CLINICAL PATHOLOGY

DIABETES MELLITUS LAB WORK-UP

By: Dr. Vergara

Drugs
Insulin-receptor
abnormalities

Gestational Diabetes
DIABETES MELLITUS
o Diabetes that begin in pregnancy
Result from:
Abnormality in the production or the use of insulin HIGH RISK GROUPS WHO MUST BE TESTED FOR
o Deficient in B cells insulin production
DIABETES
o Relatively normal synthesis or abnormal
Symptomatic patients
release
Family history of diabetes
Extrapancreatic factors
Obesity
o Peripheral tissue cell receptor
o BMI: Male over 27/ Female over 25
dysfunction
o Central obesity

Resistance to the cellular

W/H ratio: Male over 0.9/

action of insulin
Female over 0.8
o Abnormalities of non-pancreatic
Hyperlipidemia
hormones
Non-healing ulcer

Affect insulin secretion or blood

Pulmonary TB
glucose metabolism
Recurrent infections
Women with bad obstetrical history
CATEGORIES OF DIABETES
Persons taking diabetogenic drugs
Type I
Type II
All persons over 40 y.o.
-Insulin dependent
-Non-insulin dependent
-Usually (but not
always) begins
relatively early in life
-More severe
-Require insulin for
management
-Show severe insulin
deficiency on blood
insulin assay

-Affect about 80% of

diabetics
-usually (but not always)
begin in middle age or
afterward
-Frequently associated
with
=overweight body status
=less severe blood
glucose abnormality

Diagnosis of diabetes is made by demonstrating

abnormally increased glucose values under
certain controlled conditions:
o Insulin deficiency is small

Abnormality is noted only when

unusually heavy carbohydrate
load is placed on the system
o Uncompensated insulin deficiency

Fasting glucose is abnormal

o Compensated insulin deficiency

Mask the defect

Do carbohydrate tolerance test

to unmask the defect

LABORATORY TESTS FOR DM

Type II DM
Demonstrate pancreatic islet cell malfunction
Treated by
o Blood insulin measurement
o Diet alone

Direct
o Oral medications

Technically difficult
o Small doses of insulin

Indirect
Insulin Resistance

End point:
o Significantly elevated or normal insulin
demonstrate action of
production but decreased in liver and
insulin on blood
peripheral tissue insulin
glucose
o Immunoassay method for insulin
2 OTHER CATEGORIES OF DM
Secondary Diabetes
measurement
o Associated with various non-idiopathic

Commercially available
conditions and syndromes that either

Has not proved to be more

Destroy pancreatic tissue

helpful than blood glucose
measurement

Pancreatitis
METHODS FOR BLOOD GLUCOSE ASSAY

Pancreatic CA
Specimen:

Hemochromatosis
WHOLE BLOOD

Produce abnormal glucose

o Preservative: Fluoride
tolerance (extrapancreatic)

Hormones

Each four of standing at room temp

blood glucose value decrease to about
10 mg/dL
o Hematocrit may accentuate glucose
decrease

Due to RBC metabolic act.

Low Hct (<35) produce higher

result

High Hct (>55) produce lower

result
PLASMA OR SERUM
o More stable than whole blood

Serum glucose value remain

stable for up to 24 hours at
room temp
o Separate from RBC before 2hrs
o Refrigeration assist in preservation
o Values considered 10-15% higher than
those of whole blood
o Used by most current automated
analyzers
o Venous blood is customarily used
o Capillary (arterial) blood

Values are about same as

venous blood when patient is
fasting

Non-fasting capillary blood

values are higher than venous
blood

Average: 1,6mmol/L
o

Uric acid
Ascorbic acid

FACTORS THAT AFFECT GLUCOSE ESTIMATION

Host Factors
Technical Factors

Diet

Time of day

Weight

Type of test

Age

Size of glucose

Sex
load

Physical activity

Type of blood

Illness/trauma
sample

Emotional status

Preservation of

Endocrinopathies
samples

Pregnancy

Method of

Drugs
analysis
SCREENING TEST FOR DIABETES

Widely used:
o Fasting blood glucose
o 2-hour post prandial blood glucose level
o Random

If fasting blood glucose is sufficiently elevated

o No need to do glucose tolerance test

Normal fasting blood glucose

o Not reliable in ruling out possible
diabetes

FASTING BLOOD GLUCOSE

Preferred method for diagnosis of DM

METHODS FOR BLOOD GLUCOSE DETERMINATION
o Easy to do
Non-specific reducing substance method
o Convenient
o Values: significantly above true glucose
o Less expensive
value

Normal:
70-100 mg/dL
o Examples:

Diagnostic
criteria of DM

Folin-wu manual method

o
FBS
140 mg/dL on at least 2 separate

Neocuproine SMA 12/60

occasions
automated method
o 200 mg/dL after 2-hours post prandial
o Interference

Hemolysis
RBS/CAUSAL PLASMA GLUCOSE

Protein precipitates

Blood sugar is tested without regard to time since

Not entirely specific for glucose
the person last meal
o Yield results fairly close to true glucose

Glucose level >200 mg/dL may indicate diabetes

value
o Test is repeated at a later time
o Example:
o Shows the similar result

Somogyi Nelson

Orthotoluidine
GLUCOSE TOLERANCE TEST

Ferricyanide

Provocative test
o Interference:

Not routinely used anymore

Serum bilirubin and lipids

Considered the gold standard for making a

Methods using enzymes
diagnosis of DM-II
o Specific for true glucose

Used during pregnancy to diagnose gestational

o Ideal
diabetes
o Examples;

Done when patient is suspected to have DM but

Glucose oxidase
with normal FBS

Hexokinase

Relatively large dose of glucose challenges the

o Interference
body homeostatic mechanism

Bilirubin

Patient must

Must not be used to diagnose diabetes

o Be in good health/ do not have any

Hyperglycemia can occur without glucose in urine

other illness

Urine glucose level may not correspond to

o Be normally active/ambulatory
prevailing blood glucose level
o Not taking medications that could affect
blood glucose
HbA1c

Oral contraceptives

AKA:

Steroids
o Glycated hemoglobin

Diuretics
o Glycohemoglobin

Anticonvulsants

Check the amount of glucose bound to

Normal result
hemoglobin
o After ingestion of test done a lag

Best way to check how well a person is

period occur -> blood glucose curve
controlling his/her diabetes
rises sharply to a peak (usually 15-60
o Gives an idea about glucose control
mins) -> curve then falls steadily but
over period of 8-12 weeks
more slowly -> reach normal level at 2

Normal: 4-6% of hemoglobin in blood has

hours -> reach fasting level at 3 hours
glucose bound to it

Glucose binds to hemoglobin in RBC at as

WHO criteria
steady rate
FBS
2 hours
Impression
Remarks

Can also help see risk of developing problems

PP
from DM
<100
<120
Normal
Retest annually
o E.g. Renal failure/ visual problems/
neuropathy
if indicated
o The lower the HbA1c the lower chance
<120
120-179
Impaired
Retest Annually
for problem to occur
GTT

No fasting required
<120
180
DM
Treat

May be done anytime during the day

Principle:
BEDSIDE PAPER STRIP METHOD
o Chromatography

Consist of a rapid quantitative paper strip

o Thiobarbitone colorimetric method

Portion of strip is impregnated with glucose

For NIDDM
oxidase plus a color reagent
o Measured at least 2x a year

One drop of sample placed on the reagent area

-> color that developed is compared to reference

For IDDM
color chart
o Measured at least 3x a year
o Electronic read-out meter improve
accuracy
Falsely elevated
Falsely low

Concensus: using finger stick capillary blood

Fructose rich diet

Pregnancy
o Values between 2.2-7.2 mmol/L usually

Hyperlipidemia

Anemia
agree within about +/- 15% value

Uremia

After BT
obtained by standard laboratory method

Elevated

Low

Uses:
temperature
temperatur
o Diagnose hypo/hyperglycemia in

Elevated
pH
e
comatose or seriously ill-persons

Low blood
o Provide guidance for patient selfadjustment of insulin dosage at home
pH
URINE SUGAR