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1 Urinalysis a Glucosuria A specific and convenient method to detect glucosuria is the paper strip impregnated with glucose oxidase and a chromogen system (Clinistix, Diastix), which is sensitive to as little as 01% glucose in urine Diastix can be directly applied to the urinary stream, and differing color responses of the indicator strip reflect glucose concentration A normal renal threshold for glucose as well as reliable bladder emptying is essential for interpretation b Ketonuria Qualitative detection of ketone bodies can be accomplished by nitroprusside tests (Acetest or Ketostix) Although these tests do not detect -hydroxybutyric acid, which lacks a ketone group, the semiquantitative estimation of ketonuria thus obtained is nonetheless usually adequate for clinical purposes 2 Blood testing procedures a Glucose tolerance test (1) Methodology and normal fasting glucose Plasma or serum from venous blood samples has the advantage over whole blood of providing values for glucose that are independent of hematocrit and that reflect the glucose concentration to which body tissues are exposed For these reasons, and because plasma and serum are more readily measured on automated equipment, they are used in most laboratories If serum is used or if plasma is collected from tubes that lack an agent to block glucose metabolism (such as fluoride), samples should be refrigerated and separated within 1 hour after collection The glucose concentration is 10 15% higher in plasma or serum than in whole blood because structural components of blood cells are absent (2) Criteria for laboratory confirmation of diabetes mellitus If the fasting plasma glucose level is 126 mg/dL or higher on more than one occasion, further evaluation of the patient with a glucose challenge is unnecessary However, when fasting plasma glucose is less than 126 mg/dL in suspected cases, a standardized oral glucose tolerance test may be done (Table 27 5) For proper evaluation of the test, the subjects should be normally active and free from acute illness Medications that may impair glucose tolerance include diuretics, contraceptive drugs, glucocorticoids, niacin, and phenytoin Because of difficulties in interpreting oral glucose tolerance tests and the lack of standards related to aging, these tests are being replaced by documentation of fasting hyperglycemia b Glycated hemoglobin (hemoglobin A1) measurements Hemoglobin becomes glycated by ketoamine reactions between glucose and other sugars and the free amino groups on the and chains Only glycation of the Nterminal valine of the beta chain imparts sufficient negative charge to the hemoglobin molecule to allow separation by charge dependent techniques These charge separated hemoglobins are collectively referred to as hemoglobin A1 (HbA1) The major form of HbA1 is hemoglobin A1c (HbA1c) where glucose is the carbohydrate HbA1c comprises 4 6% of total.

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