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Oral Glucose Tolerance Test and Factors Influencing Blood Glucose Level
Oral Glucose Tolerance Test and Factors Influencing Blood Glucose Level
Oral Glucose Tolerance Test and Factors Influencing Blood Glucose Level
HOMEOSTASIS NORMAL
• 3Mechanisms:
1. Metabolic
2. Hormonal
3. Renal
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Metabolic 10/18/09
Hormonal
• Insulin- β cell of Langerhans favours uptake
into cell
• Glucagon,
epinephrine,glucocorticoids,GH,thyroxin-
antagonists to insulin,favours excessive
glycogenolysis and release of more glucose in
blood
• Cooperative action of both types of hormones
help maintaining the blood glucose
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10/18/09
Renal
• Rates of Glomerularfiltration and Tubular
absorption maintain blood glucose
• Kidney threshold for glucose-180 mg%, more
than this spillover in urine –glycosuria
• TMG-375 mg/min,more accurate index than
kidney threshold
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10/18/09
ABNORMAL
• HYPERGLYCEMIA
• HYPOGLYCEMIA
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10/18/09
HYPERGLYCEMIA:
DIABETES:
•
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10/18/09
GLYCOSURIA
GFR-NC,KT & TMG ↓
A.
HYPERGLYCEMIC:
• Alimentary-IFG
• Emotional-sympathetic and splanic nerve
excitation↑
• Endocrinal
• Experimental-alloxan
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10/18/09
GLYCOSURIA
• B.RENAL:
• Hereditary
• Acquired
• Threshold –( 180 mg%) ↓
• Tubular reabsorption ↓
• Experimental-phloridzine
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10/18/09
II.HYPOGLYCEMIA
DIEBETES STATUS
• MONITORING
• A.Conventional:
• Glucose-Blood (GOD-POD)
• -Urine
• Benedict reagent
• G Y O R
• 0.5% 1% 1.5% 2->2%
• GTT: 1.Lab-Oral GTT (OGTT)
• 2.Clinic-Post-prandial (meal)
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10/18/09
B. Modern investigations
1.Glycated Hb(HbA1c) (Normal 4-8%)-1%↓30% risk
(life span 120D)
2.Glycated albumin-fructosamine(life span 20D)
3.Lipid profile
GTT
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10/18/09
MANAGEMENT OF DIEBETES
• Organs involved-side effects-
complications,acute,chronic-multiple organs
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10/18/09
CLINICAL PRESENTATION IN DM
• Cardinal Symptoms:Complications
• 1.Poly-urea-Urine↑ (wt.loss)
• -dypsea-thirst-water intake ↑
• -phagia-Food intake↑
• 2.Chronic skin infection-Boils
• -Celluloitis
• -Absesses
• 3.Plaques-CVD:CHD+CAD→Myocardial infarction
• 4.Retinopathy
• 5.Nephropathy
• 6.Fatty liver
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10/18/09
• 7.Ketone bodies
• 8.altered lipid profile
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10/18/09
Differentiation of DM
Parameter Type I Type II
Features Juvenile(Puberty) Adult
Diet Under nourished Over nourished
Prevalence 10-20%% 80—90%
Genetics Weak Strong
Defect βCells β Cells-Normal
Ketosis Common Rare
Insulin ↓ No change
O.Hypogly.agent Unresponsive Unresponsive
Insulin Always required Not required