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Glucose Tolerance Test

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12 views27 pages

Glucose Tolerance Test

Uploaded by

minz.shishir2015
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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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Glucose Tolerance

Test
Glucose Tolerance Test-
It is a study of the capacity of the body for carbohydrate utilization with
artificial load of glucose.
Types of Glucose Tolerance Test
• Standard oral Glucose tolerance Test

• I/V Glucose tolerance Test

• Mini Glucose Tolerance Test


Indications of
oral Glucose Tolerance Test
• In asymptomatic persons with sustained or transient glycosuria.
• In persons with symptoms of diabetes but no glycosuria or
hyperglycemia.
• Persons with family history but no symptoms or positive blood
findings.
• In patients with neuropathies or retinopathies of unknown origin
• During pregnancy, excessive weight gain is noticed with past history of
big baby (more than 4 kg ) or past history of miscarriage.
Contraindications of GTT
• In proven cases of diabetes mellitus the test is not required.

• GTT is required only in doubtful cases, it is not recommended for


follow up of patients.

• The test should not be carried out in acutely ill patients.


Preparation of patients
• The patient is instructed to have good carbohydrate diet for 3 days
prior to the test.
The diet containing about 30-50 g of carbohydrate
should be taken on the evening prior to the test.

• The patient should avoid drugs likely to influence the blood glucose
levels, for at least , 2 days prior to the test.
• The patients should abstain from smoking during the test.

• Strenuous exercise on the previous day is to be avoided.

• The exercise is also to be avoided on the same day prior to the test.

• Patient should not take food after 8 pm the previous night, and should
not take any breakfast.
Procedure of standard glucose
tolerance test
• At about 8 a.m. the fasting blood and urine sample are collected.
These are called zero samples.

A loading dose of 75 g anhydrous glucose dissolved in 250-300 ml of


water is given to the patient.
In children 1.75 g of glucose /kg body weight is given.
• In the classical procedures, the blood and urine samples are collected
at half hourly interval of the next two and half hour or three hours.

• Glucose is estimated in all the blood samples.


• Urine is analyzed for the presence of glucose.
Glucose tolerance curve
• The curve is plotted with the blood glucose levels on the vertical axis
against the time of collection on the horizontal axis.

• The curve obtained is glucose tolerance curve.


Laboratory profile of a normal
patient after glucose load
Laboratory profile of a diabetic
patient after glucose load
Impaired glucose tolerance (IGT)
• It is otherwise called as impaired Glucose Regulation(IGR)
• Here plasma glucose values are above the normal level, but below the
diabetic levels.
• In IGT, the fasting plasma glucose level is between 110 and 126 mg/dl
and 2 hours post- glucose value is between 140 and 200 mg/dl.

• Such person need careful follow- up because IGT progresses to frank


diabetes at the rate of 2% patient per year.
Gestational diabetes Mellitus (GDM)
• This term is used when carbohydrate intolerance is noticed , for the first
time during pregnancy.
• A known diabetic patient who becomes pregnant , is not included in this
category.
• In all antenatal women , a glucose challenge test is done between22 and 24
weeks of pregnancy by giving an oral glucose load of 50 g of glucose
regardless of the time.
• If the 2 hour post- glucose value is more than 140 mg/dl, the test is
positive.
• An OGTT with 75g glucose load should be done to confirm or exclude the
GDM.
• Women with GDM are at increased risk for subsequent development
of frank diabetes.
• GDM is associated with an increased incidence of neonatal mortality.
• Maternal hyperglycaemia causes the fetus to secrete more insulin,
causing stimulation of fetal growth and increased birth weight.
Lag curve
• Fasting blood glucose is normal.
• Sharp rise within 30 minutes to one hour
• The blood glucose levels exceeds the renal threshold.
• The decline is rapid and the normal levels are attained back.
• Some of urine samples contain glucose, where the blood glucose is
above the renal threshold.
Causes of lag curve
• Hyperthyroidism
• Pregnancy
• After gastro-enterostomy
• Early diabetes mellitus
Laboratory profile of a patient
having lag curve
Intravenous GTT
• This test is done in patient with suspected malabsorption(Celiac
disease or enteropathies)
• Under these conditions oral glucose load is not possible and oral GTT
may not be conclusive.
• In the morning 25 g of glucose in 100 ml sterile distilled water given
as intravenous injection within 5 minutes.

• Completion of infusion is taken as 0 (zero) time.

• Blood samples are taken at 10 minutes interval for the next hour.

• Peak value reached within a few minutes (200-250 mg/dl)


• the value reaches 100 mg/dl by 40-60 minutes in normal person.
I/V Glucose tolerance test
Interpretation
• In normal individuals, blood glucose level returns to normal within 60
minutes.

• In diabetes decline is slow.


Mini or modern GTT
• As per current WHO recommendations, in mini or modern glucose
tolerance test, only two samples are collected.
• Fasting (zero hour) and 2 hour post glucose load.
• Urine sample are collected during same time.
• The diagnosis is made from the variations observed in these results.
Factors affecting GTT
• Carbohydrate starvation-There is rise in counter regulatory hormones ,
which show increased glucose tolerance.
Therefore , patient is advised to take carbohydrate-rich diet for 3 days
before test.

Hypothyroidism- A flat curve is obtained.


Thyroid hormone increases the absorption of glucose from gut.
• Acute infection –Cortisol is secreted , and so curve is elevated and
prolong.

• Liver diseases- Curve is elevated and prolong.

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