Case No 1

• Patient Profile: 32 years old male, BMI = 29.3 kg/m², waist circumference = 99 cm

• Family History: Stroke at 40, type 2 diabetes, obesity

• Laboratory Findings:

  • Fasting Plasma Glucose (FPG): 123 mg/dL, 118 mg/dL

  • HbA1c: 5.6%

  • Oral Glucose Tolerance Test (OGTT):

    • FPG = 121 mg/dL

    • 1 hour PG = 193 mg/dL

    • 2 hours PG = 186 mg/dL

• Diagnosis: Impaired fasting glucose (IFG) + Impaired glucose tolerance (IGT) / Prediabetes

Case No 2

• Patient Profile: 41 years old male, symptoms of polyuria, polydipsia, and 5 kg weight loss over 15 months, BMI = 32 kg/m²

• Family History: No significant history

• Laboratory Findings:

  • FPG: 115 mg/dL, 125 mg/dL

  • HbA1c: 6.4%

  • OGTT:

    • FPG = 124 mg/dL

    • 1 hour PG = 198 mg/dL

    • 2 hours PG = 208 mg/dL

• Diagnosis: Type 2 DM (slow progression of symptoms + 2 hours PG = 208 mg/dL)

• Risk Factors: Obesity, age considerations for type 1/type 2 DM

Case No 3

• Patient Profile: 29 years old female, 10 weeks pregnant, fetal macrosomia, symptoms of polyuria and polydipsia for 7-8 months, prior BMI = 30.5 kg/m²

• Personal History: Spontaneous abortion

• Laboratory Findings:

  • FPG: 124 mg/dL to 252 mg/dL

  • HbA1c: 9.3%

  • C peptide: 1.2 nmol/L

  • Anti-GAD antibodies: undetectable

• Diagnosis: Type 2 DM

• Differential Diagnosis:

  • Gestational DM: not tested between 24-28 weeks of pregnancy

  • Type 2 DM: obesity prior to pregnancy, macrosomia, slow symptom progression, undetectable Anti-GAD

  • Type 1: age, low C peptide (possible glucotoxicity)

Case No 4

• Patient Profile: 62 years old female, symptoms of polyuria, polydipsia, and 15 kg weight loss over 2 months, BMI = 34.2 kg/m²

• Family History: No significant history

• Laboratory Findings:

  • Plasma Glucose: 569 mg/dL

  • Serum Ketone: 7 mmol/L

  • Arterial pH: 6.9

  • Anion Gap: 16 mEq/L

  • Serum Bicarbonate: 9.2 mEq/L

  • Effective Serum Osmolality: 291.6 mOsm/kg

  • K+: 4.3 mEq/L, then 2.7 mEq/L after 3 hours

  • HbA1c: 15%

  • C peptide: 0.9 nmol/L

  • Anti-GAD: 1150 IE/mL

• Diagnosis: Severe Diabetic Ketoacidosis (DKA), Type 1 DM (positive Anti-GAD, ketoacidosis without acute illness, low C peptide)

Diagnostic Criteria for Diabetes (Page 6)

• A1C ≥ 6.5% (must be tested in a certified lab and standardized)

• FPG > 126 mg/dL (fasting = no intake for 8 h)

• OGTT: 2-h PG ≥ 200 mg/dL

• Random Glucose in hyperglycemia symptoms: ≥ 200 mg/dL

• Confirmation: Repeat testing if no unequivocal hyperglycemia

Categories of Increased Risk for Diabetes (Prediabetes, Page 7)

• IFG: FPG between 100 mg/dL and 125 mg/dL

• IGT: 2-h PG in 75-g OGTT between 140 mg/dL and 199 mg/dL

• A1C: 5.7% - 6.4%

• Risk Context: Continuous risk below lower limits, increasing with higher ranges

Screening and Diagnosis of Gestational Diabetes Melitus (GDM, Page 8)

• One-step strategy: 75-g OGTT performed at 24-28 weeks gestation for undiagnosed diabetes

• Diagnosis Values:

  • Fasting: ≥ 92 mg/dL

  • 1 h: ≥ 180 mg/dL

  • 2 h: ≥ 153 mg/dL

Diagnostic Criteria for DKA (Page 9)

• Normal DKA Criteria:

  • Arterial pH: 7.35-7.45

  • Serum Bicarbonate: 22-28 mEq/L

  • Serum/Ketone: negative

• Mild DKA:

  • Arterial pH: 7.25-7.30

  • Serum Bicarbonate: 15-18 mEq/L

• Moderate DKA:

  • Arterial pH: 7.00-7.24

  • Serum Bicarbonate: 10-15 mEq/L

• Severe DKA:

  • Arterial pH: <7.00

  • Serum Bicarbonate: <10 mEq/L

  • Glycemia: >250 mg/dL

  • Anion Gap: >12 mEq/L

  • Mental Status: stupor/coma