Tip 14-B on diabetes :- How
best to interpret results of laboratory
tests remember to verify the following :
i)
Is it
true glucose estimation or sugar
estimation Clue :-The latter
(sugar) method gives 10-15%
higher values.
ii)
Is it a plasma value or whole blood
value? Clue :-Whole
blood glucose values
are lower by about 20%
Tip 15 on diabetes:-- Is it capillary glucose value or venous
glucose value ? Clue :-While
there is no difference in the fasting state between
the two methods post prandial values are higher
in capillary blood as compared to
venous blood. 7:-What wrong Treatment (over treatement) can ensue by us in cases of IGT?? Ans:-Not to
prescribe very strict diet & Metformin in men or woman with IGT !!! Clue :- It is not uncommon to see an IGT patient recently and wrongly
diagnosed as a diabetic and put
on a stiff dose of
sulphonylura to preset with OAD induced
repeated hypoglycemia as the
presenting symptoms
iii)
Tip 15 on diabetes:--:--:-Diagnosis of Gestational diabetes mellitus
Historically criteria for the diagnosis of GDM have always been intensely debated
and more than one school of
thoughts has always existed. We
will bypass the details of these k debates
and rationales put forward by the various schools of thoughts
and follow the 2010 recommendations of International Association of Diabetes and Pregnancy Study Groups Which were adopted by American Diabetes in 2011
There are : Diagnosis k of GDM in Pregnancy Threshold values
GDM = one or more
values > threshold
In addition to the abovementioned method of diagnosis of GDM , WHO definition is also commonly followed in our country . As per WHO
, GDM id diagnosed when 2 hours
post 75 g glucose challenge
plasma equals or exceeds 140 mg%
Tip 16 : Know about DM from these
posts & treat your pt by your own
skill & wisdom:-Tr on diabetes:--:-How to test urine glucose? Does it
furnish any new in formations to us?? Limitations of urine glucose estimation
As regards urine glucose
estimation. It should never be
solely relied upon for diagnosis of
diabetes. It can only be used for getting a very rough idea of control on a day
to day basis provided the patient or his physician interpreting the results is thoroughly conversant with limitations and
pitfalls.
While doing urine
tests observe the following
a)
Use the dry
strip method which is specific for glucose instead of Benedict’s
test which gives many false
positive results.
In order to reduce the cost by
50% cut the test strip vertically
in two equal halves
b)
Ask
the patient to complet4ely empty the
bladder 15 minutes before the time of
urine estimation so that when the second
sample is collected for estimation
freshly formed urine is obtained
. Such urine glucose estimation will
give a more realistic idea about the spot blood
glucose value.
In many diabetics glucose is invariably spilled over in urine during the post prandial period but they can still have
a normal fasting blood glucose
and absence of urine glucose
in fasting state. However in
such patients urine voided first thing in the morning is actually
a mixture of urine formed
over several hours overnight and
hence it can show glycosuria even though
urine actually formed in the
morning does not contain glucose. Hence it is
important to always collect freshly voided urine for glucose
estimation .
: Tip 16 : Know about DM
from these posts & treat your pt by
your own skill & wisdom:-Tr on
diabetes:--:-How
to test urine glucose? Does it furnish any new in formations to us??
Limitations of urine glucose estimation
As regards urine glucose
estimation. It should never be
solely relied upon for diagnosis of
diabetes. It can only be used for getting a very rough idea of control on a day
to day basis provided the patient or his physician interpreting the results is thoroughly conversant with limitations and
pitfalls.
While doing urine
tests observe the following
c)
Use the dry
strip method which is specific for glucose instead of Benedict’s
test which gives many false
positive results.
In order to reduce the cost by
50% cut the test strip vertically
in two equal halves
d)
Ask
the patient to complet4ely empty the
bladder 15 minutes before the time of
urine estimation so that when the second
sample is collected for estimation
freshly formed urine is obtained
. Such urine glucose estimation will
give a more realistic idea about the spot blood
glucose value.
In many diabetics glucose is invariably spilled over in urine during the post prandial period but they can still have
a normal fasting blood glucose
and absence of urine glucose
in fasting state. However in
such patients urine voided first thing in the morning is actually
a mixture of urine formed
over several hours overnight and
hence it can show glycosuria even though
urine actually formed in the
morning does not contain glucose. Hence it is
important to always collect freshly voided urine for glucose
estimation .
examine glucose and ketones in
urine.
Tip 19 on diabetes –What are the usual investigations in diabetics and
suspected diabetics??? :
For the diagnosis of diabetes one should order Fasting and
Post 75 gm glucose challenge venous plasma
glucose . GTT is usually not required. One should order fasting
and post glucose challenge
blood glucose tests
in the following situations:
a)
Those having symptoms of diabetes
b)
Those
having tuberculosis peripheral
neuropathy hypertension coronary
artery disease cerebro
vascular disease peripheral vascular disease eczema premature cataract etc
c)
As a pre operative check up
d)
Those
above 40 years as part of a routine medical
checkup
These tests shou
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