone bodies.
    5. The pH drops, which triggers the buffer system and leads to metabolic acidosis.
        1. There is a fruity odor in the breath due to the volatile ketone body acetone.
    6. The patient may go into a coma.

Clinical manifestation and their explanation:

Clinical manifestation Explanation
Weight loss There is a fluid loss due to osmotic diuresis and loss of body tissue as fat and protein are used for energy.
Fatigue There are metabolic changes that result in poor food utilization, which will contribute to lethargy and fatigue.
Polyphagia This is due to the depletion of the body’s fat, proteins, and carbohydrates leading to cellular starvation and increased hunger.
Polydipsia This is due to a raised blood sugar level, which osmotically attracts the water from the cells, leading to intracellular dehydration and ultimately stimulating the hypothalamus and thirst.
Polyuria Hyperglycemia acts as an osmotic diuretic and leads to Glycosuria, which is accompanied by water loss in the urine.

What is the Treatment of Diabetes Mellitus Type 1?

  1. This will need a combination of the following:
    1. Insulin.
    2. Food planning.
    3. Exercise.
    4. More details are discussed at the end of this discussion.

Diabetes Mellitus Type 2 (NON-Insulin dependent NIDDM)

  1. This is also called:
    1. Adult-onset type diabetes.
    2. Maturity-onset Diabetes.
    3. Ketosis resistant diabetes.
  2. Patients have minimal symptoms.
  3. This is not dependent on insulin to prevent ketonuria.
  4. The insulin level may be normal, decreased or increased.
  5. Most patients have impaired insulin action.
  6. There is the interaction of metabolic, genetic, and environmental factors.
  7. It affects people after the age of 40 years, and mostly these are obese.

Pathophysiology of diabetes mellitus type 2:

  1. The cause is unknown.
  2. Genetics may play some role, but it is not clearly defined.
  3. There is no evidence of the autoimmune mechanism.
  4. Cellular resistance is a factor in 60% to 80% of people with type 11 diabetes mellitus.
  5. Insulin resistance increases with obesity.
  6.  There is a decreased response of the β-cell to blood glucose levels and abnormal glucagon secretion.
  7. There may be alterations in the insulin-receptor or post-receptor events.
    1. There may be an increase in the insulin level to compensate for insulin resistance in the peripheral tissue, but still, there is relative insulin deficiency.
  8. The changes in the pancreas are nonspecific.
    1. 10% to 40% of the cases show amyloidosis of the pancreas in type 2 diabetes mellitus.
    2. Pancreatic fibrosis occurs in 33% to 66% of the cases with type 2 diabetes, leading to a decreased number of β-cells.
    3. Generally, there is a decrease in the weight and number of β-cells, and the cause is unclear.
  9. The most common factor is obesity. It increases 10 times in obese people.
  10. Also, excessive intake of calories predisposes to type 2 diabetes.
    1. Insulin can not facilitate the entry of glucose into the muscle cells, hepatocytes, and fat cells.
  11. One of the factors is the decreased ability of insulin to act on the peripheral tissue (insulin resistance).

Signs and symptoms of diabetes mellitus type 2:

  1. These are nonspecific.
  2. Most patients are obese and overweight.
  3. There is hyperlipidemia.
  4. Onset is slow and mostly not noted, which leads to late diagnosis.
  5. Classic symptoms like polydipsia, polyphagia, and polyuria are present.
  6. There may be nonspecific symptoms like pruritus, recurrent infections, paresthesia, and visual changes.

What is the Treatment of Diabetes Mellitus Type 2?

  1. This is just like type 1 diabetes.  The aim is to keep blood sugar in the normal range.
  2. There is a need to decrease the calorie intake in an overweight person.
  3. Saturated fats and cholesterol are restricted.
  4. Some people recommend a high-fiber diet.
  5. Oral hypoglycemic drugs may be needed.
  6. Exercise also helps.
  7. Insulin may also be given.

Factors affecting glucose level:

  1. Stress like trauma, general anesthesia, infection, burns, and Myocardial infarction can Increase the glucose level.
  2. Caffeine may increase the level.
  3. Some pregnant women may experience glucose intolerance. A significantly raised level of glucose is called Gestational Diabetes.
  4. Drugs may increase the glucose level like an antidepressant (tricyclic), Beta-blockers, corticosteroids, I/V glucose, dextrothyroxine, diazoxide, diuretics, estrogen, glucagon, isoniazid, lithium, phenothiazine, phenytoin, and salicylates intoxication.
  5. Drugs like acetaminophen, alcohol, anabolic steroids, insulin, tolbutamide, propranolol, and clofibrate may decrease the glucose level.

What are the American diabetes association recommendations?

Test Normal Goal
Glucose: Capillary whole blood, Preprandial <100 mg/dL 80 to 120 mg/dL
Average bedtime glucose <120 mg/dL 100 to 140 mg/dL
HbA1c <6% <7%

What are Clinical manifestation and their explanation in Diabetes mellitus?

Clinical manifestation Explanations
Fatigue This is due to the poor metabolism of the food products, which contributes to lethargy and fatigue.
Genital pruritus Hyperglycemia and Glycosuria help the growth of fungal (candidiasis) infection, leading to pruritus, and most common in females.
Recurrent infection There may be boil, carbuncle, and skin infections. The growth of the bacteria is enhanced by increased glucose. Also, the impaired blood supply helps the infection.
Prolonged wound healing There is an impaired blood supply, which delays healing.
Paresthesia This is due to diabetic neuropathy.
Eye changes This is due to diabetic retinopathy.

Gestational diabetes mellitus:

  1. Definition: Hyperglycemia develops for the first time during pregnancy.
  2. This is also called:
    1. Asymptomatic Diabetes.
    2. Chemical Diabetes.
    3. Borderline Diabetes.
    4. Latent Diabetes.
    5. Subclinical Diabetes.
  3. Gestational diabetes mellitus develops when glucose intolerance develops during pregnancy, so all pregnant women need to be tested.
  4. After the delivery, the glucose becomes normal, impaired, or progresses to Diabetes.
  5. This is first diagnosed during pregnancy and usually in the third trimester.
  6. Already known cases of diabetic women are not included in this group.
  7. This occurs in 6 to 8% of pregnant women (another source, only 2% of pregnant ladies may have this Diabetes).
  8. Out of this group, 60% may develop Diabetes in 15 years Of gestation.
  9. Later on, these ladies are at increased risk of developing diabetes mellitus (6 to 62% of these ladies).
  10. Risk factors in developing Gestational Diabetes are:
    1. Pregnant ladies with Glycosuria.
    2. If there is a family history of Diabetes.
    3. In obese ladies.
    4. If the ladies develop pregnancy at a late age.
    5. In multiparity of 5 or more.
    6. In the case of previous complicated pregnancies.
  11. What are the diagnostic criteria for gestational diabetes mellitus:

    1. To diagnose gestational diabetes mellitus. Two blood samples on oral glucose tolerance tests (with 100 grams of glucose) are as follows:
Blood sample timings Blood glucose level
Fasting blood glucose ≥95 mg/dL
One hour sample ≥180 mg/dL
2- hour sample ≥155 mg/dL
3-hour sample ≥140 mg/dL
  1. What is the Treatment of gestational diabetes mellitus?
    1. Advise random or fasting blood glucose during the pregnancy.
    2. It should be aggressive to prevent morbidity and fetal mortality.

Impaired glucose tolerance (IGT)

  1. This group has less fasting glucose than required for diabetes mellitus.
  2. An oral glucose tolerance test is needed to diagnose this group.
  3. The overt case develops 1% to 5% per year.
    1. 10% to 20% will convert to type 11 diabetes within 10 years.
  4. Microvascular diseases are very uncommon in this group.
  5. Many of them are obese.
  6. What are the Criteria for impaired glucose tolerance?
    1. With an oral glucose tolerance test:
      1. 2-hour sample = ≥140 mg/dL and <200 mg/dL (nonpregnant ladies).

Impaired fasting glucose (IFG)

  1. There is an abnormal response to an oral glucose tolerance test.
  2. What are the Criteria for the diagnosis of Impaired fasting glucose?
    1. Fasting glucose = ≥110 mg/dL and <126 mg/dL.
    2. 2 hours of glucose = ≥ 140 mg/dL.
      1. <200 mg/dL.
  3. This is diagnosed by fasting glucose values between normal and diabetic individuals.
  4. This is a metabolic stage between normal glucose and diabetes mellitus.
  5. There is an increased risk for the development of Diabetes and cardiovascular disease.

What are the Latest classification criteria for Diabetes mellitus?

  1. Diabetes mellitus:
    1. Presence of classic symptoms.
    2. If the fasting glucose level is 126 mg/dl (>7.0 mmol/L) or above, it should be labeled as D. Mellitus (when this value is found two times).
    3. One random glucose level of more > than 200 mg/dl  (11.1 mmol/L) with symptoms of polyuria, polydipsia, and polyphagia is considered diagnostic of Diabetes.
    4. HbA1c is more than 6.5 % diagnostic for Diabetes.
    5. The 2-hour postprandial glucose level was≥200 mg/dl  (11.1 mmol/L) during OGTT.
  2. Impaired fasting glucose = > 126 mg/dl. (fasting glucose level 110 to 125 mg/dL (6.1 to 7.0 mmol/L).
  3. Impaired glucose tolerance when:
    1. Fasting glucose < 126 mg/dl (7 mmol/L).
    2. OGTT 2-hour sample is 140 mg to 199 mg/dl (7.8 to 11.1 mmol/L).

What are the Criteria for the diagnosis of diabetes mellitus?

  1. Fasting blood glucose level:
    1. 126 mg/dL (7.0 mmol/L) or higher is considered diagnostic.
  2. Random/nonfasting blood glucose level:
    1. 200 mg/dL (11.1 mmol/L) is diagnostic.
  3. Oral glucose tolerance test with 75 G of glucose:
    1. A 2-hour sample of 200 mg/dL  (11.1 mmol/L) or higher value is diagnostic.

What are the Values in diabetic patients and normal people?

Diagnosis Fasting glucose level Random glucose level 2-hour glucose level (in OGTT) HbA1c 
Normal <100 mg/dL  (5.6 mmol/L) <14o mg/dL (7.8 mmol/L) <5.7
Prediabetics 100 to 125 mg/dL (5.6 to 6.9 mmol/L) ≥140 to 199 mg/dL (7.8 to 11.0 mmoml/L) ≥140 to 199 mg/dL (7.8 to 11.0 mmol/L) 5.7 to 6.4%
Diabetes mellitus ≥ 126 mg/dL (7.0 mmol/L) 200 mg/dL (11.1 mmom/L) ≥200 mg/dL (11,1 mmol/L) ≥6.5%

What are the Differences between Diabetes Mellitus type 1 and type 2?

Parameters Type 1 diabetes mellitus Type 2 diabetes mellitus
Presentation
  1. Common in children
  2. Normal weight
  1. More in Adults
  2. Mostly, these are obese
Insulin  level
  1. Decreased blood insulin level
  2. Anti-islets cell antibodies
  1. Normal or increased blood insulin level
  2. No Anti-islets cell antibodies
Genetic role 40% seen in the twins 60 to 80% seen in the twins
Pathogenesis
  1. Autoimmunity
  2. Mechanism is immunologic
  3. There is severe insulin deficiency
  4. Insulitis may be seen early
  5. There is marked atrophy and fibrosis in islet cells
  6. It is a severe β-cell depletion
  1. There is insulin resistance
  2. There is an insulin deficiency
  3. There is no insulitis
  4. There may be amyloidosis.
  5. There is focal atrophy
  6. There is mild β-cell depletion
Biochemical difference Ketoacidosis is common Ketoacidosis is rare

What is the normal fasting glucose level?

Source 1

Age mg/dL
Cord blood 45 to 96
Premature 20 to 60
Neonates 30 to 60
Newborn 1 day 40 to 60
>one day 50 to 80
Child 60 to 100
Adult 74 to 104
60 to 90 years 82 to 115
>90 years 75 to 121
  •  To convert to SI units x 0.0555 = mmol/L
  • Values vary from the biochemical method used.

Source 6 for glucose level

Blood glucose fasting mg/dL mmol/L
Cord 45 to 96 2.5 to 5.3
Premature infants 20 to 60 1.1 to 3.3
Neonatal 30 to 60 1.7 to 3.3
Infants 40 to 90 2.2 to 5.0
Child <2 years 60 to 100 3.3 to 5.5
Child >2 years to adult
Fasting 70 to 100 <6.1
Elderly Increase after 50 years
Source Tietz

Plasma/ serum glucose level

  • Adult = 74 to 106 mg/dL (4.5 to 5.9 mmol/L)
  • Children = 60 to 100 mg/dL (3.5 to 5.6 mmol/L)
  • Premature neonates = 20 to 60 mg/dL (1.1 to 3.3 mmol/L)
  • Term neonates = 30 to 60 mg/dL (1.7 to 3.3 mmol/L)

The whole blood glucose level

  • 65 to 95 mg/dL (3.5 to 5.3 mmol/L)

CSF glucose level

  • 40 to 70 mg/dL (2.2 to 3.9 mmol/L)
    • 60% of the plasma

Urine 24 hours glucose level

1 to 15 mg/dL (0.1 to 0.8 mmol/L)

The normal value of glucose from another source:

  1. Usually, glucose between 70 to 110 mg/dl is considered normal.
  2. Fasting glucose = < 100 mg/dl.
    1. Cord blood = 45 to 96 mg/dL  (2.5 to 5.3 mmol/L)
    2. premature baby = 20 to 60 mg/dL.  (1.1 to 3.3 mmol/L).
    3. Neonates = 30 to 60 mg/dL  (1.7 to 3.3 mmol/L).
  3. Infants = 40 to 90 mg/dL  (2.2 to 5.0 mmol/L).
  4. Child <2 years = 60 to 100 mg/dL  (3.3 to 5.5 mmol/L).
    1. Child >2 years = like adult level.
  5. Adult fasting = 70 to 110 mg/dL  (<6.1 mmol/L).
  6. Adult random = <160 mg/dL  (11.1 mmol/L).

Various types of diabetes mellitus and glucose values:

Diagnosis  Fasting glucose level Random/non-fasting glucose level  2 hours glucose after 75 grams of oral test
Diabetes mellitus >125 mg/dL >199 mg/dL (classic S/S and glucose ≥200 mg/dL) >199 mg/dL
Pre-diabetes (impaired fasting glucose) >99 mg and <125 mg/dL – ≥140 to <200 mg/dL
Pre-diabetes (impaired glucose tolerance) <126 mg/dL >139 mg and <200 mg/dL
Gestational diabetes >105 mg/dL
  • After 100 g of oral glucose
  1. one hour = ≥190 mg/dL
  2. 2 hours    = ≥165 mg/dL
  3. 3 hours    = ≥145 mg/dL

 

Glucose level in various conditions

The glucose level in various conditions

Glucose values in whole blood child/adult:

Fasting Child mg/dL Adult mg/dL
Serum or plasma 60 to 105 70 to 100
Whole blood 50 to 90 60 to 100
2 hours, postprandial
Serum or plasma around 150 around 140
Whole blood around 120 around 120

Diabetes Mellitus classification based on oral 75 G Glucose overload:

Patterns of Glucose Fasting glucose mg/dL Postprandial glucose mg/dL 2 hours of glucose mg/dL
Normal <115 <200 <140
Diabetes Mellitus >140 >200 >200
Impaired glucose tolerance <140 >200 140 to 190

Critical values of Glucose:

Age Critical low glucose level mg/dL Critical high glucose level mg/ dL
Adult male < 50 > 400
Adult female < 40 > 400
Infants < 40
Newborn < 30 > 300

What are the causes of raised glucose levels (Hyperglycemia)?

  1. Diabetes mellitus, adult, and juvenile.
  2. Physiological causes.
    1. Strenuous exercise.
    2. Strong emotions.
    3. Shock and burns.
    4. Infections.
  3. Endocrine disorders.
    1. Thyrotoxicosis
    2. Acromegaly and gigantism.
    3. Pheochromocytoma.
    4. Cushing’s syndrome.
  4. Pancreatic diseases.
    1. Acute and chronic pancreatitis.
    2. Pancreatitis due to mumps.
    3. Cystic fibrosis.
    4. Hemochromatosis.
    5. Pancreatic cancers.
  5. Other causes are:
    1. Cerebrovascular accident.
    2. Chronic liver disease.
    3. Chronic renal disease.
    4. Acanthosis nigricans.

What are the causes of decreased glucose levels (Hypoglycemia)?

  1. Pancreatic disorders.
    1. Islet Cell Tumor.
    2. Glucagon deficiency.
  2. Tumors.
    1. Adrenal gland carcinoma.
    2. Carcinoma of the stomach.
    3. Fibrosarcoma.
  3. Liver diseases.
    1. In poisoning, e.g., arsenic, chloroform, carbon tetrachloride, phosphorus, salicylates, antihistamines, phenformin, and alcohol.
  4. Endocrine disorders.
    1. Hypopituitarism.
    2. Addison’s disease.
    3. Hypothyroidism.
  5. Functional disorders.
    1. Postgastrectomy.
    2. Gastroenterostomy.
    3. Autonomic nervous system disorders.
  6. Pediatric causes.
    1. Prematurity.
    2. Infant diabetic mothers.
    3. Idiopathic leucine sensitivity.
  7. Enzyme deficiency.
    1. Galactosemia.
    2. Fructose intolerance.
    3. Von Gierke’s syndrome.

What are the complications of Diabetes Mellitus?

Acute complications are:

  1. There may be hypoglycemia.
  2. Patients with uncontrolled hyperglycemia of Type I may develop life-threatening complications like diabetic Ketoacidosis.
    1. Without treatment, the patient may become acidotic and dehydrated and lose consciousness.
  3. Type II may develop hyperosmolar coma.

Chronic complications are:

  1. Peripheral neuropathy.
  2. Diabetic retinopathy and cataract formation.
  3. Cardiovascular microangiopathy.
    1. Coronary atherosclerosis.
    2. Myocardial infarction is 3 to 5 times more common in diabetic patients.
    3. AMI is the leading cause of death in diabetes mellitus type 2.
  4. Peripheral vascular diseases like ischemia of lower extremities, erectile dysfunction, and intestinal ischemia.
    1. Gangrene of the foot.
  5. Diabetic kidney disease (diabetic nephropathy) may lead to end-stage renal disease.
  6. Chronic pyogenic skin infection.
    1. Candidal infection of the skin.
  7. Bone and joints show contracture.
Diabetes mellitus complications

Diabetes mellitus complications

Diabetes Mellitus complications

Diabetes Mellitus complications

How will you monitor the Diabetes mellitus patients?

  1. In the newly diagnosed patient, check glucose frequently.
  2. The best times are:
    1. Before meals.
    2. At bedtime.
  3. The goal of therapy is:
    1. To maintain euglycemia.
    2. Avoid hypoglycemia.
    3. Prevent cardiovascular diseases.
    4. Prevent neurological complications.

How will you treat the Diabetes mellitus patients?

  1. It requires a number of modalities to treat diabetic patients:
  2. Diet control.
    1. This includes dietary fibers in the diet.
    2. Eat low glycemic index foods, which will not raise blood glucose. This glycemic index is 55 or low, including vegetables, fruits, pasta, grainy bread, and legumes.
    3. High glycemic index foods have a value above 77 or greater. This will include potatoes, white bread, and white rice.
    4. The addition of protein and fats can lower the Glycemic index.
    5. Artificial sweeteners can be used in cooking and baking.
    6. Fructose is a natural sweetener and does not increase glucose levels.
  3. Medications to lower hyperglycemia are:
    1. The first-generation sulphonylureas are tolbutamide, tolazamide, acetohexamide, and chlorpropamide.
    2. Second-generation sulphonylureas are glyburide, glipizide, gliclazide, and glimepiride.
    3. Repaglinide.
    4. Nateglinide.
  4. Drugs that lower the glucose level by their action on the liver, muscle, and adipose tissue are:
    1. Metformin.
    2. Thiazolidinediones.
  5. Medications that affect the absorption of glucose are:
    1. Acarbose.
    2. Miglitol.
  6. Incretins are oral insulin stimulators:
    1. GLP-1 receptor antagonists.
    2. DPP-4 inhibitors.
    3. Sodium-glucose co-transporter 2 inhibitors.
  7. Insulin has various preparations.
  8. Transplant of the pancreatic tissue.

Functions of various Hormones related to glucose produced by the pancreas:

Chemical substance  Clinical significance
Insulin

1. Evaluation of fasting hypoglycemia

2. Evaluation of polycystic ovary

3. Classification of Diabetes mellitus

4. Predict diabetes mellitus

5. Assessment of β-cell activity

6. To find the insulin resistance

Proinsulin

1. Diagnose the β-cell tumors

2. Cross-reactivity of insulin in different methods

3. Diagnosis of familial hyperinsulinemia

C-peptide

1. Evaluation of Fasting hypoglycemia

2. Evaluation of β-cell tumors and beta-cell activity

3. Classification of Diabetes mellitus

4. Monitoring the patient with pancreatectomy and transplant of pancreas islet cells  

Glucagon For the diagnosis of α- cell tumors

Questions and answers:

Question 1: What is the critical value of glucose level in the newborn?
Show answer
In newborn critical value is <30 mg/dL.
Question 2: What is the fasting glucose level in impaired glucose tolerance?
Show answer
It is <126 mg/dL.
Possible References Used
Go Back to Chemical pathology

Add Comment Cancel



The reCAPTCHA verification period has expired. Please reload the page.

  • Lab Tests
    • Blood banking
    • Chemical pathology
    • CSF
    • Cytology
    • Fluid analysis
    • Fungi
    • Hematology
    • Immune system
    • Microbiology
    • Parasitology
    • Pathology
    • Tumor marker
    • Urine Analysis
    • Virology

About Us

Labpedia.net is non-profit health information resource. All informations are useful for doctors, lab technicians, nurses, and paramedical staff. All the tests include details about the sampling, normal values, precautions, pathophysiology, and interpretation.

[email protected]

Quick Links

  • Blog
  • About Us
  • Contact
  • Disclaimer

Our Team

Professor Dr. Riaz Ahmad Bhutta

Dr. Naheed Afroz Syed

Dr. Asad Ahmad, M.D.

Dr. Shehpar Khan, M.D.

Copyright © 2014 - 2025. All Rights Reserved.
Web development by Farhan Ahmad.