diagnosis

Diabetes Diagnosis

Diagnostic Criteria

Random Serum Glucose :usually not considered accurate

1. Serum Glucose over 200 mg/dl with symptoms

Fasting Serum Glucose initial test for blood glucose

1. Serum Glucose exceeds 126 mg/dl on 2 different days

2. Cutoff Reduced from 140 cutoff by ADA (1997)

Glucose Tolerance Test (rarely used now)

Follow-up and Management

HemoGlobin A 1C

Gestational Diabetes Diagnosis

http://www.fpnotebook.com/END121.htm

Labs after review of history

Glucose Challenge Test (GCT)

Abnormal if Serum Glucose exceeds 130 mg/dl

Timing of Test

Low Risk

First Screen at 24-28 weeks

High Risk

Perform GCT at initial visit

Rescreen GCT at 24-28 weeks if initially negative

Glucose Tolerance Test

Indicated for abnormal Glucose Challenge Test

Insulin Resistance Syndrome Screening

Diagnosis: Three or more conditions below

Insulin Resistance (see labs below)

Hypertension (Blood Pressure 130/85 or higher) http://www.fpnotebook.com/CV119.htm

Hyperlipidemia (see labs below)

Coronary Artery Disease

Polycystic Ovary Syndrome

Acanthosis Nigricans

HAIR-AN Syndrome

Hyperandrogenism

http://www.fpnotebook.com/GYN23.htm

Waist-to-hip Ratio

http://www.fpnotebook.com/END37.htm

Abdominal Obesity

Obesity: http://www.fpnotebook.com/END112.htm

Obesity Risk: http://www.fpnotebook.com/END115.htm

Males >= 40 inches (102 cm) confers increased risk

Females >= 35 inches (88 cm) confers increased risk

Labs

Impaired Glucose metabolism

Fasting Glucose: 110 to 125 mg/dl

Two hour Glucose Tolerance Test (75 g): 140-199 mg/dl

Lipid Profile

Serum Triglycerides >150 mg/dl

Serum Very Low Density Lipoprotein (VLDL) increased

Serum HDL Cholesterol decreased

Men <40 mg/dl

Women <50 mg/dl

Serum LDL: http://www.fpnotebook.com/CV147.htm

PCOS Diagnosis

http://www.fpnotebook.com/GYN26.htm

Symptoms

Menstrual Disorders (80%)

Anovulatory Bleeding (<6 Menses per year)

Delayed menstrual regularity

Infertility (74%)

Androgenic features

See Hyperandrogenism

Acne Vulgaris

Hirsutism (69%)

Male sweat changes

Clitoris swelling

Central Obesity (49%)

Mood disturbance (e.g. Major Depression)

Labs

http://www.fpnotebook.com/ENDCh3.htm

Insulin Resistance Syndrome

Glucose to Insulin Ratio < 4.5

Sensitive marker of Insulin Resistance in PCOS

Insulin increased (C-Peptide increased)

Fasting Serum Glucose increased

Gonadotropin increases

Luteinizing hormone (LH) exaggerated surge

Serum LH to Serum FSH ratio exceeds 2.0

Serum Testosterone increased

Associated endocrine abnormality testing

Thyroid Stimulating Hormone (TSH)

Serum Prolactin

Consider adrenal function testing

Radiology: Transvaginal Ultrasound

Multiple small follicles in various stages

Thick ovarian capsule

String of pearls appearance

Syndrome X Diagnosis

http://www.fpnotebook.com/END14.htm