Criteria for Diagnosis of DM to other types of DM

Question 1

Requested during insulin shock and hyperglycemic ketonic coma

Answer 1

Random Plasma Glucose/ Random Blood
Sugar/RBS

Question 2

Reference value for RBS

Answer 2

<160 mg/dL

Question 3

T/F: If RBS is ≥160 mg/dL → perform FBS/ HbA1c/ 2-hr OGTT for confirmation

Answer 3

TRUE

Question 4

Measure of overall glucose homeostasis
It is affected by Diurnal Variation (higher in the morning than in the afternoon)

Answer 4

Fasting Plasma Glucose

Question 5

Reference value for FPG

Answer 5

70-99 mg/dL

Question 6

If FBG is done in the afternoon, the result will

Answer 6

falsely decrease

Question 7

FBG increase with age for how many per decade?

Answer 7

2mg/dL (per decade)

Question 8

o Uses standardized Glucose Load (75g equivalent complete meal)
o After the 2-hour after meal, the patient must not eat anything

Answer 8

2nd hour Post Prandial Blood Glucose

Question 9

Reference value for 2hr Post prandial Glucose

Answer 9

60-140 mg/dL

Question 10

Diabetic value for 2hr PPG

Answer 10

≥200 mg/dL

Question 11

2hr PPG increase with age for how many mg per decade

Answer 11

4 mg

Question 12

Called “glycosylated/glycated” because glucose is non-enzymatically attached to one or both beta chain of the hemoglobin

Answer 12

Glycosylated (Glycated) Hemoglobin (HbA1c)

Question 13

• referred test to assess long-term glycemic control
• Reflects the average glucose level over the past 2-3 months

Answer 13

Glycosylated (Glycated) Hemoglobin (HbA1c)

Question 14

Decrease RBC life span in hemolytic anemia or hemoglobinopathies will cause

Answer 14

False decrease HbA1c

Question 15

Substitute test for patient with hemolytic anemia and hemoglobinopathies

Answer 15

Fructosamine

Question 16

Reference value: HbA1C

Answer 16

Adult: 4.0-6.0 % (American Diabetes Association: <5.7%) ▪ Pediatrics:<7.5%

Question 17

Diabetic value for HbA1C

Answer 17

≥6.5%

Question 18

Prediabetes value for HbA1c

Answer 18

5.7-6.4%(normal but at risk)

Question 19

• Most widely used to assess short-term glycemic control (3-6 weeks)
• Specimen: Serum with or without fasting

Answer 19

Fructosamine/Glycosylated/Glycated albumin/Plasma Protein Ketoamine

Question 20

Methods used for fructosamine

Answer 20

HPLC, Affinity chromatography, photometric assay

Question 21

Interference for fructosamine

Answer 21

High uric acid, triglyceride and bilirubin levels, heparin, hemolysis

Question 22

You cannot perform this if the patient has
hypoalbuminemia (albumin less than or equal 30 g/dL because

Answer 22

It will cause false decrease fructosamine

Question 23

Reference value for Fructosamine

Answer 23

205-285 umol/L

Question 24

• It is used to determine how well the body metabolizes glucose over a required period of time
• Recommended for diagnosis of GDM
  Not routinely performed in patient with DM

Answer 24

Glucose Tolerance Test (Multiple Sugar test)

Question 25

Recommended method for Non-pregnant patients

Answer 25

Oral Glucose Tolerance Test

Question 26

Reference value for OGTT

Answer 26

2hr - 60-140 mg/dL

Question 27

Diabetic value for OGTT

Answer 27

2hr, ≥ 200 mg/dL

Question 28

Value of impaired glucose tolerance for OGTT

Answer 28

140-199 mg/dL

Question 29

Requirement for OGTT

Answer 29

- Patient should be ambulatory/able to walk (the only test in clinical chemistry that requires ambulatory patient and not performed on bedridden patients) - Unrestricted diet of 150g carbohydrate/day for 3 days prior to test - Restrictions: Exercise, food intake, drinking (only water), smoking - Fasting for at least 10 hours - Must be performed in the morning

Question 30

Smoking and alcohol can __ blood glucose

Answer 30

Increase

Question 31

Glucose load standards

Answer 31

▪ 75 grams – WHO standard glucose load ▪ 100grams–pregnant; as requested ▪ 1.75 grams of glucose/KBW - children (max. 75g)

Question 32

- Performed on patients with gastrointestinal disorders (malabsorption syndrome) - Glucose load: 0.5 g/KBW (administer within 3 mins)

Answer 32

Intravenous Glucose Tolerance Test

Question 33

Janney-Isaacson Method also known as

Answer 33

Single-Dose method

Question 34

Steps for Janney-Isaacson Method

Answer 34

Steps: a. Extract first blood sample (FBS) b. Administer standard glucose load (75g) c. Collect 1 hour, 2 hour, and 3 hour blood samples after glucose loading - Total of 4 blood samples (including FBS) d. Patient is not allowed to eat before collecting all four blood samples (he or she can only after collection of the 3 hour blood sample)

Question 35

Called double-dose because it uses 100g glucose load then, divide into 2

Answer 35

Exton Rose Method (Double-Dose/Divided Oral Dose Method)

Question 36

Exton Rose Method (Double-Dose/Divided Oral Dose Method) steps

Answer 36

- Extract first blood sample (FBS) - Administer 1st half of the glucose load (50g) - Collect blood sample; 30 minutes after the first glucose load Administer remaining 2nd half of glucose load (50g) - Collect blood again 30 minutes after the 2nd glucose load - Total of 3 blood samples including FBS

Question 37

- Recommended by International Association of Diabetes and Pregnant Study Groups (IADPSG) - Type of OGTT performed among pregnant women 24-28 weeks age of gestation who are not previously diagnosed with diabetes mellitus (can be used as screening method)

Answer 37

One-step Method

Question 38

In one step method, this is the ff criteria to diagnose GDM

Answer 38

Patient has GDM if one of the following criteria is met: o FBS: ≥92 mg/dL o 1hr: ≥180 mg/dL o 2nd hr: ≥153 mg/dL

Question 39

Recommended by the National Institute of Health (NIH)

Answer 39

Two-step method

Question 40

In two-step method, this criteria is used fi diagnose GDM

Answer 40

Patient has GDM if the patient met 2 out of 4 criteria ▪ FBS:>95mg/dL ▪ 1st hour: ≥180 mg/dL ▪ 2nd hour: ≥155 mg/dL ▪ 3rd hour: ≥140 mg/dL

Question 41

Removal of pancreas or any disorder can alter the normal production of insulin which may lead to hyperglycemia then, Type 1 DM

Answer 41

Pancreatic Disorders/Pancreatectomy

Question 42

Increase cortisol

Answer 42

Cushing’s Syndrome

Question 43

Increased catecholamines

Answer 43

Pheochromocytoma

Question 44

Increased in Growth hormones

Answer 44

Acromegaly

Question 45

Increase in Thyroid hormone (T3 and T4)

Answer 45

Hyperthyroidism

Question 46

Drugs or chemical inducer of Beta Cell dysfunction

Answer 46

- Dilantin - Pentamidine

Question 47

Drugs or chemical causing impairment of Insulin action

Answer 47

- Thiazides - Glucocorticoids

Question 48

It can cause Type 1 DM due to immune defect

Answer 48

Down Syndrome (Trisomy 21)

Question 49

Causes immune defect

Answer 49

Klinefelter’s (XXY)

Question 50

Shows severe insulin resistance – Type 2 DM

Answer 50

Rabson-Mendengall and Leprechaunism

Question 51

Death of brain cells Causes DM

Answer 51

Huntington’s chorea

Question 52

- Occurs among females - Partial or complete depletion of one X chromosomes

Answer 52

Turner’s Syndrome