Session 4 Phase 2

Session 4 -
Content 01 04
Oral glucose urine and stool
tolerance test analysis
02 03
DM & FBG Report solving
Glucose tests and diabetes Mellitus
By: Mariam Amri

Blood Glucose Normal levels
Normal fasting blood glucose (FBG) is 70-99 mg/dl
Normal two hours postprandial level (2hr-PPG) is less than 140

mg/dl
Normal random blood glucose test (RBG test) is 80-140mg/dl

Hypoglycemia Hyperglycemia
Glucose<70 mg% Glucose >100 mg%
1. Increase of insulin level either
due to Beta cell tumor or 1. Diabetes Mellitus
Overdose. 2. Hyperactivity of Pituitary and
2. Hypoactivity of Pituitary Adrenal glands
(growth hormone) and Adrenal 3. Hyperthyroidism
glands (cortisol)
3. Hypothyroidism
Diabetes Mellitus
Diabetes mellitus is a heterogeneous group of syndromes characterized by an
elevation of fasting glucose level caused by relative or absolute deficiency in insulin The main
diagnostic signs are:
1. Polyuria
2. Polydipsia
3. Polyphagia
The complications may be:
Microvascular:
Nephropathy
Neuropathy
Retinopathy
Or Macrovascular (Cardiovascular Complications)

Glycosylated Haemoglobin
4-5.7%
(HbA1c) of total Hb.
owing to high glucose concentration in diabetic patients, the HbA]
increase in
their RBCs during the 120-day lifespan of the cells.
The determination of HbA1c
used to monitor the patient compliance and response to the
prescribed Anti-hyperglycemic.
Glycosylated Haemoglobin
(HbA1c)
HbA1c of 6.5% or more means diabetes
(diagnostic)
HbAlc of 6.5-7% controlled diabetes
6.5-7 %: controlled Diabetes mellitus.
> 7 %: uncontrolled Diabetes mellitus.
Oral Glucose Tolerance
is the ability of the body to utilize glucose in the circulation without
appearance of hyperglycemia & glucosuria. Since blood glucose level increases after
ingestion of carbohydrate, stimulating the secretion of insulin.
Blood glucose level decreases 2-4 hrs after ingestion of a meal and so remains
constant between meals and insulin decreases.
Oral Glucose Tolerance Test
(OGTT)a valuable diagnostic aid in the diagnosis of diabetes
mellitus, insulin resistance, impaired beta-cell function
the most sensitive test for detecting borderline diabetes

mellitus. It is indicated by the nature of blood glucose curve following glucose
adminstration.
(OGTT)
Patients having symptoms suggestive of diabetes mellitus, but fasting blood sugar
value is inconclusive
(between 100-126 mg/dl).
During pregnancy (gestational diabetes)

To rule out benign renal glucosuria if suspected.
OGTT not used for:

Person with confirmed diabetes mellitus.
OGTT has no role in the follow-up of diabetes. It is indicated only for the initial
diagnosis.
(OGTT)
(OGTT)
1. A fasting sample of venous blood is collected in a fluoride vial.
2. The bladder is emptied completely and urine is collected for qualitative test for
glucose and ketone bodies.
3. The individual is given 75 grams of glucose dissolved in water (about 250 ml).
Addition of lemon juice lesens the risk of patient vomiting.
4. Note the time of oral glucose administration.
5. A total of five specimens of venous blood and urine are collected every 1/2 hour
(30 minutes) after the oral glucose administration.
(OGTT)
(OGTT)
6. Glucose content of all five samples of blood are estimated by the specific methods
used in laboratory. Corresponding urine samples are tested qualitatively for the
presence of glucose and ketone bodies.
7. A curve is plotted by plotting time on X-axis and plasma glucose level on Y-axis,
which iscalled Glucose Tolerance Curve (GTC).
(OGTT)
lipids
By: Mariam Amri

Type of lipid :
A- Free faty acid C- Triacylglycerol
B- Cholesterol ( Free and D- phospholipid

Esterified )
Cholesterol: TG:
phospholipid Free faty acid
Cholesterol :
It is a fat related , Complex alcohol that can be either systematized
by all body cells except the brain( 70% from liver and 30% from
extra-hepatic tissues) or ingested from animal origin.
Cholesterol is water insoluble, can form esters with fatty acid by ( lecithin
cholesterol acyl transferase-LCAT), free cholesterol can bind to lipoprotein
mainly to low density LDL, also high Density HDL and VLDL, although
cholesterol is Considered as a body lipid, it’s dose not serve as source of
energy.
Type of lipoprotein :
HDL LDL
Chylomicron
VLDL
Size
Denisty
lipid profile
It's a common blood test that healthcare providers use
to monitor and screen for the risk of cardiovascular
disease.
risk factors
• Being over 45 males and 50 females
• Smoking
• Obesity
• diabetes
• have a first-degree relative that has heart disease at an early stage.
the panel includes
• Total cholesterol
• Triglycerides
• LDL
• VLDL
• HDL
WHY?
• HDL --> Absorbs cholesterol and carries it back to the liver.
• LDL --> Builds up on the wall of the blood vessels causing
heart diseases, atherosclerosis, etc.
• VLDL --> Very-low-density lipoprotein (VLDL) cholesterol is produced
in the liver and released into the bloodstream to supply body tissues with
a type of fat (triglycerides). High levels of VLDL cholesterol have been
associated with the development of plaque deposits on artery walls,
which narrow the passage and restrict blood flow. There's no simple,
direct way to measure VLDL cholesterol, which is why it's normally not
mentioned during a routine cholesterol screening.
• Triglycerides--> A type of fat (lipid) found in your blood. When you eat,
your body converts any calories it doesn't need to use right away into
triglycerides. The triglycerides are stored in your fat cells. Later,
hormones release triglycerides for energy between meals. Being
physically inactive, eating foods that are high in fat and sugar, or
drinking too much alcohol may increase blood triglycerides.
total cholesterol
reference range
factors affecting the results
• sickness
• Smoking
• medicines
• diet
• physical activity
precautions
the candidate should be fasting from 10-12h and provide information
about any taken drugs .

Urine & stool
analysis
By: Ayoub Shams
physical characters of Urine :
• Volume :
Normal: 0.5 to 1.5 cc/kg/hour or 600 and 2,000 mL daily in adults

(typically 1,000– 1,600 mL/day)
physical characters :
• Associations :
Anuria (less than 100 ml/day) and oliguria (less than 500 cc/day): Severe
dehydration from vomiting, diarrhea, hemorrhage or excessive sweating;
renal disease, renal obstruction, renal ischemia secondary to heart failure or
hypotension
Polyuria (greater than 2,500 - 3,000 ml/day): Alcohol or caffeine

consumption, diabetes mellitus, diabetes insipidus, diuretics, increased
water intake, saline or glucose intravenous therapy
• Color :
Normal: Yellow (light/pale yellow )

• Associations :
- Orange: Bile pigments, carrots, coumadin, nitrofurantoin, phenothiazines,

phenazopyridine, rifampin, vitamin C
- Red: Beets, blackberries, chlorpromazine, food dyes, hematuria
- brown in case of bile acids
- Green/Blue: pseudomonal UTI, promethazine, Amitriptyline

• Aspect (appearance)
Normal: freshly voided urine is clear.
Appearance of urine specimen depends on both its

pH and its dissolved solids composition.
Unless urine it’s contains protein
or blood or bile then it’s turbid .
• Turbid (expressed as +,++)
Due to presence of crystalline or amorphous solids as well as blood and

proteins
Crystals are precipitated at certain pH, as shown in table below....
Acidic pH Alkaline pH
Uric acid crystals Phosphate crystals
Amorphous urates Amorphous phosphate
calcium oxalate Calcium carbonate
crystals
• Specific gravity:
Normal specific gravity of urine is 1.010 to 1.025 .
Specific gravity is affected also by solute concentration like glucose and

proteins (Direct
Specific gravity of urine is a measure of concentrating ability of kidneys

and is determined to get information about this tubular function.
• Specific gravity:
Urine specific gravity is measured by urinometer or reagent strip

• pH (Reaction)
The pH of urine may range from 4.5 to 7

(average:6 i.e slightly acidic )
except after meals due to alkaline tide ( physiologically )

• Associations :
High Values (alkaline): Stale/old urine specimens (most common),

hyperventilation, presence of urease-producing bacteria, renal tubular
acidosis, vegetarian diet, vomiting.
Low Values (acid): Cranberry juice, dehydration, diabetes mellitus, diabetic

ketoacidosis, diarrhea, emphysema, high protein diet, starvation, potassium
depletion, medications (methionine, mandelic acid, etc.), and a possible
predisposition to the formation of renal or bladder calculi.
• Odor
Normal urine has a faintly aromatic odor called uriniferous odor ; due to
volatile organic acids .
After standing : old urine sample develops ammoniacal odor ;

due to bacterial decomposition of urea and formation of ammonia.
Abnormal urine odors:
1- Fruity (acetone like odor): Ketoacidosis as in diabetic ketoacidosis
or starvation due to presence of ketone bodies
2- Ammoniacal odor: Old standing samples, nephritis, cystitis or
urinary tract infection.
3- Mousy or musty odor : Phenylketonuria (PKU)
4- Fishy odor : Urinary tract infection with Proteus
5- Caramelized odor : Maple syrup urine disease (MSUD)
stool analysis
What’s stool analysis :
Series of tests done on a sample of stool (feces). It can find problems with
the digestive tract. These health problems can include infection, poor
nutrient absorption, or cancer.
Stool can be examined macroscopically, microscopically, chemically,

immunologically, and microbiologically.
Stool samples to be examined should be collected in a clean container,

fresh or kept under appropriate conditions.
Abnormal values
• High levels of fat in the stool may be caused by diseases such as
pancreatitis, sprue (celiac disease), cystic fibrosis, or other disorders
that affect the absorption of fats.
• The presence of undigested meat fibers in the stool may be caused by
pancreatitis.
• A low pH may be caused by poor absorption of carbohydrate or fat.
Stool with a high pH may mean inflammation in the intestine (colitis),
cancer, or antibiotic use.
• Blood in the stool may be caused by bleeding in the digestive tract.
Abnormal values
• White blood cells in the stool may be caused by inflammation of the intestines,
such as ulcerative colitis, or a bacterial infection.
• Rotaviruses are a common cause of diarrhea in young children. If diarrhea is

present, testing may be done to look for rotaviruses in the stool.
let’s Solve a real Report
Thank you!

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Session 4 -

By: Mariam Amri

Normal two hours postprandial level (2hr-PPG) is less than 140

Normal random blood glucose test (RBG test) is 80-140mg/dl

Or Macrovascular (Cardiovascular Complications)

the most sensitive test for detecting borderline diabetes

During pregnancy (gestational diabetes)

OGTT not used for:

4. Note the time of oral glucose administration.

By: Mariam Amri

B- Cholesterol ( Free and D- phospholipid

the candidate should be fasting from 10-12h and provide information

about any taken drugs .

Normal: 0.5 to 1.5 cc/kg/hour or 600 and 2,000 mL daily in adults

Polyuria (greater than 2,500 - 3,000 ml/day): Alcohol or caffeine

Normal: Yellow (light/pale yellow )

- Orange: Bile pigments, carrots, coumadin, nitrofurantoin, phenothiazines,

- Red: Beets, blackberries, chlorpromazine, food dyes, hematuria

- brown in case of bile acids

- Green/Blue: pseudomonal UTI, promethazine, Amitriptyline

Normal: freshly voided urine is clear.

Appearance of urine specimen depends on both its

Due to presence of crystalline or amorphous solids as well as blood and

Crystals are precipitated at certain pH, as shown in table below....

Normal specific gravity of urine is 1.010 to 1.025 .

Specific gravity is affected also by solute concentration like glucose and

Specific gravity of urine is a measure of concentrating ability of kidneys

Urine specific gravity is measured by urinometer or reagent strip

The pH of urine may range from 4.5 to 7

except after meals due to alkaline tide ( physiologically )

High Values (alkaline): Stale/old urine specimens (most common),

Low Values (acid): Cranberry juice, dehydration, diabetes mellitus, diabetic

After standing : old urine sample develops ammoniacal odor ;

Stool can be examined macroscopically, microscopically, chemically,

Stool samples to be examined should be collected in a clean container,

• Rotaviruses are a common cause of diarrhea in young children. If diarrhea is

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