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Praktikum Block Endocren 2018

This document provides information about performing an oral glucose tolerance test (OGTT) to test for diabetes and other disorders. It describes the standard procedure which involves fasting overnight, drinking a glucose solution, and having blood drawn at baseline and 2 hours to measure blood glucose levels. Normal and abnormal results are provided to indicate diabetes, prediabetes, and gestational diabetes. Additional tests for ketones, HbA1c, microalbuminuria, and glucose challenge tests in pregnancy are also summarized.

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79 views15 pages

Praktikum Block Endocren 2018

This document provides information about performing an oral glucose tolerance test (OGTT) to test for diabetes and other disorders. It describes the standard procedure which involves fasting overnight, drinking a glucose solution, and having blood drawn at baseline and 2 hours to measure blood glucose levels. Normal and abnormal results are provided to indicate diabetes, prediabetes, and gestational diabetes. Additional tests for ketones, HbA1c, microalbuminuria, and glucose challenge tests in pregnancy are also summarized.

Uploaded by

stella pangestika
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Praktikum Block Endocren

2018
ORAL GLUCOSE TOLERANCE TEST:
Glucose is given orally and blood samples taken afterward to
determine how quickly it is cleared from the blood.

Used to test for diabetes, insulin resistance, and sometimes


reactive hypoglycemia or rarer disorders of carbohydrate
metabolism.

MOST COMMONLY PERFORMED VERSION OF THE TEST :


a standard dose of glucose is ingested by mouth and blood
levels are checked two hours later. (many variations of the
GTT have been devised over the years for various purposes)
Standard OGTT

The patient is instructed not to restrict carbohydrate intake in the days or weeks before
the test.

The test should not be done during an illness, as results may not reflect the patient's
glucose metabolism when healthy.

A full adult dose ( 75 gr glucose ) should not be given to a person weighing less than 43
kg (94 lb).
If < 43 kg glucose dose is : Body weight X 1.75 gr glucose

Usually the OGTT is performed in the morning .

The patient is instructed to fast (water is allowed) for 8–12 hours prior to the tests.
Procedure :
1. A zero time (baseline) blood sample is drawn ==FASTING BLOODGLUCOSE VALUE
2. The patient is then given a measured dose of glucose solution (The WHO
recommendation is for a 75g oral dose in all adults > 43 kg) .
Dose of glucose and variations In the US, dosing is by weight, and since the
late 1970s has been 1.75 grams of glucose per kilogram of body weight, to
a maximum dose of 75 g,
3. Glucose solution should be drunk within a 5 minute time frame.
4. 2 hours blood sample is drawn== 2 HOURS BLOOD GLUCOSE VALUE
5. For simple diabetes screening, the most important sample is the 0 hour and
2 hour sample

Sometimes other laboratory continues to collect blood for up to 3 hours


depending on the requesting physician.
A variant is often used in pregnancy to screen for gestational diabetes, with a
screening test of 50 grams over one hour. If elevated, this is followed with -------
----------a test of 100 grams over three hours.
WHEN BLOOD NORMAL PRE DIABETES DIABETES GESTATIONAL
IS DRAWN DIABETES

FASTING < 100 mg/dL 100 – 125 > 126 > 92/ > 95
mg/dL mg/dL mg/dL

AFTER 1 HOUR > 180 mg/dL

AFTER 2 < 140 mg/dL 140 – 199 > 200 mg/dL > 153/>155
HOURS mg/dL mg/dL
NOTE :
1.Make sure hands are clean before testing. If you have been
handling something sweet before testing, the residue of it on
your fingers may get into your test and make it falsely high.
You will get a much better sized drop of blood if your hands
are warm before testing.

2.Prick your fingers on the side of your finger (towards the tip)
rather than on the pad (or tip) of your finger. This will be more
comfortable for you, especially if you use a keyboard.

3.When you then squeeze out the blood you will get a much
larger sample. You may find that by doing this you may also
be able to reduce the depth gauge on your finger pricker
which will mean your finger prick will be less deep. This will
make your testing more comfortable
PENAFSIRAN HASIL HbA1c /Hb glicosilate
HbA1c / A1c / Hb A1c is a lab test that shows the average level of
blood sugar (glucose) over the previous 3 months / 12 Weeks
It shows how well are controlling diabetes.

The following are the results when A1c is being used to diagnose
diabetes:
Normal : Less than 5.7%
Pre-diabetes: 5.7% to 6.4%
Diabetes: 6.5% or higher

For ps have diabetes,----- For many people the goal is to keep level
below 7%.
The test result may be incorrect in people with anemia, kidney
disease, or certain blood disorders (thalassemia).
Normal value ranges may vary slightly among different laboratories.
What Abnormal Results Mean
Abnormal results mean that have had a high blood sugar
level over a period of 3 months/ 12 weeks
If A1c is above 6.5% and do not already have diabetes, ---
may be diagnosed with diabetes.
If level is above 7% and have diabetes, it often means
that blood sugar is not well controlled.
HbA1C >>>>> eAG

5.7 % 117 mg/dL

6.0 % 125 mg/dL

6.5 % 140 mg/dL

7.0% 154 mg/dL

7.5 169 mg/dL

8.0 183 mg/dL


KETONURIA
Ketone is a chemical produced when there is a shortage of insulin in
the blood and the body breaks down body fat for energy.
Ketones in the urine is a sign that body is using fat for energy instead
of using glucose because not enough insulin is available to use
glucose for energy.
Ketones in the urine is more common in type 1 diabetes.

DIABETIC PS SHOULD BE CHECK FOR KETONES UNDER THE FOLLOWING


CONDITIONS:
= blood glucose is more than 300 mg/dl
= nauseated, are vomiting, or have abdominal pain
= sick (for example, with a cold or flu) , feel tired all the time
= thirsty or have a very dry mouth, skin is flushed
= hard time breathing , breath smells "fruity"
= feel confused
Small or trace amounts of ketones may mean that
ketone buildup is starting ====should test again in a
few hours.
Moderate or large amounts are a danger sign.
Never exercise when urine checks show moderate
or large amounts of ketones and blood glucose is
high ==these are signs that diabetes is out of
control.
MICROALBUMINURIA
- Albumin urine : 20 – 200 ug/L---- (20 – 200 mg/L)
- Occur in incipient diabetic & hypertension mediated
nephropathy in early stage.--- still therapeutic possibly
for halting the progression of nephropathy and
preventing renal failure.
- Know is regarded as most important indicator for
occurrence of diabetic nephropathy ---therapy can still
stop a developing nephropathy
- Usual strip only detect albumin > 150 mg/L --- need
modern and special deep stick for detection
microalbuminuria.
- Examination first morning urine is recommended
GCT For pregnant women/ Screening Gestational Diabetes
The one hour oral glucose challenge test [GCT] is a screening test for
gestational diabetes that measures plasma or serum glucose
concentration 1 hour after a 50-g oral glucose load.

The California Diabetes and Pregnancy Program recommends


that women with values 140 mg/dl to 179 mg/dl should have a 3-
hour 100 gram oral glucose tolerance test (OGTT) within one week.
If the patient has a screening value > 180 mg/dl, a fasting blood
sugar should be checked as soon as possible.
If the fasting is > 95 and the one hour screening test > 180 mg/dl this
provides two abnormal values and the 3 hour OGTT is not required.
If the fasting value is less than 95 then proceed with the 3 hour OGTT.
A glucose challenge test is not necessary in patients with a fasting
plasma glucose level >126 mg/dl (7.0 mmol/l) or a casual plasma
glucose >200 mg/dl (11.1 mmol/l) since these values meet the
threshold for the diagnosis of diabetes.
THE END

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