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Old 07-14-2012
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ObGyn Gestational Diabetes; Diagnostic Criteria and Glucose Levels!

If the FBS >95... My understanding is that this is overt diabetes mellitus. Do you screen still screen with the three hour OGTT or do you stop there?

At what point do we begin the three hour OGTT?
Is it when the FBS <95 or when its <126?

This part of the screening really confuses me. I would appreciate if someone can clarify this. thank you.
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the purpose of doing the OGTT is to diagnose DM.
if you have already diagnosed overt DM --- no need to do the 3 hour OGTT.

overt DM will be diagnosed as ---- a random BSL >200 and a FBS>75


if it is anything less the the above value... but more than the normal value... you will go in for OGTT
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Quote:
Originally Posted by mbbs2010 View Post
the purpose of doing the OGTT is to diagnose DM.
if you have already diagnosed overt DM with the FBS being over 95 --- no need to do the 3 hour OGTT.
Yes, this is what I thought. but someone was telling me that you still have to carry out the three hour test if fasting blood sugar is under 126... So that confused me a little. thanks for clarifying.
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Quote:
Originally Posted by usmledee View Post
Yes, this is what I thought. but someone was telling me that you still have to carry out the three hour test if fasting blood sugar is under 126... So that confused me a little. thanks for clarifying.
You will.

First you need to do 50g OGTT, if >140 ➡ Proceed with FBS. WHat if >200? Proceed still

then FBS scenario#1 if >125 then STOP! it its OVERT DM
scenario#2 if >95, check previous 50g OGTT.
if previous 50g oGTT is >200 Stop! It is GDM
if previous 50g OGTT is <200 CONTINUE with 3h
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Quote:
Originally Posted by mbbs2010 View Post
the purpose of doing the OGTT is to diagnose DM.
if you have already diagnosed overt DM --- no need to do the 3 hour OGTT.

overt DM will be diagnosed as ---- a random BSL >200 and a FBS>75


if it is anything less the the above value... but more than the normal value... you will go in for OGTT
I don't understand ? Probably it's a typo.

Quote:
The following are the values which the American Diabetes Association considers to be abnormal during the 100 g of glucose OGTT:
Fasting blood glucose level ≥95 mg/dl (5.33 mmol/L)
1 hour blood glucose level ≥180 mg/dl (10 mmol/L)
2 hour blood glucose level ≥155 mg/dl (8.6 mmol/L)
3 hour blood glucose level ≥140 mg/dl (7.8 mmol/L)
Quote:
Non-challenge blood glucose tests
When a plasma glucose level is found to be higher than 126 mg/dl (7.0 mmol/l) after fasting, or over 200 mg/dl (11.1 mmol/l) on any occasion, and if this is confirmed on a subsequent day, the diagnosis of GDM is made, and no further testing is required.[5] These tests are typically performed at the first antenatal visit.
Impaired fasting glucose

Quote:
Impaired fasting glucose (IFG), more commonly known as pre-diabetes refers to a condition in which the fasting blood glucose level is consistently elevated above what is considered normal levels; however, it is not high enough to be diagnosed as diabetes mellitus.
ADA criteria: fasting plasma glucose level from 5.6 mmol/L (100 mg/dL) to 6.9 mmol/L (125 mg/dL).

Last edited by Novobiocin; 07-14-2012 at 07:55 PM.
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Quote:
Originally Posted by Novobiocin View Post
I don't understand ? Probably it's a typo.





Impaired fasting glucose
Sorry...I must be getting dizzy after seeing all these numbers... Let me just try to get this straight.... If you do the FBS....and it measures under 126, but it's above 95 (I.e. between 95-126).... You don't consider that gestational DM and will proceed with the with the 3 hr OGTT.?
Please help me get this clarified once and for all...
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Old 07-15-2012
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2 clarifications ----
firstly the value in the above post should be >95 (not >75 --typo)
2ndly ----- if your FBS is more than 95 you DONOT NEED TO GO ON WITH OGTT.

CHECK OUT THE LATEST VERSION OF KAPLAN OBGYN NOTES --- PG 90 (last line of the screening paragraph)
(QUOTE ---"IF THE RANDOM SCREENING VALUE (non fasting) is over 200mg/dl , the FBS is >95mg/dl ----GDM is diagnosed and NO FURTHER OGTT is required.)



so here is the algorithm ---


1- female comes in between 24-28 weeks. (if with risk factore -- done at 1st prenatal visit and then repeated at 24-28 weeks)

2- check the RANDOM BSL (not fasting)
values:--
<140 ----- normal
140-200 -------OGTT
>200----- GDM DIAGNOSED


3- for values between 140-200mg/dl NOW patient comes FASTING.
--->first check FBS ---- if >95 ---- GDM diagnosed --- no need to go on with test.
--->else administer 100g Glucose.
check values at 1 hours (normal <180) 2 hours (normal <155) and 3 hours(normal <140)

if any 2 out of 4 values ie FBS/1 hour/2 hour/ 3 hour is abnormal ---GDM diagnosed.
proceed with management.
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Quote:
Originally Posted by usmledee View Post
Sorry...I must be getting dizzy after seeing all these numbers... Let me just try to get this straight.... If you do the FBS....and it measures under 126, but it's above 95 (I.e. between 95-126).... You don't consider that gestational DM and will proceed with the with the 3 hr OGTT.?
Please help me get this clarified once and for all...
No, that's not for Gestational Diabetes. Those are for the regular garden variety Diabetes. I put it in there for comparison.
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Quote:
Originally Posted by mbbs2010 View Post
[B] if your FBS is more than 95 you DONOT NEED TO GO ON WITH OGTT.


But you don't do FBS unless you are doing 100g oGTT
Quote:
Originally Posted by mbbs2010 View Post

CHECK OUT THE LATEST VERSION OF KAPLAN OBGYN NOTES --- PG 90 (last line of the screening paragraph)
(QUOTE ---"IF THE RANDOM SCREENING VALUE (non fasting) is over 200mg/dl , the FBS is >95mg/dl ----GDM is diagnosed and NO FURTHER OGTT is required.)
Quote:
Originally Posted by mbbs2010 View Post


so here is the algorithm ---


1- female comes in between 24-28 weeks. (if with risk factore -- done at 1st prenatal visit and then repeated at 24-28 weeks)

2- check the RANDOM BSL (not fasting)
values:--
<140 ----- normal
140-200 -------OGTT
>200----- GDM DIAGNOSED


3- for values between 140-200mg/dl NOW patient comes FASTING.
--->first check FBS ---- if >95 ---- GDM diagnosed --- no need to go on with test.
--->else administer 100g Glucose.
check values at 1 hours (normal <180) 2 hours (normal <155) and 3 hours(normal <140)

if any 2 out of 4 values ie FBS/1 hour/2 hour/ 3 hour is abnormal ---GDM diagnosed.
proceed with management.
what happened to 50g oGTT ?
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Quote:
Originally Posted by Novobiocin View Post
But you don't do FBS unless you are doing 100g oGTT
yup technically you are right.

let me be more clear.

when the patient comes fasting... YOU FIRST CHECK THE FBS.
if that is more than 95.... then that gives you a diagnosis then and there... and you DONOT NEED TO GO ON WITH THE administration of the 100g Oral Glucose to check with the rest of the values at 1,2,3 hours...




the OGTT is done with 100g glucose.


after the baby is delivered.... the test is done again with the 2 hour -- 75g glucose to check for glucose intolerance
which if positive signifies increased risk of DM in the next 10 years.



(the values of the glucose used always confused me. so dr.sakala gave us these 2 to remember and forget everything else...
thats what im doin to avoid confusion on the test day)

hope that helps.
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But as neoeinstein mentioned won't you do the 50g OGTT as the screening test first?
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Quote:
Originally Posted by Novobiocin View Post
what happened to 50g oGTT ?
that is what you need for screening @ 24-28 weeks. (the random screen.. without fasting.. checked after 1 hour of administration)


(wanted to edit that out in the algorithm above but ran out of the time limit within which you can edit the post... sorry about that)
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Old 02-19-2013
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Quote:
Originally Posted by neoeinstein View Post
First you need to do 50g OGTT, if >140 ➡ Proceed with FBS. What if >200? Proceed still

then FBS scenario#1 if >125 then STOP! it its OVERT DM
scenario#2 if >95, check previous 50g OGTT.
if previous 50g oGTT is >200 Stop! It is GDM
If previous 50g OGTT is <200 CONTINUE with 3h
I was reviewing this topic and this by far the best explanation.

So,

If previous 50g oGTT >200 + FBS >95 at the start of 100g OGTT-------> Gestational DM

If FBS >125 at the start of 100g OGTT --------------------------------> OVERT DM

In both cases DO NOT give 100g Glucose
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Last edited by Novobiocin; 02-19-2013 at 05:35 PM.
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