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Laboratory findings in diabetes mellitus

Laboratory  findings in diabetes mellitus


1 - Hyperglycemia


- Glucose level may exceed 200 mg/ dl or more

- When the level of blood glucose exceed the renal threshold , glucose will descend in the urine causing glucosuria .


2 - Lipemia and Ketonemia


- When glucose utilization diminished in diabetic animals , metabolism turns to utilization of fatty acids as a source of energy .


- Mobilization of body fat occurs and utilization by the liver .

Lipemia occurs due to excessive mobilization of fat .


- Ketone bodies accumulates in the blood and then descend in the urine , so that ketonemia is followed by ketonuria and usually  occurs in the advanced stages of diabetes and accompanied with blood acidosis .


3 - Cholesterol level


- Hypercholesterolemia , which indicate chronicity and severity of the disease ( it may reach 300- 900 mg/dl ) .


4 - Acidosis


- Vomiting occurs due to the accumulation of ketone bodies in the blood and acidosis leads to loss of potassium , sodium and chloride .

- Decrease of bicabonates  and P co2 due to hyperpnoea .


5 - Electrolytes balance 


- Sodium and potassium are also lost by renal excretion of acetoacetic acid and beta hydroxy butyric acid , which are strong acids

- Hyperkalemia may occur terminally due to severe acidosis . 

6 - Dehydration 
- Dehydration and acidosis may result in collapse and coma . 

7 - Hemogram 

- Leukocytosis may occur when when there is concurrent  infection . 
- Hemolysis of blood is frequently present in the lipimic blood due to increase susceptibility of the erythrocytes to hemolysis when achylomirca present in large number .
 - Eosinopenia and lymphopenia  indicating stress 
  
8 - Serum enzyme activity 

- Amylase enzyme increase when there is a cute pancreatitis  associated with the case 
- ALT& AP increased due to fatty metamorphosis of the liver . 

9 - Blood - urea nitrogen and serum creatinine levels 
- Uremia occurred frequently due to dehydration ( pre-renal uremia ) 
- BUN & creatinine usually increase in cases where renal failure is developed in advanced cases of diabetes mellitus and they measured for for prognostic purposes 

10 - Increased glycosylated hemoglobin  
- Diabetic patients that are on a long term of insulin therapy should be monitored on a regular basis . The use of glycosylated hemoglobin has been recommended . 
- The rate of glycosylation of hemoglobine depends up  on the nature and concentration of carbohydrates in the erythrocytes over a time . 
- Because erythrocytes are insulin - independent cell , intracellular glucose increases as plasma glucose rises 
- Glycosylated hemoglobin is in low concentration in red cells of clinically normal cases and is found in increased amounts in patients with uncontrolled diabetes 
- The level of glycosulated hemoglobin indicates blood glucose level over the previous 2 - 3 weeks before measurements . 

11 - Urinalysis 
 a- Glucosuria 
b - Polyuria 
c - Increased specific gravity of the urine due  to glucose 
( 0.004 units of sp. gr is increased for each gram /dl of urine ) , So that increases in the sp, Gr is minimal and affected by amount of water intake . 
d - Ketonuria  occurs in the advanced diabetes and not detected in mild cases of diabetes . 
e - Proteinuria : I t is observed in the  diabetic patients with uncontrolled blood glucose level and changes in the basement memberan in the kidney glomerulus have occured . U rine casts may be observed in the animals with protienuria . 
f - Anuria can be occurred in seriously  ill diabetic patients .

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