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Fig. 11.1 Plasma [glucose] changes in response to an oral glucose tolerance test. The shaded
area indicates the approximate limits within which responses to a 75 g load of anhydrous
glucose normally fall.

Glucose can be detected in urine specimens collected after the renal threshold for glucose has been exceeded; the normal threshold corresponds to a plasma [glucose] of 10 mmol/L, and the lowered threshold in patients with renal glucosuria to a lower level of plasma [glucose]. The various responses to the glucose tolerance test are described in greater detail in the text

Oral glucose tolerance test (GTT) (Fig. 11.1)

The main value of a GTT is that it may help to establish the
diagnosis of diabetes mellitus or impaired glucose tolerance at
a time when the metabolic abnormality is mild. The GTT is
particularly valuable in the diagnosis of impaired glucose
tolerance in pregnancy (p. 316). Several precautions must be
observed in prepar\u00ading for and in performing the test.

Before the test

It should not be performed on patients who are suffering from
the effects of trauma or recovering from a serious illness. It
should also be delayed if the patient has an intercurrent
infection. Drugs such as corticosteroids and diuretics may
impair glucose tolerance; they should be stopped before the
test, if possible

The patient should have been on an unrestricted diet
containing at least 150 g carbohydrate/day for at least 3 days,
and should not have indulged in unaccus\u00adtomed amounts of
exercise. The patient must not smoke on the day of the test,
either: before or during the test, nor eat or drink anything
other than as specified

below.
Performing the test

A GTT is usually performed after an overnight fast,
although a fast of 4\u00ad5 hours mad, be enough. The patient is
allowed to drink water during the fast, and may have a cup of
unsweetened tea before the test; this helps to reduce any
tendency to nausea that might otherwise be caused by the oral
glucose drink.

Astandard dose of glucose (82.5 g glucose monohydrate

or 75 g anhydrous glucose) dissolved in 250\u00ad350 mL of water,
lemon\u00adflavoured or chilled (or both) to avoid nausea, is given
by mouth. Smaller amounts of glucose (1.92 g glucose
monohydrate or 1.75 g anhydrous glucose/kg body weight)
should be given to children or small adults to a maximum dose
of 82.5 g glucose monohydrate or 75 g anhydrous glucose.

During the test the patient should be sitting up, or lying
over on the right side so as to facilitate rapid emptying of the
stomach,not lying flat or over on the left side.

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