Endocrinology practical

• Strict criteria by WHO and national diabetic associations for diagnosing diabetes include symptoms like polyuria, polydipsia, polyphagia, and unexplained weight loss for type I, along with specific glucose concentration levels
• For diagnosis, criteria include:

  • Random venous plasma glucose concentration > 11.1 mmol/l
  • Fasting plasma glucose concentration > 7.0 mmol/l (126 mg/100 ml)
  • Plasma glucose concentration > 11.1 mmol/l at 2 hrs after 75g anhydrous glucose in an oral glucose tolerance test (OGTT)
• Oral Glucose Tolerance Test (OGTT) is used for subjects with or without diabetic symptoms who cannot be classified by the above criteria
• Impaired Glucose Tolerance (IGT) is diagnosed if plasma glucose is < 11 but > 7.8 mmol/l after OGTT
• Hyperinsulinemia can be caused by food with a high glycemic index
• Screening for diabetes as an adult is relevant for those with risk factors like family history of diabetes, high BMI, sedentary lifestyle, hypertension, dyslipidemia, history of gestational diabetes, or at-risk ethnicity
• People with prediabetes should be tested yearly, and those diagnosed with gestational diabetes should have lifelong testing at least every 3 years
• Impaired fasting glucose is diagnosed when glucose levels are between 100 to 125 mg/dL in fasting patients
• An oral glucose tolerance test is unnecessary for diagnosis if fasting plasma glucose is confirmed to be in the diabetic range on two occasions
• OGTT is a good predictor for future cardiovascular complications, especially for those diagnosed only on OGTT with normal fasting glucose
• OGTT is essential for diagnosing gestational diabetes and can significantly increase the detection rate of diabetes in some populations
• Abnormal glucose metabolism was detected in a higher percentage of patients by OGTT compared to FPG testing
• HbA1C glycosylation level is used as a measure of glycemic control in established diabetes, reflecting the average blood glucose levels over the past 3 months
• Every 1.0% absolute decrease in HbA1c leads to specific decreases in end-points related to diabetes, all-cause mortality, myocardial infarction, and micro-vascular complications
• Lifestyle interventions, sometimes with metformin for cardiovascular protection, are recommended steps for managing diabetes based on HbA1c levels
• For Type II Diabetes therapy:

  • Step 3: If HbA1c ≥6.5%, add Insulin. If not suitable, consider sitagliptin, glitazone, or exenatide/liraglutide.
  • Step 4: If HbA1c ≥7.5%, intensify insulin regimen. If not suitable, add insulin if not already on it or consider adding Glitazone.
  • Step 5: If HbA1c ≥7.5%, the target HbA1c is <6.5% at steps 1–3 but 7.5 at steps 4 & 5. Insulin is ADDED to current oral therapy, and does not replace it
• Blood glucose finger prick test:

  • Wash hands
  • Insert a test strip into the glucose meter
  • Prick the side of the fingertip to get a drop of blood
  • Touch and hold the edge of the test strip against the drop of blood and wait for the result
• Factors affecting finger stick blood glucose tests:

  • Temperature, humidity, and elevation
  • Testing site location, such as fingertip vs. forearm
  • Expired or damaged test strips
  • Residue on unwashed fingers
  • Insufficient blood drop
• Insufficient Blood Drop:

  • Potential Causes: cold hands, poor circulation, shallow lancing depth, fine lancet gauge, reusing a lancet
  • Solutions: warm hands under warm water, let hand hang down to improve circulation, adjust lancing device settings, experiment with different lancet gauges, use a new lancet each time
• Target blood glucose ranges:

  • Child with type 1 diabetes: 4 to 7mmol/l when waking up and before meals, 5 to 9mmol/l after meals
  • Adult with type 1 diabetes: 5 to 7mmol/l when waking up and before meals, 4 to 7mmol/l before meals at other times, 5-9mmol/l after meals
  • Type 2 diabetes: 4 to 7mmol/l before meals, less than 8.5mmol/l two hours after meals