The document discusses laboratory investigations for diabetes mellitus, including urine analysis to check for glucose, ketones, and microalbuminuria; blood tests like fasting blood glucose, oral glucose tolerance test, HbA1c, and lipid profile; and immunological assays. Urine tests check for glucose and ketones to detect hyperglycemia and assess kidney damage, while blood tests diagnose and monitor diabetes and assess control and complications. Microalbuminuria detects early kidney damage from diabetes.

1. Diabetes Mellitus
Mr. Abhijit Bhoyar
Assistant Professor
Department of
Child Health
Nursing
Investigation of

2. Specific Learning Objectives
At the end of the lecture, the students will be
able to
• Explain the investigation of Diabetes Mellitus.

4. Laboratory diagnosis
1. Urine analysis - Glucose, Ketone , Microalbuminuria
2. Blood chemistry
• Blood glucose estimation
• Glucose tolerance test
• Glycated hemoglobin measurement
• Lipid profile
• Serum insulin or C- peptide level
3. Immunological Assays

5. Urine analysis
• Urine tests done in people with diabetes to evaluate
severe hyperglycemia (severe high blood sugar) by
looking for ketones in the urine.
• Ketones are a metabolic product produced when fat
is metabolized. Ketones increase when there is
insufficient insulin to use glucose for energy.
• Urine tests are also done to look for the presence
of protein in the urine, which is a sign of kidney
damage.

6. Cont….
• Urine glucose measurements are less reliable than
blood glucose measurements and are not used to
diagnose diabetes or evaluate treatment for
diabetes.
• They may be used for screening purposes.
• Testing for ketones is most common in people
with type 1 diabetes.
• Both people with type 1 diabetes and type 2
diabetes typically have microalbumin testing.

7. Urine Sugar
Detection of urinary glucose (Glycosuria)
Glycosuria is a term that defines the
presence of reducing sugars in the
urine, such as glucose, galactose,
lactose, fructose, etc.

8. Glucosuria
• It is a first-line screening test for diabetes mellitus
• Normally glucose does not appear in urine until the
plasma glucose rises above 160- 180 mg/dl.
• In certain individuals due to low renal threshold glucose
may be present despite normal blood glucose levels.
• Conversely renal threshold increases with age so many
diabetics may not have Glycosuria despite high blood
sugar levels.

9. Cont.…..
• 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 0.1% glucose in urine.
• Diastix can be directly applied to the urinary stream, and
differing colour responses of the indicator strip reflect
glucose concentration.
• Benedict’s and Fehling’s test can also detect glucosuria.
• Diastix- Reagent strips.

10. Interpretation of Urine sugar

12. Microalbuminuria
• The microalbumin test detects microalbumin, a type of
protein, in the urine.
• Protein is present in the urine when there is damage to
the kidneys.
• Since the damage to blood vessels that occurs as a
complication of diabetes can lead to kidney problems.
• the microalbumin test is done to check for damage to
the kidneys over time.

13. • The importance of micro- albuminuria in the diabetic
patient is that it is a signal of early reversible renal
damage.
• Performing an albumin-to- creatinine ratio is probably
easiest. o Microalbuminuria is a common finding (even
at diagnosis) in type 2 diabetes mellitus and is a risk
factor for macro vascular (especially coronary heart)
disease.

14. Cont….
• Microalbuminuria defined as an albumin excretion rate
intermediate between normality (2.5-25 mg/day) and
macroalbuminuria (250mg/day).
• The small increase in urinary albumin excretion is not
detected by simple albumin stick tests and requires
confirmation by careful quantization in a 24 hr urine
specimen.

15. Assays for Microalbuminurea
1. Qualitative -
• Dipstick method
2. Quantitative
• Enzyme linked Immunosorbant assay
• Radioimmuno assay
• Immunoturbidometric assay

16. What Are Ketones?
• Acids that result when the body does not have enough
insulin and uses fats for energy
• May occur when insulin is not given, during illness or
extreme bodily stress, or with dehydration
• Can cause abdominal pain, nausea, and vomiting
• Without sufficient insulin ketones continue to build up
in the blood and result in diabetic ketoacidosis (DKA).
Urine Ketone Bodies
Ketonuria

17. Why Test for Ketones?
• DKA is a critical emergency state
• Early detection and treatment of ketones prevents
diabetic ketoacidosis (DKA) and hospitalizations due to
DKA
• Untreated, progression to DKA may lead to severe
dehydration, coma, permanent brain damage, or death
• DKA is the number one reason for hospitalizing
children with diabetes.

18. When Should Ketones Be Checked?
When blood glucose remains elevated
During acute illness, infection or fever
Nausea Vomiting or diarrhoea, Abdominal Pain
Fruity breath odour
Rapid breathing
Thirst and frequent urination
Fatigue or lethargy

19. Checking for Ketones
• Urine testing - Most widely used method
• Blood testing -
Requires a special meter and strip
Procedure similar to blood glucose checks.

20. How to Test Urine Ketones
• Gather supplies.
• urinates in clean cup.
• Put on gloves, if performed by someone other
• Dip the ketone test strip in the cup containing urine.
Shake off excess urine.
• Wait 15 - 60 seconds.
• Read results at designated time.
• Record results.

23. Considerations
• Colors on strips and timing vary according to brand.
• If using a scale with “urine glucose” and “urine
ketones,” be sure to read the correct scale when
testing for ketones.
• Follow package instructions regarding expiration
dates, time since opening, correct handling, etc., as
incorrect results may occur.

24. Estimation of blood glucose
• Measurement of blood glucose is indicative of current
state of carbohydrate metabolism.
• Depending on time of collection:
• Fasting blood glucose- after an overnight fast.
• Post meal or postprandial blood glucose- 2 hrs after
the subject has taken a normal meal.
• Random blood glucose – Any time of the day.

25. Fasting blood sugar (FBS)
• Measures blood glucose after fasting for at least 8-12
hrs.
• It often is the first test done to check for diabetes.
• Patient with mild or borderline diabetes may present
with normal FBG values.
• If diabetes is suspected, GTT can confirm the
diagnosis.
• Normal levels: 70-100mg/dl.

26. Post-Prandial Blood Sugar (2-hour PPBS)
• After the patient fasts for 12 hours, a meal is given
which contains starch and sugar (approx. 100 gm).
• Then after 2 hours blood is collected to measure
glucose level.
• home blood sugar test is the most common way to
check 2-hour postprandial blood sugar levels.
• It should be below 140 mg/dL (7.8 mmol/L).

27. Random blood sugar (RBS)
• Measures blood glucose randomly at any time
throughout the day without patient fasting.
• It is useful because glucose levels in healthy
people don’t vary widely throughout the day.
• Blood glucose levels that vary widely may indicate
a problem.

28. Blood Sugar Chart
Category
Fasting Value (mg/dl) Post Prandial (mg/dl)
Minimum
Value
Maximum
Value
Just after
eating
Value 2
hours after
consuming
glucose
Normal 70 100
170 to
200
Less than
140
Early
Diabetes
101 126
190 to
230
140 to 200
Established
Diabetes
More than
126
-
230 to
300
More than
200

30. Other test
• Insulin Test - The Insulin ELISA-
• Islet Cell Antibody (ICA)
• C-peptide Test

31. Expected Questions
Short
• Explain the investigations in diabetes mellitus.
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