It is the rise of blood glucose Level above 140 Causes Insulin in: Diabetes mellitus (commonest cause) surgical pancreatectomy (removalof pancreas) Streptozotcin injection that destroy b-cells pancreatitis and pancreatic cancer HYPRERGLYCEMIA

1-ACTH and glucocorticoids: as in adrenal cortical tumors and cushing’s syndrome (b c reduce senstivity of tissues (me adipose tissue) to the offect of insulin on glucose uptake and utilization + rate of gluconeogensis) 2-Adrenaline :as in emotionsstress and pheochromocytoma glycogenolysis in ms&liver+lipolvsis+inhibit insulin secretion) 3-TSHand thyroxine as in hyperthyroidism(b c thyroid H has diabetogenic action ( absorption of gluconse+gluconeogensis) 4- Pituitary growth hormone : as in acromegaly (b c chronic administrationof GH> glucose uptake in ms +fat tissue glucose > production by liver > insulin secrtion >>exhaustion of B cell ) Dietary or alimentary high cardohydrate diet rich in simpl sugars drug-induced e g chronic use of corticosteroids INCREAS ANTI-INSULIN HORMONES:

Normal:70-110mg/dl Dm:>= 126mg/dl [%] on at least two occasion s Impiared fasting glucose: fasting glucose( )mg/dl A risk factor for future diabetes Normal:<180mg/dl Dm: >200mg/dl in more than one occasion 1-FASTING BLOOD GLUCOSE(FBS) LEVEL: 2-random blood glucose level(RBS):

Normal:<140mg/dl Dm:>200mg/dl even at one occasion 3-TWO HOUR POSTPRANDIAL TEST(PPS)

 It measures the ability of body to utilize oral glucose dose  Measuring FBS [aftar 8-12h fasting ] and blood Glucose levels five times (every 30 min) over a period of 3 hours after ingestion of 75 grams glucose [1-1.5 gm/dl]of glucose. Urineis also collected and glucose is estimated 4-THE ORAL GLUCOSE TOLERANCE TEST:

 Normal FBS [70-110mg/dl]  Peak within 1h [not> renal threeshold [180mg/dl]  The normal FBS isreached after h [<140mg/dl]  No glucose or KB inany urine specimen  In renal glycosuria,OGTT is normal  Normal FBS [70-110mg/dl]  Peak within 1h [not> renal threeshold [180mg/dl]  The normal FBS isreached after h [<140mg/dl]  No glucose or KB inany urine specimen  In renal glycosuria,OGTT is normal A- NORMAL RESPONSE

 FBS is >110 and <126  2-hour glucose is >=140 but <200mg/dl  This is also considereda risk factor for future diabetes B-IMPAIRED GLUCSE TOLERANCE [IGT}

 A pregnant woman has any two of the dfollowing  AFBS>110mg/dl  A1-hour glucose level< ;190mg/dl  A2 hour glucose level <;165mg/dl  Or a 3hour glucose level of< ;145mg/dl C- GESTATIONAL DIABETES :

 FBG>=126mg/dl  The peak is >180mg/dl  FBG is not reached after 2-3h[200mg/dl]  Urine samples Always+ve for glucose whil KB are+ve or –ve depending on the condition D- DIABETIC GTT:

Normal FBS peak aftar h and is 180mg/dl returns to normal aftar 2-2 5h. As in alimentary glucosuria E-LAG CURVE

Easy inexpensive rabid and noninvasive below renal threshold 180mg/dl HBA1c will tell ehat the diabetic’s blood sugar levels have been running for the past 2-3 months [life span of RBCs normal HB A1c is 4-6,5 5.MEASUREMENT OF GLUCOSE IN URINE 6-measurement of glycoseylated hemoglobin glycated hb or hb a1c

 Condensation product of glucose with serum albumin  Estimate plasma glucose levels over (2-3 weeks) (half life of alb )  Normal range ( mmol/l) 7- MEASUREMENT OF SERUM FRUCTOSAMINE:

 Detection in serum and urine : using (nitroprusside test ) acetone or acetoacetate nitroprusside to from violet color)  Acetest tablets or ketostix (strips) : It is an indicator of B-cell function and insulin secetory capacity in diabetic patients on insulin (doesnot cross react with exogenous insulin) -C-peptide is 0,9-4,2 ng/ml Normal serum insulin pm/l 8- MEASUREMENT OF KETONE BODIES : 9- measurement of c-peptide 10- measurement of insulin : by ELIZA