LABORATORY EXAMINATIONS in DIABETES

MELLITUS
1.DEFINITION:
Diabetes mellitus (DM) is a chronic disease that characterized by changes in the
metabolism of each of the major body fuels/ source of energy (carbohydrate, fat
and protein) and is associated by disturbances of a variety of hormones.
2.CLASSIFICATION of DM
2a. DM type 1 (T1DM): Autoimmune process that selectively destroys
pancreatic beta cells; T cell mediated process, with unknown antigenic
stimuli lack of insulin
2b. DM type 2 (T2DM): carbohydrate intolerance as cardinal feature
Insulin resistance or insulin deficeny although sometimes
hyperinsulinism can be found ; 95% of DM case
2c.Gestational DM: DM in pregnancy
2d. Other specific type of DM: drug or chemical-induced forms of diabetes
3.CLINICAL SIGNS & SYMPTOMS:
Polyuria, nocturia, polydipsia, polyphagia,fatigue, weight changes,
blurredvision, extremity pain, sexual dysfuntcion, nephropathy, neuropathy, foot
ulceration (gangrene diabetic foot), joint problem
4.DIAGNOSIS of DM
4a.Screening
Screening for T1DM is not recommended;
Screening for T2DM : checking FBG begin at age 45, especially in people
with BMI 25
Screening for GDM: High risk women : FBG > 85 mg/dL should be followed
by 75 gram OGTT
4b.Confirmatory tests
When FBG 100 125 mg/dL OGTT
c-peptide test
5.FOLLOW UP TESTS
5a.Effectiveness of therapy/ management: Fasting blood glucose, HbA1c
(glycosylated Hb), Lipid profile (total cholesterol, HDL,LDL, triglyceride),

5b.Early detection of complications:

serum creatinine, microalbuminuria (microalbumin/creatinine ratio), ECG
5c.Self monitoring blood glucose (SMBG) at least 4 times/day:
6.INTERFERING FACTORS:

Falsely high : dextrose IV-infusion, steroids, stress, infection, caffeine,

nicotine, -blockers, adrenal gland infection, total parenteral nutrition
(TPN), diuretics, estrogen, phenytoin

Falsely low : insulin, alcohol, anabolic steroids, OAD

7.SPECIFIC CONDITIONS:
a.Diabetic ketoacidosis
b.Coma hyperglycemia: hyperosmolar
c.Coma hyperglycemia, ketoacidosis
d.Coma hypoglycemia

HbA1c
Good DM control

2,5-6,0%

Fair DM control
Poor DM control

HbA1-total
< 7,5%

6,1-8,0%
> 8%

7,6-9,0%

> 9%