Suez Canal University

Faculty of Medicine

Oral Glucose Tolerance Test

Contents

1. Definition
2. Indications
3. Procedure
4. Normal Sugar Curve
5. Diabetic Curve

6. Renal Glucosuria

Department of Biochemistry and

Molecular Biology
 1. Definition
 When diabetes is suspected, diagnosis can be confirmed by
a random blood glucose greater than 200 mg/dl or fasting
blood glucose greater than 126 mg/dl.

 In mild diabetes when there are normal fasting or random

glucose levels, Glucose tolerance test (GTT) is indicated.

Glucose tolerance test is the test done to check the capacity of

the body for utilizing a given amount of glucose & to determine
how quickly it is cleared from the blood.

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 Glucose tolerance test

 In a healthy individual, the

insulin response to a large oral
glucose dose is almost immediate.

It peaks in 30 to 60 minutes
and returns to normal levels
within 3 hours when sufficient
insulin is present to metabolize
the glucose ingested at the
beginning of the test.

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 2. Indications
• It is used for:
1- Detection of mild diabetes when there are normal fasting or
random glucose levels.
2- To ascertain the renal threshold for glucose

• It is indicated if:
1. Family history of diabetes.
2. Obesity.
3. Unexplained episodes of hypoglycemia.
4. History of recurrent infections (boils & abscesses)
5. In women, history of delivery of large infants, stillbirths,
neonatal death, and premature labor.
6. Transitory glycosuria or hyperglycemia during pregnancy,
surgery, trauma, stress, and MI.
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 Procedure

1. The patient is instructed not to restrict carbohydrate intake in

the days or weeks before the test

2. Ensure that the following drugs are discontinued 3 days before

the test because they may influence test results e.g. hormones,
oral contraceptives, steroids.. etc

3. Insulin and oral hypoglycemic should be withheld until the test

is completed and the test should not be done during an illness.

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4. Record the patient's weight.
a. Pediatric doses of glucose are based on body weight,
calculated as 1.75 g/kg not to exceed a total of 75 g.
b. Pregnant women: 100 g glucose
c. Nonpregnant adults: 75 g glucose

5. Samples of blood and urine are then taken every 0.5- 1 hour
for 2.5 hours and each is estimated for its glucose content.

6. A curve is prepared showing the relation between blood

glucose in mg% and time in hours.

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 A-NORMAL BLOOD SUGAR CURVE

1. Fasting blood glucose 70-110 mg%

A gradual increase to a peak which is

reached after 0.5- 1 hour.

This peak amounts to 120-140 mg%

i.e. always below the renal threshold
(180 mg%).

4. The gradual rise in concentration of blood glucose seen is due to

increased rate of absorption of glucose from intestine which exceeds
the rate of utilization by tissues.

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 A-NORMAL BLOOD SUGAR CURVE

5. A gradual decrease to the fasting level

is started after the peak is reached.
This is due to release of insulin from
the beta-cells of pancreas.
This released insulin produces
increased rate of glucose utilization

6. All urine samples are free from

glucose.

The total duration of curve is about two hours. A decrease below the
fasting level may occur after two hours due to overaction or
oversecretion of insulin.

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 B- DIABETIC BLOOD SUGAR CURVE

Mild Diabetes Severe Diabetes

Fasting Blood-1
Glucose %mg 140-160 %mg 180-200

: Peak -2
Time  After 1 Hour After 1 Hour
Value  %mg 200-250 %mg 300-400

Return to fasting -3
level after 2 hours Not reaching fasting level

Glucose in Urine -4 ++ ++++

In diabetes mellitus there is mild to severe deficiency of insulin with

a corresponding decrease in the rate of glucose utilization
i.e. decrease tolerance to carbohydrates

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 C- CURVE OF RENAL GLUCOSURIA

1- Here there is a congenital defect in

renal absorption of glucose from
glomerular filtrate.

2- This result from congenital

lowering of renal threshold
e.g. to 100-110 mg% (normal renal threshold = 180 mg%)

3- The pancreas, insulin release, glucose utilization are normal but

there is a glucosuria due to congenital lowering of renal threshold.

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 Diabetes Mellitus Renal Glucosuria

Lack or deficiency of insulin Congenital lowering of renal

Cause -1 i.e. the defect is in the threshold i.e. the defect is in
pancreas .the kidney

Urine Glucose -2 Present Present

Blood Glucose -3 Hyperglycemia Normal or even lowered

Pancreas -4 Diseased Normal

Kidney -5 Normal Diseased

Treatment -6 Insulin Intake Glucose Intake

Ketosis -7 Can occur if not treated Can occur if not treated