China
Africa
Explore chapters and articles related to this topic
Answers
Published in Calver Pang, Ibraz Hussain, John Mayberry, Pre-Clinical Medicine, 2017
Calver Pang, Ibraz Hussain, John Mayberry
This question focuses on diabetes. Blood sugar levels in diagnosing diabetes are different dependent on the plasma glucose test. In a random glucose test or a 2-hour postprandial test, a level of 11.1 mmol/L is diagnostic whereas a fasting glucose test level of 7.0 mmol/L or more is diagnostic. Insulin is a hormone that has many physiological effects not only on carbohydrate metabolism but also lipid (increases lipogenesis and decreases lipolysis) and protein (increases protein synthesis and decreases protein degradation) metabolism. Enzyme kinetics is a common exam topic and it is important to appreciate that a competitive inhibitor increases Km but has no effect on Vmax; an uncompetitive inhibitor decreases both Km and Vmax; a non-competitive inhibitor has no effect on Km but decreases Vmax.
Diagnosis and Treatment
Published in Awanish Kumar, Ashwini Kumar, Diabetes, 2020
Apart from these tests, a random glucose test (random plasma glucose or RPG) is also often performed and the plasma glucose value equal to or greater than 200 mg/dL suggests a diabetic state. The ADA also suggests the presence of at least two autoantibodies for the confirmation of T1DM, although the antibody specificity and titre would denote the progression and stage of T1DM. But the glucose-dependent factors (FPG, HbA1c, OGTT and RPG) are raised long before the onset of the diabetic symptoms [6]. As a special instruction, to avoid misdiagnosis, the HbA1c should be measured as per the NGSP (National Glycohemoglobin Standardization Program) certified criteria and standardised to the DCCT (Diabetes Control and Complications Trial) assay points. The ADA recommends that the clinical diagnosis should be confirmed when at least two glucose-dependant criteria turn out to be positive (same test twice at different points in time or two different tests). But as a point of caution, the ADA also states that as compared to the FPG and HbA1c tests, the 2-h PG diagnoses more people with diabetes [6]. The Joslin Diabetes Centre also states that the point-of-care HbA1c testing may not be considered very reliable and should not be accepted for the diagnosis of diabetes [7]. Considering the accelerated cases of diabetes globally, the ADA and physicians recommend the testing of ‘pre-diabetes’ condition. Pre-diabetes is considered when the plasma glucose levels do not meet the diabetes criteria but are high enough to not be normal. Patients are diagnosed with an impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and HbA1c level between 5.7–6.4%. IFG is defined as the plasma glucose value between 100–125 mg/dL, while IGT is considered to be a 2-h PG value between 140–199 mg/dL.
Intravitreal Dexamethasone Implant (Ozurdex) to Control Recurrent Severe Idiopathic Uveitis Leads to Improvement in Steroid-Induced Diabetes Mellitus
Published in Ocular Immunology and Inflammation, 2018
Ashraf A. Khan, Georgios Kontos, Sheila P. Paterson-Brown, Baljean Dhillon
The patient developed symptoms of polyuria, polydipsia, and lethargy in 2012 and a random glucose test showed 27.9 mmol/L. There was no prior history of diabetes or any family history confirming SIDM. She was commenced on metformin and 60 units/day of Novomix 30.