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A patient who weighs 135 kg with extreme abdominal obesity
and metabolic syndrome, is given an order for a oral glucose tolerance
test.
What should the dose of the glucose be?
1. 75 grams
2. 100 grams
3. 110 grams
4. 1.75 grams of glucose per kilogram
For adults, there are no recommendations from the American Diabetes
Association (ADA) or World Health Organization (WHO) to alter the dose
of the oral glucose challenge based on absolute body mass, lean body
mass, or body surface area. At one time, up to 100 grams of glucose
were recommended for OGTTs. However, for nonpregnant adults, ADA long
ago standardized the dose to 75 grams. In children, 1.75 grams of glucose
are used per kilogram to a maximum dose of 75 grams. Also, there are
no reference ranges for expected glucose responses to different doses
of glucose. Likewise, there are no reference ranges for expected glucose
responses in different weight individuals. In short, if we are going
to use the current ADA guidelines for the diagnosis of prediabetes or
diabetes, a 75-gram OGTT should be performed.
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