1. Dr saurav singh

2.  Definition
 Classification
 Symptoms
 complications
 Investigations
 Fasting and post-prandial blood glucose
 GTT
 Urinary glucose testing
 Glycosylated Hb1Ac

3.  The term Diabetes mellitus describes a metabolic
disorder of multiple aetiology characterized by chronic
hyperglycaemia with disturbances of carbohydrate, fat
and protein metabolism resulting from defects in
insulin secretion, insulin action, or both.
 The effects of diabetes mellitus include long–term
damage, dysfunction and failure of various organs

4. Type 1 Diabetes
Type 2 Diabetes
- blood glucose levels rise due to
- Absolute deficiency of insulin due
to destruction of β cells of
pancreas .
- results in insulin dependence
- commonly detected before 30
1) Lack of insulin production
2) Insufficient insulin
action (resistant cells)
- commonly detected after 40
- effects > 90%
- eventually leads to β-cell failure
(resulting in insulin dependence)

5. Type 1
 Young age
 Normal BMI, not obese
 No immediate family
history
 Short duration of
symptoms (weeks)
 Can present with diabetic
coma (diabetic
ketoacidosis)
 Insulin required
Type 2
 Middle aged, elderly
 Usually overweight/obese
 Family history usual
 Symptoms may be present
for months/years
 Do not present with
diabetic coma
 Insulin not necessarily
required
 Previous diabetes in
pregnancy

6.  characteristic symptoms are increased thirst, polyuria,
blurring of vision, unexplained weight loss, fatigue
and recurrent infections such as candida.
 In its most severe forms, ketoacidosis or a non-ketotic
hyperosmolar state may develop and lead to stupor,
coma and, in absence of effective treatment, death.

7.  Short term:
 Symptoms of diabetes
 Dehydration
 Diabetic Coma
 Infections
 Long term:
 Kidney disease
 Eye disease
 Heart
 Circulation
 Amputation
 Nerve damage

8.  Diagnosis of Diabetes mellitus
 Screening of Diabetes mellitus
 Assessment of glycemic control
 Assesment of associated long term risks
 Management of acute metabolic complications

9.  The diagnosis of diabetes in an asymptomatic subject
should never be made on the basis of a single
abnormal blood glucose value.
 For the asymptomatic person, at least one additional
plasma/blood glucose test result with a value in the
diabetic range is essential, either fasting, from a
random (casual) sample, or from the oral glucose
tolerance test (OGTT)

10.  -Glucose may be estimated in either plasma or
whole blood.
 -The glucose concentration in whole blood is
approximately 15% lower than the glucose

concentration in serum or plasma, because the
volume of distribution of glucose is lower, as
erythrocytes contain less free water than plasma.
 -Samples for glucose can be obtained either by
veinpuncture or by a fingerprick technique
(collected in capillary tubes).

11.  -Blood cells continue to metabolize glucose after
veinpuncture and serum or plasma must be
refrigerated and separated from the cells within 1
hour to prevent substantial losses of glucose by the
cellular fraction.
 -A preservative that inhibits glycolysis should be
used (sodium fluoride, together with potassium
oxalate as an anticoagulant, is used for this
purpose).

12. 
Fasting Plasma Glucose Test (FPG)
Fasting morning blood glucose is the best initial test.
It is a cheap and fast test done after 10-16 hrs of
fasting.
* fasting B.G.L. 100-125 mg/dl signals pre-diabetes
* >126 mg/dl signals diabetes

13.  -The two-hour postprandial glucose measurement is
often used in conjunction with the fasting plasma
glucose.
 -The patient is advised to consume a meal that
contains approximately 75 grams of
carbohydrates.

14.  -Two hours after eating, a blood sample is drawn for
plasma glucose measurement.
 -A glucose value greater than 200 mg/ dl indicates
diabetes mellitus.

15.  -The OGTT is the most sensitive test for the diagnosis
of diabetes.
 It refers to the ability of the body to metabolize
glucose.
 -A sample of the patient's blood is drawn after an over
night fast.
 -The patient then consumes 75g of a glucose solution
and blood is drawn every 30 minutes for two hours.

16.  Impaired glucose tolerance is diagnosed with a plasma
glucose between 140 and 200 mg/dL (7.8 and 11.1
mmo1/L) at 2 hours time point in the test ( prediabetes)
 A plasma glucose greater than or equal to 200 mg/dL
(11.1 mmol/L) at the 2-hour
time point indicates diabetes mellitus.

17.  Gestational diabetes is considered present when the
values of the OGTT are greater than the following;
 fasting, 105 mg/dL (5.8 mmo1/L)
 1 h, 190 mg/dl (10.6 mmo1/L)
 2 h, 165 mg/dL (9.2 mmo1/L)

18. Test
Normal
Prediabetes
Diabetes
FBG
< 100
100-125
(IFG)
>125
< 140
140-199
(IGT)
≥ 200
(mg/dl)
OGTT –
2hr result
(mg/dl)

19.  If serum glucose level exceeds the renal glucose
threshold (180 mg/dl), it appears in urine
(GLUCOSURIA) as in diabetes mellitus.
 Glucose can be detected in urine using the specific test
strips that contain glucoseoxidase, peroxidase, and a chromagen.
 -Other carbohydrates using Benedict's and Fehling's
reagents.

21.  HbA1c is the largest subfraction of normal HbA in both
diabetic and non-diabetic subjects and is formed by the
reaction of the-beta chain of HbA with glucose.
 This fraction reflects the concentration of glucose
present in the body over a prolonged time period.
 The measurement of glycated haemoglobin therefore
gives an indication of the overall degree of blood
glycaemic control, in contrast to glucose measurements
which give information for a single time-point.

22.  HgA1C is therefore the gold standard test
 All treatment decisions for Type 2 Diabetics
should be based on Hb A1C levels
 There appears to be a direct relationship between
cardiovascular risk and HbA1C.
 The goal is to achieve an HbA1C as low as possible,
preferably less than 7.0%, without causing
unacceptable hypoglycaemia.
 HbA1C > 8 mmol/L is a sign of inadequate control
for most people

23.  HgA1C < 6% - normal.
 HgA1C < 7% - goal.
 HgA1C 7.0 - 7.5% - good control.
 HgA1C > 7.5% - additional therapy