Introduction to

Diabetes Mellitus
Diabetes mellitus is a chronic metabolic disorder characterized by
elevated blood glucose levels, resulting from the body's inability to
produce or effectively utilize insulin, a hormone critical for regulating
blood sugar. This condition can lead to a range of serious health
complications if left unmanaged, making it essential to understand the
various forms of diabetes and their impact on overall well-being.

AS by Aabha Sureja
Oral Glucose Tolerance
Test (OGTT)
The Oral Glucose Tolerance Test (OGTT) is a widely used diagnostic tool
for evaluating an individual's ability to metabolize glucose. This
comprehensive test provides valuable insights into the body's glucose
regulation and can help identify potential issues, such as prediabetes or
diabetes.
Indications for OGTT
Suspected Diabetes
The OGTT is commonly used to
diagnose diabetes mellitus,
particularly in cases where
fasting blood glucose levels are
not clearly indicative of the
condition.
Gestational Diabetes
OGTT is the standard test for
screening and diagnosing
gestational diabetes, a form of
diabetes that develops during
pregnancy.
Unclear Diagnosis
The OGTT can help clarify a
diagnosis when standard blood
glucose tests do not provide a
clear picture of a patient's
glycemic status.
Procedure of OGTT
Blood Draw
The oral glucose tolerance test
(OGTT) begins with an initial
blood draw to establish the
patient's baseline blood glucose
level. This fasting blood sample
is taken after the patient has
not consumed any food or drink
(other than water) for at least 8
hours prior to the test.
Glucose Loading
The patient is then instructed to
drink a specific amount of a
glucose solution, typically 75
grams of glucose dissolved in
water. This glucose load
challenges the body's ability to
regulate blood sugar levels.
Timed Blood Draws
Additional blood samples are
taken at specific intervals,
usually 1 hour and 2 hours after
the glucose load. These timed
blood draws allow the
healthcare provider to monitor
how the body is responding to
and processing the glucose.
Interpretation of OGTT Results
Fasting Glucose
The OGTT begins with a fasting blood
glucose test. Normal fasting glucose
levels are below 100 mg/dL. Levels
between 100-126 mg/dL indicate
impaired fasting glucose, and levels
above 126 mg/dL suggest diabetes.
2-Hour Glucose
After drinking the glucose solution,
blood glucose levels are measured
again at the 2-hour mark. Normal 2-
hour glucose is less than 140 mg/dL.
Levels between 140-199 mg/dL
indicate impaired glucose tolerance,
and levels of 200 mg/dL or greater
indicate diabetes.

Interpreting the Curve

The shape of the OGTT curve provides additional insights. A normal curve rises
steadily and returns to baseline. An impaired curve may have a higher peak or take
longer to return to normal. A diabetic curve continues to rise or remains elevated.
Types of OGTT Curves
Normal OGTT Impaired Glucose Diabetes Curve Reactive
Curve Tolerance Hypoglycemia
The diabetic OGTT
The normal OGTT The impaired glucose curve has a very high In some cases, the
curve shows blood tolerance (IGT) curve peak, often over 200 OGTT curve may dip
glucose levels rising has a higher peak mg/dL, that takes a below 70 mg/dL
to a peak within 1-2 and slower return to long time to return to after the initial peak,
hours after ingesting baseline compared to baseline. This indicating reactive
the glucose load, normal. This demonstrates the hypoglycemia. This is
then gradually indicates the body is body's inability to caused by an
declining back to less effective at using properly regulate exaggerated insulin
baseline within 2-3 insulin to lower blood sugar due to response that
hours. This reflects blood sugar levels, a insulin resistance or overcompensates
the body's effective precursor to type 2 insufficient insulin and drops blood
insulin response to diabetes. production. sugar too low.
regulate blood sugar
levels.
Variations of Glucose
Tolerance Tests
While the standard Oral Glucose Tolerance Test (OGTT) is commonly
used to diagnose diabetes, there are several variations that can provide
additional information or be better suited for certain situations. These
alternative glucose tolerance tests offer more nuanced insights into an
individual's glucose metabolism and glycemic control.
Mini OGTT

1 Purpose
A mini OGTT is a shortened version
of the standard oral glucose
tolerance test. It helps screen for
impaired glucose tolerance or
prediabetes by measuring blood
glucose levels after a smaller
glucose load.
2 Procedure
The patient drinks a smaller glucose
solution, usually 75g instead of the
standard 100g. Blood samples are
then taken at fasting and 2 hours
after drinking the solution to
measure changes in blood glucose.

3 Advantages
The mini OGTT is more convenient for patients as it requires a smaller glucose load
and less blood draws. It can be a good screening tool for diabetes risk, especially in
people with impaired fasting glucose.
Extended OGTT
Longer Duration
The extended oral glucose
tolerance test involves
measuring blood glucose levels
over a longer period of time,
usually 3-4 hours. This allows
for a more comprehensive
assessment of glucose
regulation and can help identify
delayed glucose intolerance.
Detailed Evaluation
By extending the testing period,
the extended OGTT provides a
more detailed picture of how
the body handles glucose. This
can be particularly useful for
diagnosing conditions like
prediabetes or gestational
diabetes that may not be
detected with a standard OGTT.
Glucose Curve Analysis
The extended OGTT allows for
a more nuanced analysis of the
glucose curve. Clinicians can
look for patterns like delayed
peak, prolonged elevation, or
slow return to baseline, which
can provide valuable insights
into the individual's glucose
metabolism.
IV GTT

1 Overview
The intravenous glucose tolerance
test (IV GTT) is a variation of the
standard oral glucose tolerance test
(OGTT). Instead of drinking a
glucose solution, the patient
receives a glucose infusion directly
into the bloodstream through an IV.
2 Procedure
During the IV GTT, the patient's
blood glucose levels are measured
at regular intervals over the course
of 2-3 hours after the glucose
infusion begins. This allows for a
more precise assessment of how the
body responds to a controlled
glucose challenge.

3 Uses
The IV GTT is often used to diagnose conditions like diabetes, insulin resistance,
and hypoglycemia. It can provide more accurate information compared to the
OGTT, especially in cases where the patient's gastric emptying or absorption may
be impaired.