Diagnosis

The diagnostic criteria for diabetes have recently been revised, lowering the serum glucose values at which the diagnosis can be made, and include an intermediate category for patients whose glucose levels do not meet criteria for diagnosis of diabetes but are significantly abnormal. These changes reflect advances in knowledge of what levels constitute abnormality significant enough to produce the complications of diabetes. Replacing the old term of "borderline" diabetes are IFG (3110 to <126 mg/dL) and IGT, which constitute a group of patients who are generally euglycemic in everyday life but manifest hyperglycemia on oral glucose tolerance tests (>126 but <200 mg/dL) 2 h after an oral 75-g glucose load. In nonpregnant patients, these categories are not diagnostic entities in themselves but represent a group of patients at high risk of developing diabetes. An additional 12 million to 14 million Americans are thought to be glucose intolerant.

Diabetes can be diagnosed in three ways. Two of these may be feasible for emergency department physicians ( Table„„2.0.9-3). The criteria are based on symptoms of diabetes and a random or nonfasting plasma glucose level of 200 mg/dL or more, fasting plasma glucose level (no caloric intake for at least 8 h) of 126 mg/dL or more, or a 2-h post-75-g oral glucose challenge plasma glucose level of 200 mg/dL or more. Unless a patient is showing unequivocal hyperglycemia (300 mg/dL or more in the setting of acute metabolic decompensation such as DKA or HHNS), these values should be reproducible on at least one separate occasion to confirm the diagnosis.1

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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