Diabetes Mellitus
Yulius Dony
Diabetes Mellitus
• A group of metabolic disorders of carbohydrate
metabolism in which glucose is both underutilized as an
energy source and overproduced due to in- appropriate
gluconeogenesis and glycogenolysis, resulting in
hyperglycemia (ADA, 2024)
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Specific types of diabetes
Gestational diabetes
Classification
due to other causes
Type 1 diabetes
Type 2 diabetes
mellitus
Type 1 Diabetes Melitus
• Accounts for 5-10% of diabetes
• Autoimmune markers:
– Islet cell autoantibodies
– Autoantibodies to glutamic acid decarboxylase (GAD) (such as
GAD65)
– Autoantibodies to insulin
– Autoantibodies to tyrosine phosphatases islet antigen 2 (IA-2)
and IA-2b
– Autoantibodies to zinc transporter 8 (ZnT8)
Type 1 Diabetes Mellitus Staging
Type 2 Diabetes Mellitus
• Accounts for 90–95% of all diabetes
• Encompasses individuals who generally have relative
(rather than absolute) insulin deficiency and have
peripheral insulin resistance (i.e., decreased biological
response to insulin)
• Most, but not all, people with type 2 diabetes have
overweight or obesity
Gestational Diabetes Mellitus
• Any degree of glucose intolerance that was first
recognized during pregnancy, regardless of the degree of
hyperglycemia
• Carries risks for the mother, fetus, and neonate
• Diagnosis can be accomplished with either of two
strategies:
– The “one-step” 75-g OGTT derived from the IADPSG criteria, or
– The older “two-step” approach with a 50-g (nonfasting) screen
followed by a 100-g OGTT for those who screen positive
Glucose Measurement - Specimen Considerations
• Whole blood
• Plasma Glycolysis causes plasma glucose to decline over
time while the plasma is in contact with cells.
• Serum
The decline can be 10 mg/dL per hour (5-7%)
• Cerebrospinal fluid depending on leukocyte counts, temperature, and
other factors.
• Pleural fluid A specimen is appropriate for glucose analysis if
• Urine serum/plasma is separated from the cells within 30
minutes.
Glucose Measurement - Whole Blood
• Analyzed with point-of-care monitoring devices tends to
• Give approximately 10% to 15% lower glucose readings than plasma, but the
percentage varies on the basis of hematocrit, analysis technique, and sample
timing (fasting vs. post-glucose load)
• Source: capillary blood
• Point-of-care devices should not be used to diagnose diabetes or
hypoglycemic disorders
Glucose Measurement - Whole Blood
• Errors that may contribute to inaccurate readings using POCT:
– Application of an insufficient volume of blood
– Milking the finger to acquire sufficient blood
– Use of outdated test strips
– Use of alternative sites
– Environmental factors (humidity, heat, altitude)
– Use of a malfunctioning meter
– Use of a dirty meter
– Hypertriglyceridemia, hypotension
– Measurements outside of the hematocrit or temperature range
Glucose Measurement - Whole Blood
• Some blood glucose monitoring devices are influenced by high
levels of salicylate, acetaminophen, levodopa, vitamin C, uric
acid, bilirubin, lipids, or low oxygen levels; others are altered by
touching the reaction area.
• Results can be misleading when samples are obtained from
critically ill patients with poor perfusion and edema.
• Oxygen pressure can also affect accuracy in systems that use
glucose oxidase.
Glucose Measurement - Methods
• Enzymatic
– Glucose oxidase
– Hexokinase
– Glucose dehydrogenase
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