LABORATORY EXAMINATIONS

IN DIABETES MELLITUS
DEFINITION:

 Diabetes mellitus (DM): chronic disease

 Characterized by changes in the metabolism of

each of the major body fuels/ source of energy
(carbohydrate, fat and protein)

 Associated by disturbances of a variety of

hormones.
CLASSIFICATION

1. DM type 1 (T1DM):
- Autoimmune  selectively destroys pancreatic
beta cells;
- T cell mediated process, with unknown
antigenic stimuli  lack of insulin
2. DM type 2 (T2DM):
carbohydrate intolerance as cardinal
feature
Insulin resistance or insulin deficiency
sometimes hyperinsulinism can be found
95% of DM case
3. Gestational DM: DM in pregnancy
4. Other specific type of DM: drug or
chemical-induced forms of diabetes
CLINICAL SIGNS & SYMPTOMS:

 Polyuria, nocturia, polydypsia, polyphagia,

fatigue, weight changes, blurred vision,
extremity pain, sexual dysfuntcion,
nephropathy, neuropathy, foot ulceration
(gangrene diabetic foot), joint problem
 Symptoms due to hyperglycemia : polydipsia,
tiredness, polyuria, glycosuria, tendency to infections,
coma
 Symptoms due to starvation : weight loss, wasting,
weakness
 Symptoms due to ketoacidosis : vomiting, acetone smell
of the breath, ketonuria, polyuria, dehydration,
hyperventilation, reduced consciousness, convulsions,
coma
 Symptoms due to chronic complications :
decreased visual acuity, reduced sensation in the
limbs, proteinuria, edema, intermittent
claudication, ischemic heart disease, hypertension,
hypercholesterolemia
DIAGNOSIS of DM
 Screening for T1DM is not recommended;
 Screening for T2DM :
Checking FBG (fasting blood glucose)
Begin at age 45, especially if BMI ≥25
 Screening for GDM:
High risk women : FBG > 85 mg/dL 
50gram OGTT (oral glucose tolerance test)
followed by 75 gram OGTT
Low risk women: FBG > 100 mg/dL 
OGTT
 CONFIRMATORY TESTS

When FBG 100 – 125 mg/dL  OGTT

c-peptide test: reflects level of functional
endogenous insulin hormone
 LAB INTERPRETATION:
NORMAL DM
1. FASTING 60-100 mg/dl ≥126 mg/dl
70-100 mg/dl
2. POST PRANDIAL < 140 mg/dl ≥ 200 mg/dl

3. RANDOM 100-150 mg/dl ≥ 200 mg/dl

4. HbA1c < 5.9% ≥ 6.5%

 IMPAIRED FASTING GLUCOSE :
- 100 mg/dl ≥ FBG < 126 mg/dl

 IMPAIRED GLUCOSE TOLERANCE :

- 101 mg/dl ≥ FBG < 126 mg/dl (in non-pregnant
adult) WITH
- 140mg/dl ≥ 2 hrs post meal < 200mg/dl
PATIENT PREPARATION in OGTT:
 Diet : >150g of carbohydrate per day, 3 days

 Discontinue any drugs that can affect glucose plasma

level 3 days before the test

 Fasting : 10-12 hours, no strenuous exercise at least 8
hours prior to the test
 A parallel urine sample must be taken for fasting

glucose and ketone.

 A positive test of urine glucose and ketone are
contra-indication for OGTT procedure (discontinue/
abort the test)

 FOLLOW UP TESTS
 Effectiveness of therapy:
 Fasting BG, 2-h post meal BG
 HbA1c (glycated Hb):

 Lipid profile (total cholesterol, HDL,LDL, triglyceride),

 State of diabetic control:
HbA1c total HbA1
 Good DM control 2.5-6.0% < 7.0%
 Fair DM control 6.1-8.0% 7.0-9.0%
 Poor DM control > 8% > 9%
Early detection of complications:
 Microalbuminuria = uACR

(urinary albumin/creatinine ratio)

 ECG (electro-cardiography)

 Self monitoring blood glucose (SMBG) at least 4

times daily
SPECIFIC CONDITIONS:
 Diabetic keto-acidosis
 Coma hyperglycemia: hyperosmolar
 Coma hyperglycemia, keto-acidosis
 Coma hypoglycemia (complication)
INTERFERING FACTORS in lab glucose exami-
nation:
 Falsely high : dextrose IV-infusion, steroids,
stress, infection, caffeine, nicotine, ß-blockers,
adrenal gland infection, total parenteral
nutrition (TPN), diuretics, estrogen, phenytoin
 Falsely low : insulin, alcohol, anabolic steroids,
OAD
POCT: GLUCOSEMETER
OTHER TYPE OF GLUCOSEMETER
Urinalysis : URINE DIPSTICK
Sebelum menggunakan strip urine, harus dipe-
riksa dahulu:
 Expiry date

 Botol kemasan tertutup dengan baik

 warna strip yang belum digunakan: semua

warna pad harus sama dengan kolom warna
negatif.
 Bila ada hanya satu saja warna pad yang
berubah, strip tidak boleh digunakan (rusak)
 Urine dituang ke dlm tabung periksa setinggi ±
10 cm (sampai kira2 semua pad akan tercelup
semua dalam satu celupan)
 Celupkan strip selama 2 detik (lihat petunjuk

penggunaan dari masing2 pabrik, mungkin waktu

pencelupan berbeda (1-3 detik))
 Kelebihan urine dibuang dengan menyentuhkan

bagian belakang pad (sisi plastik) pada kertas

tisue.
 Hasil dibaca dengan cara membandingkan
warna strip dengan standar warna pada botol
kemasan
 Strip urine harus sudah selesai dibaca dalam
waktu 2-5 menit (sesuai petunjuk manufakturer);
setelah waktu tsb, hasil yang dibaca tidak valid.
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