Diabetes mellitus
Last updated: Saturday, 27, November, 2010
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Laboratory diagnosis is usually based on measurement of fasting or random (>2 hours post-prandial) glucose in plasma. Glucose tolerance test is indicated when results are equivocal or to establish the diagnosis of gestational diabetes. The glucose challenge test is used to screen for gestational diabetes; see Antenatal screening. |
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Monitoring (control) |
Glucose test strips, usually done by patient. Glycated haemoglobin to assess control over the previous 3 months. Fructosamine is rarely used, giving an indication of control over the previous 3 weeks. For insulin-dependent diabetes, urinalysis for ketones should also be performed. |
| Acutely ill diabetic, including |
Glucose, electrolytes, anion gap, urea, creatinine. Blood gases, hydroxybutyrate, lactate, FBC if indicated. Osmolality can be calculated; direct measurement is not required. The possibility of underlying infection should be considered, especially urinary tract infection. |
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Hyperglycaemia |
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Patients with ketoacidosis may not have severe hyperglycaemia. If lactic acidosis is present, urine ketone tests may underestimate the degree of ketoacidosis. Frequent monitoring of glucose and electrolytes, esp potassium, is required. |
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Hypoglycaemia |
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| Long-term consequences | |
| Diabetic nephropathy |
Albumin - urine (“microalbuminuria”) for early detection of nephropathy. Urine microscopy and urinalysis. Creatinine, urea. Renal biopsy if considered appropriate. See also Nephrotic syndrome, Renal failure - chronic. |
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Diabetic retinopathy Cataracts Peripheral Neuropathy Peripheral vascular disease |
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Infection |
See Immunodeficiency - secondary and Infection (increased susceptibility). |
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| Pregnancy and neonatal complications | |
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Difficult control |
Management requirements change during pregnancy; monitoring may be required more frequently. |
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Fetal macrosomia |
Birth of a disproportionately large baby is an indication for careful maternal assessment for diabetes during subsequent pregnancies and is associated with an increased risk of diabetes in later life. |
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Fetal abnormalities |
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Neural tube defects |
Plasma alpha fetoprotein at 14-16 weeks gestation; amniotic fluid alpha fetoprotein if plasma level is increased and fetal abnormality has not been identified on ultrasound. |
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Spontaneous abortion Fetal death |
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Neonatal hypoglycaemia |
Observation and blood glucose monitoring of neonate |