Diabetes mellitus type 1 laboratory findings: Difference between revisions
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{{Diabetes mellitus type 1}} | {{Diabetes mellitus type 1}} | ||
{{Diabetes mellitus}} | {{Diabetes mellitus}} | ||
{{CMG}} | {{CMG}}{{AE}}{{VD}} | ||
==Overview== | ==Overview== | ||
Laboratory findings consistent with the [[diagnosis]] of [[diabetes mellitus type 1|type 1 DM]] include [[blood sugar|FPG]] ≥126 mg/dL (7.0 mmol/L), or 2-h [[blood sugar|PG]] ≥200 mg/dL (11.1 mmol/L) during an [[Glucose tolerance test|OGTT]], or [[Glycosylated hemoglobin|A1C]] ≥6.5% (48 mmol/mol), or classic [[symptom|symptoms]] of [[hyperglycemia]] or [[hyperglycemia|hyperglycemic]] crisis, a random [[blood sugar|plasma glucose]] ≥200 mg/dL (11.1 mmol/L). | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
Laboratory findings consistent with the [[diagnosis]] of [[diabetes mellitus type 1|type 1 DM]] include:<ref>Type 1 Diabetes mellitus "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on December 27th,2016</ref><ref>{{Cite web|url=https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis|title=NIDDK|last=|first=|date=|website=|publisher=|access-date=}}</ref><ref name="pmid17457482">{{cite journal| author=Karaguzel G, Ozer S, Akcurin S, Turkkahraman D, Bircan I| title=Type 1 diabetes-related epidemiological, clinical and laboratory findings. An evaluation with special regard to autoimmunity in children. | journal=Saudi Med J | year= 2007 | volume= 28 | issue= 4 | pages= 584-9 | pmid=17457482 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17457482 }}</ref> | |||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="4" |Laboratory findings in type 1 diabetes based on presentation | !ADA Criteria for the [[diagnosis]] of [[diabetes]] | ||
|- | |||
|[[blood sugar|FPG]] ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no [[calorie|caloric]] intake for at least 8 h.* | |||
|- | |||
|OR | |||
|- | |||
|2-h [[blood sugar|PG]] ≥200 mg/dL (11.1 mmol/L) during an [[Glucose tolerance test|OGTT]]. The test should be performed as described by the [[World Health Organization|WHO]], using a [[glucose]] load containing the equivalent of 75 g anhydrous [[glucose]] dissolved in water.* | |||
|- | |||
|OR | |||
|- | |||
|[[Glycosylated hemoglobin|A1C]] ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.* | |||
|- | |||
|OR | |||
|- | |||
|In a [[patient]] with classic [[symptom|symptoms]] of [[hyperglycemia]] or [[hyperglycemia|hyperglycemic]] crisis, a random [[blood sugar|plasma glucose]] ≥200 mg/dL (11.1 mmol/L). | |||
|} | |||
↵* In the absence of unequivocal [[hyperglycemia]], results should be confirmed by repeat testing. | |||
* | |||
{| class="wikitable" | |||
! colspan="4" |Laboratory findings in [[diabetes mellitus type 1|type 1 diabetes]] based on presentation | |||
|- | |- | ||
| | | | ||
| | | | ||
|Classic new onset | |Classic new onset | ||
|Diabetic Ketoacidosis | |[[Diabetic Ketoacidosis]] | ||
|- | |- | ||
| rowspan=" | | rowspan="16" |[[Blood]] | ||
|Glucose | |[[Glucose]] | ||
| | | | ||
* Random: | * Random: random (nonfasting) [[blood glucose|plasma glucose]] concentration of 200 mg/dL or higher | ||
* Fasting plasma glucose concentration of 126 mg/dL (6.99 mmol/L) or higher | * Fasting [[blood glucose|plasma glucose]] concentration of 126 mg/dL (6.99 mmol/L) or higher | ||
|Random glucose | |Random [[glucose]] level is more then 250 mg/dl | ||
|- | |- | ||
| | |[[Glycosylated hemoglobin|HbA1C]] | ||
|HbA<sub>1c</sub> level of 6.5% or higher | |HbA<sub>1c</sub> level of 6.5% or higher | ||
|Not applicable | |Not applicable | ||
|- | |- | ||
|CBC with differential | |[[C-Peptide]] below | ||
|below 5 µU/mL | |||
|Not applicable | |||
|- | |||
|[[Islets of Langerhans|Islet-cell]] ([[Islets of Langerhans|IA2]]) | |||
|Measurements of [[Islets of Langerhans|IA2]] [[autoantibody|autoantibodies]] within 6 months of [[diagnosis]] can help differentiate between [[diabetes mellitus type 1|type 1]] and [[diabetes mellitus type 2|type 2 DM]] | |||
|Not applicable | |||
|- | |||
|Anti-[[Glutamate decarboxylase|GAD65]] | |||
|Usually present | |||
|Not applicable | |||
|- | |||
|Anti-[[insulin]] [[autoantibody|autoantibodies]] | |||
|Usually present | |||
|Not applicable | |||
|- | |||
|[[Complete blood count|CBC]] with differential | |||
|Normal | |Normal | ||
|Mildly elevated with normal differential | |Mildly elevated with normal differential | ||
Line 32: | Line 71: | ||
|Basic metabolic panel | |Basic metabolic panel | ||
|Normal | |Normal | ||
|Serum bicarbonate < 18 mEq/L | |[[bicarbonate|Serum bicarbonate]] < 18 mEq/L | ||
Serum Sodium: Often normal or elevated | Serum [[Sodium]]: Often normal or elevated | ||
Serum Phosphate: Often normal or elevated | Serum [[Phosphate]]: Often normal or elevated | ||
Serum Potassium: Often normal or elevated | Serum [[Potassium]]: Often normal or elevated | ||
|- | |- | ||
|Serum Creatinine | |Serum [[Creatinine]] | ||
|Normal | |Normal | ||
|Often elevated | |Often elevated | ||
|- | |- | ||
|Serum calicum | |Serum [[calicum]] | ||
|Normal | |Normal | ||
|Decreased | |Decreased | ||
|- | |- | ||
|Serum amylase | |Serum [[amylase]] | ||
|Normal | |Normal | ||
|Mildly elevated | |Mildly elevated | ||
|- | |- | ||
|Serum Lipase | |Serum [[Lipase]] | ||
|Normal | |Normal | ||
|Normal | |Normal | ||
|- | |- | ||
|Serum osmorality | |Serum [[osmorality]] | ||
|Normal | |Normal | ||
|Normal | |Normal | ||
|- | |- | ||
|Serum Ketones | |Serum [[keton|Ketones]] | ||
|Normal | |Normal | ||
|High | |High | ||
|- | |- | ||
|Anion gap | |[[Anion gap]] | ||
|normal | |normal | ||
|High | |High | ||
|- | |- | ||
|Arterial Blood gas | |[[Arterial Blood gas]] | ||
|Normal | |Normal | ||
|Metabolic acidosis, compensated by | |[[Metabolic acidosis]], compensated by | ||
respiratory alkalosis | [[respiratory alkalosis]] | ||
|- | |- | ||
| rowspan="2" |Urine | | rowspan="2" |[[Urine]] | ||
|Glucose | |[[Glucose]] | ||
|May or may not be present( | |May or may not be present, ([[blood sugar|blood glucose]] should be more then 200 mg/dl to appear in [[urine]]) | ||
|Often present | |Often present | ||
|- | |- | ||
|Ketones | |[[ketone|Ketones]] | ||
|absent | |absent | ||
|Present | |Present | ||
|} | |} | ||
[[Image:FPG-new.gif|200px]] [[Image:OGTTColorfinal.gif|200px|OGTT]] | [[Image:FPG-new.gif|200px]] [[Image:OGTTColorfinal.gif|200px|OGTT]] | ||
FPG OGTT | FPG OGTT | ||
* [[Islets of Langerhans|IA2]], [[Glutamate decarboxylase|GAD65]] and [[insulin]] [[autoantibody|autoantibodies]] have been detected numerous months or years before the [[Diabetes mellitus type 1|type 1 diabetes mellitus]] onset. This fact leads to the idea of using these [[autoantibody|autoantibodies]] as predictive tools for individuals at risk of developing clinical [[disease]]. Chance of developing [[Diabetes mellitus type 1|type 1 diabetes mellitus]] within 5 years was ∼10%, ∼50% and 60–80% in the presence of one, two or three [[autoantibody|autoantibodies]] respectively, based on one study.<ref name="Notkins2002">{{cite journal|last1=Notkins|first1=Abner Louis|title=Immunologic and Genetic Factors in Type 1 Diabetes|journal=Journal of Biological Chemistry|volume=277|issue=46|year=2002|pages=43545–43548|issn=0021-9258|doi=10.1074/jbc.R200012200}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 13:22, 20 September 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Vishal Devarkonda, M.B.B.S[2]
Overview
Laboratory findings consistent with the diagnosis of type 1 DM include FPG ≥126 mg/dL (7.0 mmol/L), or 2-h PG ≥200 mg/dL (11.1 mmol/L) during an OGTT, or A1C ≥6.5% (48 mmol/mol), or classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).
Laboratory Findings
Laboratory findings consistent with the diagnosis of type 1 DM include:[1][2][3]
ADA Criteria for the diagnosis of diabetes |
---|
FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.* |
OR |
2-h PG ≥200 mg/dL (11.1 mmol/L) during an OGTT. The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.* |
OR |
A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.* |
OR |
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L). |
↵* In the absence of unequivocal hyperglycemia, results should be confirmed by repeat testing.
Laboratory findings in type 1 diabetes based on presentation | |||
---|---|---|---|
Classic new onset | Diabetic Ketoacidosis | ||
Blood | Glucose |
|
Random glucose level is more then 250 mg/dl |
HbA1C | HbA1c level of 6.5% or higher | Not applicable | |
C-Peptide below | below 5 µU/mL | Not applicable | |
Islet-cell (IA2) | Measurements of IA2 autoantibodies within 6 months of diagnosis can help differentiate between type 1 and type 2 DM | Not applicable | |
Anti-GAD65 | Usually present | Not applicable | |
Anti-insulin autoantibodies | Usually present | Not applicable | |
CBC with differential | Normal | Mildly elevated with normal differential | |
Basic metabolic panel | Normal | Serum bicarbonate < 18 mEq/L
Serum Sodium: Often normal or elevated Serum Phosphate: Often normal or elevated Serum Potassium: Often normal or elevated | |
Serum Creatinine | Normal | Often elevated | |
Serum calicum | Normal | Decreased | |
Serum amylase | Normal | Mildly elevated | |
Serum Lipase | Normal | Normal | |
Serum osmorality | Normal | Normal | |
Serum Ketones | Normal | High | |
Anion gap | normal | High | |
Arterial Blood gas | Normal | Metabolic acidosis, compensated by | |
Urine | Glucose | May or may not be present, (blood glucose should be more then 200 mg/dl to appear in urine) | Often present |
Ketones | absent | Present |
FPG OGTT
- IA2, GAD65 and insulin autoantibodies have been detected numerous months or years before the type 1 diabetes mellitus onset. This fact leads to the idea of using these autoantibodies as predictive tools for individuals at risk of developing clinical disease. Chance of developing type 1 diabetes mellitus within 5 years was ∼10%, ∼50% and 60–80% in the presence of one, two or three autoantibodies respectively, based on one study.[4]
References
- ↑ Type 1 Diabetes mellitus "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on December 27th,2016
- ↑ "NIDDK".
- ↑ Karaguzel G, Ozer S, Akcurin S, Turkkahraman D, Bircan I (2007). "Type 1 diabetes-related epidemiological, clinical and laboratory findings. An evaluation with special regard to autoimmunity in children". Saudi Med J. 28 (4): 584–9. PMID 17457482.
- ↑ Notkins, Abner Louis (2002). "Immunologic and Genetic Factors in Type 1 Diabetes". Journal of Biological Chemistry. 277 (46): 43545–43548. doi:10.1074/jbc.R200012200. ISSN 0021-9258.