Thursday, November 15, 2012

BIOCHEMICAL MEASUREMENTS IN DIABETES MELLITUS


FOR DIAGNOSIS

PRECLINICAL (screening)

·         Immunological markers – ICA, IAA, GAD, Protein tyrosine phosphatase antibodies (IA-2)
·         Genetic markers – (HLA)
·         Insulin secretion – fasting, pulse, response to glucose challenge
·         Blood glucose

ADA recommends screening of first degree relatives of patients with type 1 diabetes by measuring immune related markers (autoantibodies) to protract the clinical outcome by giving immune intervention.

ADA also advocates screening in all asymptomatic individuals over the age of 45 years for development of type 2 diabetes. Screening should be performed particularly in overweight individuals by FPG. If results are less than 110 mg/dL testing should be repeated at 3 year intervals. Testing may be considered at a younger age or be carried out more frequently in individuals at increased risk of diabetes. For high risk groups testing should be done every 2 years starting at 10 years of age. Rationale for screening is that about 33% of individuals with type 2 diabetes are undiagnosed.

CLINICAL

·         Blood glucose
·         OGTT
·         Ketone (urine and blood)
·         Other (e.g. insulin, C-peptide and stimulation tests)
These tests are done to diagnose diabetes and classification after onset of clinical outcome.

FOR MANAGEMENT

ACUTE

·         Glucose (blood, urine)
·         Ketone (blood, urine)
·         Acid-base status (pH, bicarbonate)
·         Lactate

CHRONIC

·         Glucose (blood, urine)
·         Glycated protein (GHb, Fructosamine)
·         Urinary protein (UAE, microalbuminuria, proteinuria)
·         Evaluation of complications (e.g. creatinine, cholesterol, and Tg)
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