endocrinology criteria diagnosis by yusti_zega

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									ENDOKRINOLOGI                                     dr.F.Z.P

Related Criteria for Diabetes, Nutrition and Endocrinology

   Pharmacokinetics of Insulin Preparations
   Diagnosis of Gestational Diabetes Mellitus (GDM)
   Criteria for the Diagnosis of Diabetes Mellitus
   Wagner and the University of Texas Wound Classification
    Systems of Diabetic Foot Ulcers
   International Clinical Diabetic Retinopathy and Diabetic
    Macular Edema Disease Severity Scales
   Criteria for the Metabolic Syndrome
   Body Mass Index (BMI) Calculator




Pharmacokinetics of Insulin Preparations
                                                          Time of Action
Preparation                                  Onset, h     Peak, h       Effective
                                                                        Duration, h
Short-acting, subcutaneous
  Lispro                                     <0.25        0.5–1.5       3–4
  Aspart                                     <0.25        0.5–1.5       3–4
  Glulisine                                  <0.25        0.5–1.5       3–4
  Regular                                    0.5–1.0      2–3           4–6
Short-acting, inhaled
  Inhaled regular insulin                    <0.25        0.5–1.5       4–6
Long-acting
  NPH                                        1–4          6–10          10–16
  Detemir                                    1–4          —a            12–20
  Glargine                                   1–4          —a            24
Insulin Combinations
  75/25–                                     <0.25        1.5 hb        Up to 10–16
  75% protamine lispro, 25% lispro
  70/30–                                     <0.25        1.5 hb        Up to 10–16
 70% protamine aspart, 30% aspart
  50/50–                                     <0.25        1.5 hb        Up to 10–16
 50% protamine lispro, 50% lispro
  70/30–                                     0.5–1        Dual          10–16
 70% NPH, 30% regular insulin
  50/50–                                     0.5–1        Dual          10–16
 50% NPH, 50% regular insulin

 a
  Glargine has minimal peak activity; detemir has some peak activity at 6–14 h.
 b
  Dual: two peaks; one at 2–3 h; the second several hours later.
Criteria for the Diagnosis of Diabetes Mellitus

1. Symptoms of diabetes plus casual plasma glucose concentration
200 mg/dl (11.1 mmol/l). Casual is defined as any time of day
without regard to time since last meal. The classic symptoms of
diabetes include polyuria, polydipsia, and unexplained weight loss.

or

2. Fasting Plasma Glucose (FPG) 126 mg/dl (7.0 mmol/l). Fasting is
defined as no caloric intake for at least 8 h.

or

3. 2-h postload glucose 200 mg/dl (11.1 mmol/l) during an Oral
Glucose Tolerance Test (OGTT). The test should be performed as
described by WHO, using a glucose load containing the equivalent of
75 g anhydrous glucose dissolved in water.




In the absence of unequivocal hyperglycemia, these criteria should be
confirmed by repeat testing on a different day. The third measure
(OGTT) is not recommended for routine clinical use.
Diagnosis of Gestational Diabetes Mellitus (GDM)

Screening for gestational diabetes mellitus

    1. 50-g oral glucose load, administered between the 24th and
       28th weeks, without regard to time of day or time of last
       meal. Universal blood glucose screening is indicated for
       patients who are of Hispanic, African, Native American,
       South or East Asian, Pacific Island, or Indigenous Australian
       ancestry. Other patients who have no known diabetes in first-
       degree relatives, are under 25 years of age, have normal
       weight before pregnancy, and have no history of abnormal
       glucose metabolism or poor obstetric outcome do not require
       routine screening.
    2. Venous plasma glucose measure 1 hour later.
    3. Value of 130 mg/dL (7.2 mmol/L) or above in venous
       plasma indicates the need for a full diagnostic glucose
       tolerance test.

Diagnosis of gestational diabetes mellitus

The diagnosis of GDM is based on an OGTT. Diagnostic criteria for
the 100-g OGTT are derived from the original work of O’Sullivan
and Mahan modified by Carpenter and Coustan. Alternatively, the
diagnosis can be made using a 75-g glucose load and the glucose
threshold values listed for fasting, 1 h, and 2 h; however, this test is
not as well validated as the 100-g OGTT.
Diagnosis of GDM with a 100-g or 75-g glucose load

                                           mg/dl                mmol/l
100-g glucose load
Fasting                                     95                   5.3
1-h                                         180                  10.0
2-h                                         155                  8.6
3-h                                         140                  7.8
75-g glucose load
Fasting                                     95                   5.3
1-h                                         180                  10.0
2-h                                         155                  8.6

  Two or more of the venous plasma concentrations must be met
  or exceeded for a positive diagnosis. The test should be done in
  the morning after an overnight fast of between 8 and 14 h and
  after at least 3 days of unrestricted diet (>150 g carbohydrate
  per day) and unlimited physical activity. The subject should
  remain seated and should not smoke throughout the test.
Wagner and the University of Texas Wound Classification
Systems of Diabetic Foot Ulcers

Wagner Classification of Diabetic Foot Ulcers

Grade 0: No ulcer in a high risk foot.
Grade 1: Superficial ulcer involving the full skin thickness but not
underlying tissues.
Grade 2: Deep ulcer, penetrating down to ligaments and muscle, but
no bone involvement or abscess formation.
Grade 3: Deep ulcer with cellulitis or abscess formation, often with
osteomyelitis.
Grade 4: Localized gangrene.
Grade 5: Extensive gangrene involving the whole foot.
University of Texas Wound Classification System of Diabetic
Foot Ulcers

Grade I-A: non-infected, non-ischemic superficial ulceration
Grade I-B: infected, non-ischemic superficial ulceration
Grade I-C: ischemic, non-infected superficial ulceration
Grade I-D: ischemic and infected superficial ulceration

Grade II-A: non-infected, non-ischemic ulcer that penetrates to
capsule or bone
Grade II-B: infected, non-ischemic ulcer that penetrates to capsule or
bone
Grade II-C: ischemic, non-infected ulcer that penetrates to capsule or
bone
Grade II-D: ischemic and infected ulce
								
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