Teaching Demo

Define Diabetes as a disease and its
categories and classifications.

Differentiate Type 1, Type 2, and
Gestational Diabetes
Identify different tests that help
determine and monitor Diabetes
Mellitus.
 A metabolic disease characterized by hyperglycemia, resulting from
defects in insulin secretion, insulin action, or both.
 Primary symptoms of Diabetes Mellitus are as follows:

1. Polyuria – increased urine output
2. Polydipsia – excessive thirst
3. Polyphagia- excessive hunger
4. Persistent non-healing of wounds
 It can be classified mainly into three (3) types:

1. Type 1 Diabetes Mellitus
2. Type 2 Diabetes Mellitus
3. Gestational Diabetes
Source: Richard A. McPherson, Matthew R. Pincus, Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22 nd ed. Elsevier, 2011
 Glucose intolerance during
pregnancy due to metabolic and
hormonal changes.
 During gestational diabetes, fetal

insulin secretion of the fetus is
stimulated.
 After birth, with the immediate

cutoff of glucose supply (umbilical
cord cut), the neonate has still
increased insulin levels, resulting in
severe hypoglycemia.
1. RANDOM BLOOD SUGAR TEST
2. FASTING BLOOD GLUCOSE TEST
3. 2 HOUR-POST PRANDIAL GLUCOSE TEST
4. ONE-STEP ORAL GLUCOSE TOLERANCE TEST
5. 2 STEPS-ORAL GLUCOSE TOLERANCE TEST
6. GLYCOSYLATED HEMOGLOBIN (HbA1C)
7. POINT-OF-CARE TESTING (GLUCOMETER)
 SIGNIFICANCE- Usually requested during emergency cases
such as Insulin Shock and Hyperglycemic Ketogenic Coma.
 CONSIDERATIONS- Specimen collected at any time of the

day without regard for the time of the last meal.
 SIGNIFICANCE- The most used test for the diagnosis of
Diabetes Mellitus
 CONSIDERATIONS- The patient should fast for 6-8 hours or

up to 14 hours. It should be measured in all asymptomatic
persons at the age of 45, with follow-up testing every 3 years.
 SIGNIFICANCE- Screening and
Diagnosis of Diabetes Mellitus as well
as for monitoring and control.
 CONSIDERATIONS-
1. Blood collected 2 hours after meal
or ingesting glucose load.
2. Ideal: Non diabetics (<140 mg/dl)
and Diabetics (<180 mg/dl)
 SIGNIFICANCE- Diagnosis of Gestational Diabetes and Impaired Glucose
Tolerance Test for patients with unexplained nephropathy, neuropathy or
retinopathy, with RBS concentration less than 140 mg/dl.
 CONSIDERATIONS
1. Discontinue any medications that can affect glucose tolerance.
2. Carbohydrate consumption: at least 150 d/day during the 3-day preparation.
Physical activity is not restricted.
3. Fasting is required the night before the test is performed. Testing begins
between 7-9 AM.
 DURING THE TEST: 100 g LOAD 75 g LOAD
(mg/dL) (mg/dL)
1. Fasting Blood Glucose is measured.
2. Oral Glucose load is given (non- Fasting 95 95
pregnant adults: 75 g; pregnant: 100 g; 1 hour 180 180
children: 1.75 g/kg to 75 g maximum).
3. Glucose load should be dissolved in 2 hours 155 155
300 mL water, and taken for not over 5
3 hours 140 -
minutes.
4. Blood glucose is then measured. *NOTE: Two (2) abnormal results are
required to diagnose the patient as diabetic.
 SIGNIFICANCE- Initial screening procedure for gestational diabetes at
24-48 weeks of gestation in women not previously diagnosed with overt
diabetes.
 CONSIDERATIONS- No preparation is needed. A 50 g oral glucose load

is given and determine blood glucose after 1 hour.
 REFERENCE VALUE: If the value is greater than or equal to 140

mg/dL, proceed with 1 step OGTT
 SIGNIFICANCE- Provides an index of average blood glucose for the past 2-
3 months. Mainly for diabetes control and monitoring.
 CONSIDERATIONS-
1. The frequency of test should be at least two (2) times a year for patients
having treatment and stable glycemic control. Quarterly for patients with
changed therapy or poor glucose control.
2. Limitations: Hemoglobinopathies, alcohol and drug use, iron deficiency,
and lead poisoning; decrease erythrocyte survival.
3. Specimen: EDTA preferred anticoagulant then apply hemolysate before the
assay.
 Each glucometer test strip contains an enzyme called glucose oxidase.
This enzyme then reacts with the glucose in the blood sample and
creates an acid called gluconic acid.
 The gluconic acid thus formed then reacts with another chemical in the
testing strip called ferricyanide. The ferricyanide and the gluconic acid
then combine with each other and forms ferrocyanide.
 Immediately as the ferrocyanide has been formed, the device
glucometer runs an electronic current through the blood sample on the
strip.
 The current thus produced is capable of reading the ferrocyanide and
identifying the amount of glucose present in the blood sample on the
testing strip.
 This number is the only value that is displayed on the screen of the
glucometer.
TEST NORMAL IMPAIRED DIAGNOSTIC
Random Blood Glucose <200 mg/dL 140-199 mg/dL ≥ 200 mg/dL

Test
Fasting Blood Glucose Test <100 mg/dL 100-125 mg/dL ≥ 126 mg/dL
2-hr Post OGTT <200 mg/dL 140-199 mg/dL ≥ 200 mg/dL
Hemoglobin A1c <5.7% 5.7-6.4% ≥ 6.5%

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Define Diabetes as a disease and its

categories and classifications.

 Primary symptoms of Diabetes Mellitus are as follows:

 It can be classified mainly into three (3) types:

 During gestational diabetes, fetal

 After birth, with the immediate

 CONSIDERATIONS- Specimen collected at any time of the

 CONSIDERATIONS- The patient should fast for 6-8 hours or

 CONSIDERATIONS- No preparation is needed. A 50 g oral glucose load

 REFERENCE VALUE: If the value is greater than or equal to 140

Random Blood Glucose <200 mg/dL 140-199 mg/dL ≥ 200 mg/dL

2-hr Post OGTT <200 mg/dL 140-199 mg/dL ≥ 200 mg/dL

Hemoglobin A1c <5.7% 5.7-6.4% ≥ 6.5%

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