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1 1 Lab 1: Diabetes Reading 13 th Edition Hole s Diabetes Clinical Application & From Science To Technology (pages ) Table Appendix C (pages ) Objectives 1. To define diabetes mellitus. 2. To interpret glucose results to diagnosis if a person has diabetes 3. To determine the best way to treat a patient with diabetes 4. To be able to graph in an Excel program Introduction Diabetes mellitus is defined by Taber s Medical Dictionary as a disorder of carbohydrate metabolism, characterized by hyperglycemia and glycosuria and resulting from inadequate production or utilization of insulin. (Venes 2001). Hyperglycemia refers to high blood glucose levels and glycouria refers to glucose in the urine. The systems include: Polyuria, excessive urine production, polydipsia, increased thirst polyphagia, increased hunger and food intake and fatigue Since every system needs glucose to function diabetes directly affects every physiological system. It can lead to everything from: Cardiovascular disease Seizures and coma Hypertension Stroke Renal failure Neuropathy Foot problems Skin conditions Retinopathy There are 3 primary types of diabetes. Type I results from the destruction of the insulin producing beta (β) cells in the isles of Langerhan (pancreatic isles) of the pancreas. Type II results from insulin resistance at the target cells. Basically the individual produces insulin, although maybe not enough, but the problem occurs at the insulin receptors. Gestational (type IV) diabetes occurs during pregnancy also affect the insulin receptors. It is also a problem with insulin resistance at the target cells. Unlike type I and II gestational diabetes is not a life-long condition. It stops as soon as the pregnancy ends. There are a variety of other types that we will not go into here. For instance Type III may be the cause of Alzheimer s. The lecture material covers these in more depth. Insulin levels will vary without treatment. In type I the patient is not producing insulin because of a problem with the beta (β) cells; as a result they will have very low

2 2 insulin levels. In type II and gestational the patient is producing insulin that is not working so the feedback mechanism will result in the increasing levels of insulin. They will actually have high levels of insulin however, eventually the beta cells may burn out and the patient may need insulin. A diagnosis of diabetes is made through several tests that measure blood glucose level. The first is fasting plasma glucose that is taken after an 8 hour fast. A person with diabetes will have a high fasting plasma glucose level. The oral glucose tolerance test that involves several measurements that occur before and after an individual drinks a high glucose drink. A base line blood sample is taken and additional samples are taken either every 30 minutes or every hour after the individual has completed the solution. A person without diabetes will have a spike in glucose level that will drop back down. A person with diabetes will have a spike that does not lower over time. A random blood glucose test is given to a person with diabetic symptoms. A high blood glucose level will lead to additional testing. Hemoglobin A1C measures the level of glycogen that coats the hemoglobin. Students confuse this with a hemoglobin test for anemia. This is not measuring the quantity of hemoglobin as much as it measuring the quality of the hemoglobin. It is a test that is given to measure how well a person with diabetes is managing their condition. The following tables indicate what the results of the tests mean. Measurements are made in milligrams of glucose per deciliter of plasma. A deciliter = 100 milliters. It is also measured in millimoles per liter. A mole is a chemical measure of concentration that is based on the atomic mass of the molecule. A millimole is one-one thousandth of a mole. Make sure that any number you use is followed by a unit. A unit refers to the unit of measure. Writing down 10 means nothing. As you can see from the first chart 10 mmol/l means that a person has hyperglycemia (high blood sugar) and they have diabetes. However 10 mg/dl means the person has severe hypoglycemia (low blood sugar) and is probably in a coma. The type of test also matters. A morning fasting blood glucose is expected to be lower. Look at the first 2 tables. The morning fasting normal number is between 70 to 99 mg/dl however the normal result of the oral glucose test is 140 mg/dl. According to the morning fasting blood glucose test 140 mg/dl means the person has diabetes. So pay attention to the test that is performed. Fasting Glucose Ranges From 70 to 99 mg/dl, or 3.9 to 5.5. mmol/l From 100 to 125 mg/dl, or 5.6 to 6.9 mmol/l 126 mg/dl or higher, or 7.0 or higher Morning Fasting Blood Glucose Normal glucose tolerance, not diabetic Impaired fasting glucose (IGF) or Pre-diabetes Diabetes

3 3 Oral Glucose Tolerance Test Ranges (except during pregnancy) 2 Hours after drinking 75 grams of glucose Less than 140 mg/dl, or 7.8 mmol/l From 140 to 200 mg/dl, or 7.8 to 11.1 mmol/l Over 200 mg/dl, or 11.1 or higher on more than one occasion Normal glucose tolerance, not diabetic Impaired glucose tolerance (IGT), or Pre-diabetes Diabetes Oral Glucose Tolerance Test Normal Ranges 75-gram oral glucose tolerance test Time Fasting for before glucose load Range mg/dl 1 hour less than 200 mg/dl 2 hour less than 140 mg/dl ( mg/dl is "prediabetes" and a glucose level of 200 mg/dl or higher is a sign of diabetes.) 3 hour less than 130 mg/dl Gestational Diabetes Screening: Glucose Challenge Test (during pregnancy) 1 Hour after drinking 50 grams of glucose Less than 140* mg/dl 140 mg/dl or, (1) 7.8 mmol/l or higher Normal glucose tolerance Abnormally elevated, woman needs an Oral Glucose Tolerance Test (OGTT) Gestational Diabetes Diagnostics Guidelines Oral Glucose Tolerance Test During Pregnancy) Time after glucose load (after drinking 100 grams of glucose) Fasting (before glucose load) Normal Ranges (1) 95 mg/dl (5.3 mmol/l) or lower 1 Hour after glucose load 180 mg/dl (10.0 mmol/l) or lower 2 hours after glucose load 155 mg/dl (8.6 mmol/l) or lower 3 hours after glucose load 140 mg/dl (7.8 mmol/l) or lower

4 4 Work Cited Venes, D. (2001). Taber's cyclopedic medical dictionary (19th ed.). Philadelphia: F.A. Davis Company. All tables are from: Islets of Hopes Diabetes Glucose Information retrieved on June Materials Tables supplied Case study supplied Excel program sheet supplied Procedure There are 3 case studies that describe a patient. It also reports the Oral Glucose Test Results. This test is usually a 2 hour test, however 3 hours worth of data are listed in order to be able to graph the information. Using the information supplied in the case studies create tables in the EXCEL sheet and graph the results with the normal results. One table and graph are shown on the first sheet. It demonstrates the graphing the normal results of the Oral Glucose Tolerance Test. Each of the following pages must have a Completed table Completed combined graph that has a line for: o Normal values o Case study values Use the information from the case study and the graph to answer the questions on the WORD sheet. Also fill in the table on the worksheet and answer any other questions. With the exception of the table all answers must be in complete sentences and any numbers stated have to have a corresponding unit. There are instructions on how to create a graph in the Excel document and another document has been included to help students with this assignment.

5 5 Case Study A: BOB Bob is 45 years old and has been feeling a bit fatigued lately and he is about 40 pounds overweight. He is given an75-gram oral glucose tolerance test. The following results are reported. Fasting for before glucose load 98 mg/dl One hour after glucose load 200 mg/dl Two hour after glucose load 160 mg/dl Three hour after glucose load 150 mg/dl Case Study B: SUE Sue is 36 years old and 6 months pregnant. She comes in for a routine physical and urine stick test. The urine stick test indicated the presence of glucose. (Look at the appendix tables to see what this means) Her doctor orders an oral glucose test. The following results are reported. Fasting for before glucose load 105 mg/dl One hour after glucose load 190 mg/dl Two hour after glucose load 180 mg/dl Three hour after glucose load 170 mg/dl Case Study C: DAVID David is 20 years old and in great physical shape. He is not overweight and exercises routinely. However, he is feeling tired and thirsty all of the time. His mother is a diabetic. He is given an75-gram oral glucose tolerance test. The following results are reported. Fasting for before glucose load 120 mg/dl One hour after glucose load 310 mg/dl Two hour after glucose load 250 mg/dl Three hour after glucose load 240 mg/d

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