Understanding Hyperglycemia: Causes, Tests, and Indicators

1. WAAD ALOTIBI 311200661

2. Hyprerglycemia • It is the rise of blood glucose • Level above 140 • Causes • Insulin in: • Diabetes mellitus (commonest cause) surgical pancreatectomy • (removalof pancreas) • Streptozotcin injection that destroy b-cells pancreatitis and pancreatic cancer

3. Increas Anti-insulin hormones: • 1-ACTH and glucocorticoids: as in adrenal cortical tumors and cushing’s syndrome (b c reduce senstivity of tissues (me adipose tissue) to the offect of insulin on glucose uptake and utilization + rate of gluconeogensis) • 2-Adrenaline :as in emotionsstress and pheochromocytomaglycogenolysis in ms&liver+lipolvsis+inhibit insulin secretion) • 3-TSHandthyroxine as in hyperthyroidism(b c thyroid H has diabetogenic action ( absorption of gluconse+gluconeogensis) • 4- Pituitary growth hormone : as in acromegaly (b c chronic administrationofGH> glucose uptake in ms +fat tissue glucose > production by liver > insulin secrtion>>exhaustion of B cell ) • Dietary or alimentary high cardohydrate diet rich in simpl sugars drug-induced e g chronic use of corticosteroids

4. 1-fasting blood glucose(fbs) level: • Normal:70-110mg/dl • Dm:>= 126mg/dl [%] on at least two occasion s • Impiared fasting glucose: fasting glucose(110-125)mg/dl • A risk factor for future diabetes • Normal:<180mg/dl • Dm: >200mg/dl in more than one occasion 2-random blood glucose level(RBS):

5. 3-two hour postprandial test(PPS) • Normal:<140mg/dl • Dm:>200mg/dl even at one occasion

6. 4-the oral glucose tolerance test: • It measures the ability of body to utilize oral glucose dose • Measuring FBS [aftar 8-12h fasting ] and blood • Glucose levels five times (every 30 min) over a period of 3 hours after ingestion of 75 grams glucose [1-1.5 gm/dl]of glucose. Urineis also collected and glucose is estimated

7. A- normal response • Normal FBS [70-110mg/dl] • Peak within 1h [not> renal threeshold [180mg/dl] • The normal FBS isreached after 2-2.5 h [<140mg/dl] • No glucose or KB inany urine specimen • In renal glycosuria,OGTT is normal

8. B-impaired glucse tolerance [IGT} • FBS is >110 and <126 • 2-hour glucose is >=140 but <200mg/dl • This is also considereda risk factor for future diabetes

9. C- gestational diabetes : • A pregnant woman has any two of the dfollowing • AFBS>110mg/dl • A1-hour glucose level< ;190mg/dl • A2 hour glucose level <;165mg/dl • Or a 3hour glucose level of< ;145mg/dl

10. D- diabetic GTT: • FBG>=126mg/dl • The peak is >180mg/dl • FBG is not reached after 2-3h[200mg/dl] • Urine samples Always+ve for glucose whil • KB are+ve or –ve depending on the condition

11. E-lag curve • Normal FBS peak aftar 0.5-1 h and is 180mg/dl returns to normal aftar 2-2 5h. As in alimentary glucosuria

13. 5.measurement of glucose in urine • Easy inexpensive rabid and noninvasive • below renal threshold 180mg/dl • HBA1c will tell ehat the diabetic’s blood sugar levels have been running for the past 2-3 months [life span of RBCs • normal HB A1c is 4-6,5 6-measurement of glycoseylated hemoglobin glycatedhb or hb a1c

14. 7- measurement of serum fructosamine: • Condensation product of glucose with serum albumin • Estimate plasma glucose levels over (2-3 weeks) (half life of alb ) • Normal range (205-285 mmol/l)

15. 8- measurement of ketone bodies : • Detection in serum and urine : using (nitroprusside test ) acetone or acetoacetate nitroprusside to from violet color) • Acetest tablets or ketostix (strips) • : • It is an indicator of B-cell function and insulin secetory capacity in diabetic patients on insulin (doesnot cross react with exogenous insulin) • -C-peptide is 0,9-4,2 ng/ml • Normal serum insulin 29-181 pm/l 9- measurement of c-peptide 10- measurement of insulin : by ELIZA

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