ClinPathLab_Glucose kristindayan

GLUCOSE DETERMINATION Dr. Christine Ayochok 7 January 2014 Important in the diagnosis of diabetes mellitus and monitoring of diabetes; and in emergency cases as in hypoglycemia Preferred specimen : venous blood (capillary blood can also be used) Do not allow the specimen to stand more than 1 hour in room temperature Gray tube: contains sodium fluoride; ideal anticoagulant If the patient is fasting, the capillary and venous approximates each other o Higher capillary glucose if not fasting o B. Enzymatic methods: approximate true glucose value (more reliable) 1. Glucose oxidase method: the one performed in the lab o o Dye: read in the spectrophotometer Causes of falsely decreased values: o o 2. Vitamin C Bilirubin >15 mg/dL Uric acid >50 mg/dL ASA Hydralazine INH Acetaminophen

Causes of falsely increased values:

Specimens
a) b) Whole blood Capillary blood Emergency measures of blood Suspicion of hypo/hyperglycemia Also used for sugar monitoring

Advise the patient to stop the medications for a week before the examination Produces red/pink color: directly proportional to the glucose concentration (the darker the color: higher glucose in the blood)

Hexokinase method o NADPH: spectrophotometer

Standing at room temperature Whole blood: decreased in glucose 10mg/dl/hr o o Accentuated by increased hematocrit value (>55%) Fluoride: best preservative

Principle of the test:

Glucose-Oxidase Method D-glucose to D-glucono-6-lactone + 2H2O2 (glucose oxidase + oxygen) H2O2 + 4-aminophenazone + p-hydroxybenzoate = red dye o Enyme: peroxidase Read at 510 nm Reference Range: 70-105 mg/dl

Plasma and serum: more stable than whole blood Venous blood: routinely used Capillary blood: o o Same w/ venous blood when patient fasting Non-fasting: 30 mg/dl higher than venous blood

Other Tests for Glucose Determination (based on the specimen use)d

1. 2. 3. 4. 5. 6. CBG (Capillary Blood Glucose) OGTT (Oral Glucose Tolerance Test) FBS (Fasting Blood Sugar)* RBS (Random Blood Sugar)* HbA1c (Glycosylated Hemogblobin)* 2-hour post-prandial test (2PPBS)*

METHODS FOR GLUCOSE DETERMINATION A. Reducing substance methods: oldest methods: values measured is above the actual value of sugar 1. 2. Folin-Wu Neocuproine Somgyi-Nelson: fairly close value

ClinPathLab_Glucose kristindayan
Diagnosis of Diabetes Mellitus: *FBS: >126 mg/dl + Elicit symptoms of DM (7 mmol/L) *RBS : > 200 mg/dl + signs and symptoms (11.1 mmol/ L) *2 hour post prandial: >200 mg/dl after a 75 gm glucose load with s/s HbA1c: > 6.5% (48mmol/mol)

ALGORITHM FOR DIAGNOSIS DIABETES MELLITUS: A. RBS B. FBS <110 mg/dl: Normal <126: request for 2 PPBS 110-125 mg/dl: IFG (Impaired Fasting Glucose): request for 2 hour Post prandial and label accordingly >126 mg/dl: repeat test after 1 week observation for diagnosis DM (do not rely in one abnormal result) Classic Symptoms of Diabetes Mellitus Polydipsia Polyuria Polyphagia Unexplained weight loss <140 mg/dl: Normal <200 mg/dl: request for 2 Hour post prandial test and label accordingly 140-199 mg/dl: IGT (Impaired Glucose tolerance) >200 mg/dl: diagnose Diabetes mellitus