Summarize the following text to main points and sub-points and make detailed explain for them:

nack. 
4. Increasing exercise or physical activity without eating more or 
adjusting medications. 
 
183 
 
16.BLOOD GLUCOSE 
ﺩ.ﺯﻫﺮﺍﺀ ﺟﻤﻴﻞ ﻋﺰﻳﺰ
 
ﺭﺋﻴﺲ ﺗﻘﻨﻲ ﺗﺤﻠﻴﻠﺎﺕ ﻣﺮﺿﻴﻪ ﺃﻗﺪﻡ ﺣﺴﻦ ﻋﺒﺪ
 
ﺍﻟﺮﺣﻴﻢ
 
5. Drinking alcohol. 
4.5.7.3Why is Grey tube used for glucose test? 
This tube contains potassium oxalate as an anticoagulant and 
sodium fluoride oxalate as a preservative used to preserve glucose in 
whole blood and for the test. 
According to that, we need 1ml of serum or plasma (fasting or two 
hours specimens, separate serum or plasma from cells within 30 
minutes of venipuncture, use Grey tubes and each tube should be 
labeled with patient name, date, and collection time interval. 
4.5.8 Glucose Tolerance Test (GTT) 
This test used to can be diagnosis diabetes, prediabetic and 
gestational diabetic   
a. The ability to utilize carbohydrates can be determined by Glucose 
tolerance test. 
b. The blood glucose levels are estimated at regular intervals after 
the glucose load 
c. In conditions of insulin deficiency or resistance, blood glucose 
levels get elevated due to impaired utilization of glucose. 
4.5.8.1 Procedure of Standard Oral Glucose Tolerance Test 
A. At about 8 a.m. the fasting blood and urine samples are collected. 
These are called zero samples. 
B. A loading dose of 75 g. anhydrous glucose dissolved in 250-300 
ml of water is given to the patient. 
In children 1.75 g of glucose /kg body weight is given. 
 
 
 
184 
 
16.BLOOD GLUCOSE 
ﺩ.ﺯﻫﺮﺍﺀ ﺟﻤﻴﻞ ﻋﺰﻳﺰ
 
ﺭﺋﻴﺲ ﺗﻘﻨﻲ ﺗﺤﻠﻴﻠﺎﺕ ﻣﺮﺿﻴﻪ ﺃﻗﺪﻡ ﺣﺴﻦ ﻋﺒﺪ
 
ﺍﻟﺮﺣﻴﻢ
 
Procedure 
a. In the classical procedures, the blood and urine samples are 
collected at half hourly interval of the next two and a half hour or 
three hours. 
b. Glucose is estimated in all the blood samples. 
Table (4-5):  Laboratory profile of a normal person after glucose load 
 
Fasting 
(Zero 
sample) 
30 
minutes 
60 
minutes 
90 
minutes 
120 
minutes 
150 
minutes 
180 
minutes 
Blood 
glucose 
(mg/dl) 
90 
 
100 
150 
120 
110 
80 
70 
Urinary 
glucose 
nil 
nil 
nil 
nil 
nil 
nil 
nil 
Fasting blood glucose (Zero hour sample) is 90 mg /dl, which is well 
within the normal range (Normal60-100 mg/dl) see table (4-5). 
- There is rise of blood glucose after glucose load and the peak 
value is observed at I hour. 
- This is due to absorption of glucose from the intestine. 
- Insulin is released upon increase of blood glucose level. There is 
fall in blood glucose as shown in figure (4-7). 
- With time due to glucose utilization promoted by insulin. 
- The normal blood glucose level is achieved after 150 minutes. 
 
185 
 
16.BLOOD GLUCOSE 
ﺩ.ﺯﻫﺮﺍﺀ ﺟﻤﻴﻞ ﻋﺰﻳﺰ
 
ﺭﺋﻴﺲ ﺗﻘﻨﻲ ﺗﺤﻠﻴﻠﺎﺕ ﻣﺮﺿﻴﻪ ﺃﻗﺪﻡ ﺣﺴﻦ ﻋﺒﺪ
 
ﺍﻟﺮﺣﻴﻢ
 
 
Figure (4-7): Normal Glucose tolerance curve 
Table (4-6):  Laboratory profile of a diabetic patient after glucose load 
 
Fasting 
(Zero 
sample) 
30 
minutes 
60 
minutes 
90 
minutes 
120 
minutes 
150 
minutes 
180 
minutes 
Blood 
glucose 
(mg/dl) 
200 
 
225 
350 
300 
275 
250 
225 
Urinary 
glucose 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
1. Fasting blood glucose is higher than normal see tabling (4-6). 
2. The highest value is attained at 1 hour to 1 hour 30 minutes. 
3. The highest value exceeds the renal threshold. 
4. Glucose is found in almost all the urine samples. 
5. The blood glucose level does not return to the fasting level even 
within 2hour 30 minutes. 
4.5.8.2 Indication of OGTT 
- Screening for Gestational DM (24-28 weeks of pregnancies). 
- To discrim8nate diabetes from prediabetes (when other glucose 
parameters are discripant or lies in the prediabetes range. 
 
186 
 
16.BLOOD GLUCOSE 
ﺩ.ﺯﻫﺮﺍﺀ ﺟﻤﻴﻞ ﻋﺰﻳﺰ
 
ﺭﺋﻴﺲ ﺗﻘﻨﻲ ﺗﺤﻠﻴﻠﺎﺕ ﻣﺮﺿﻴﻪ ﺃﻗﺪﻡ ﺣﺴﻦ ﻋﺒﺪ
 
ﺍﻟﺮﺣﻴﻢ
 
- Evaluation of patients with unexplained neuropathy, nephropathy, 
and retinopathy along with single random blood glucose more than 
200 mg/dl. 
4.5.8.2.1 Preparation of the patient 
1. The patient must be free from fever, acute illness, and trauma for 
at least two weeks before this test. 
2. The patient should be on diet containing at least 150 g of 
carbohydrate/day for at least three day before the test (patient 
should not be in a diet with restricted CHO  
) . 
3. Any drug interfacing with blood glucose should be stop for 3 
days before this test. 
4. Patient should be fasting for 8-12 hours. 
5. No physical exercise is allowed during the test and patient should 
be in sitting position and avoid smoking before and during the 
test. 
4.5.9 HbA1c 
- Glycated haemoglobin is a form of hemoglobin that is measured 
primarily to identify the three month average plasma glucose 
concentration because the lifespan of a red blood cell is three 
months(120Days) 
- It is formed in a non-enzymatic glycation pathway by 
haemoglobin exposure to plasma glucose. 
4.5.9.1 What does the A1c test measure? 
1. Normally, some of the glucose (sugar) in the bloodstream 
attaches itself to haemoglobin. 
2. Once the sugar is attached to the haemoglobin, it stays there for 
the life of the red blood cell, which is about 120 days (3 months). 
 
187 
 
16.BLOOD GLUCOSE 
ﺩ.ﺯﻫﺮﺍﺀ ﺟﻤﻴﻞ ﻋﺰﻳﺰ
 
ﺭﺋﻴﺲ ﺗﻘﻨﻲ ﺗﺤﻠﻴﻠﺎﺕ ﻣﺮﺿﻴﻪ ﺃﻗﺪﻡ ﺣﺴﻦ ﻋﺒﺪ
 
ﺍﻟﺮﺣﻴﻢ
 
3. When blood glucose levels are high, glucose molecules attach 
more readily to the haemoglobin in red blood cells. The longer 
hyperglycaemia occurs in blood, the more glucose binds to 
haemoglobin in the red blood cells and the higher the glycated 
haemoglobin and the higher of haemoglobin which is 
glycosylated (HbA1c). 
4. HbA1c concentrations therefore are widely used to blood glucose 
determinations for monitoring long-term glycemic control. 
5. In addition, HbA1c has recently been recommended for the 
diagnosis   of diabetes and is a measure of risk for the 
development of micro vascular complications of diabetes. 
6. Interpretation of HbA1c depends on RBCs having a normal life 
span. 
7. Patients with hemolytic disease or other conditions with 
shortened RBC survival exhibit misleading reduction in HbA1c, 
while patients with iron deficiency anemia exhibit a misleading 
increase in HbA1c. 
4.5.9.2 Reference values of HbA1c 
1. 4.5-5.6%- Normal. 
2. 5.7-6.4%- prediabetes. 
3. More than 6.5%- Diabetics. 
4. 6.6-7%- Adequate control. (Different targets can be decided by 
the specialist doctor) 
5. 7-8%- Inadequate control. (Different targets can be decided by 
the specialist doctor) 
6. More than 9% Very poor control. 
 
188 
 
17.TOTAL SERUM BILIRUBIN ﺩ.ﺣﺎﻣﺪ ﺟﺪﻭﻉ ﻋﺒﺎﺱ
 
ﻛﻴﻤﻴﺎﻭﻱ ﺃﻗﺪﻡ ﺍﻧﻔﺎﻝ ﺻﻠﺎﺡ ﺳﻤﻴﻦ
 
4.6 Jaundice 
 Is a yellowish discoloration of skin and sclera of the eye as shown 
in figure (4-8), due to high serum bilirubin levels. 
 
Figure (4-8): yellowish in sclera of the eye 
4.6.1 The causes of jaundice may be classified as: 
1. Pre-hepatic jaundice: 
    It is caused by anything that causes increased hemolysis rate of 
RBCs. The production of un-conjugated bilirubin may exceed the 
conjugating capacity of the liver, and hence the serum levels of indirect 
and total bilirubin will be raised. There is increased production of urine 
Urobilinogen with no bilirubin in urine. 
2. Hepatic jaundice:  
The pathological is located within the liver. There will be 
increased levels of both conjugated and unconjugated bilirubin in blood. 
3. Post- hepatic jaundice (obstructive):   
The conjugated is bilirubin regurgitated into the blood and 
excreted into the urine (raised conjugated and total bilirubin). The 
patient has pale stool, dark bilirubin, absent urobilinogen and itching 
due to bile acid deposition. As shown in figure (4-8). 
 
 
 
 
 
 
189 
 
17.TOTAL SERUM BILIRUBIN ﺩ.ﺣﺎﻣﺪ ﺟﺪﻭﻉ ﻋﺒﺎﺱ
 
ﻛﻴﻤﻴﺎﻭﻱ ﺃﻗﺪﻡ ﺍﻧﻔﺎﻝ ﺻﻠﺎﺡ ﺳﻤﻴﻦ
 
 
 Figure (4-9): Types of jaundice major cause 
4.6.2 Neonatal jaundice 
 
The medical term for jaundice in newborn baby is neonatal 
jaundice (Unconjugated hyperbilirubinemia). It is usually harmless, but 
can cause kernicterus. 
4.6.2.1 Classification of neonatal jaundice 
1. Physiological jaundice:  
a. Appears after 24 hours of age. 
b. Increase of bilirubin < 5 mg/dl/day. 
c. TSB < 15 mg /dl. 
 
190 
 
17.TOTAL SERUM BILIRUBIN ﺩ.ﺣﺎﻣﺪ ﺟﺪﻭﻉ ﻋﺒﺎﺱ
 
ﻛﻴﻤﻴﺎﻭﻱ ﺃﻗﺪﻡ ﺍﻧﻔﺎﻝ ﺻﻠﺎﺡ ﺳﻤﻴﻦ
 
d. Clinically note detectable after 14 days as shown in figure (4-10). 
e. Maximum intensity by 4th- 5th day in full-term & 7th day in 
preterm. 
f. Disappears without treatment. 
2. Pathological jaundice:  
a. Appears within 24 hours of age. 
b. Increase of bilirubin > 5 mg/dl/day. 
c. TSB > 15 mg /dl. 
d. Jaundice persisting after 14 days in full-term babies. 
e. Direct bilirubin > 2mg/dl or > 20% of TSB. 
f. Treatment is needed. 
 
            Figure (4-10): Jaundice in Newborns 
Treatment: Neonatal jaundice can be treated by blood transfusion or 
phototherapy as shown in figure (4-11), (4-12). 
 
Figure (4-11): Replace the baby’s blood 
with blood from a matching donor.The 
bilirubin-heavy blood will be replaced 
with bilirubin-free blood reducing levels 
quickly. 
Figure (4-12): Lower newborn’s level of bilirubin with 
phototherapy , baby will be placed under special lighting 
that emits blue-green light. This changes the shape and 
s

Summary :