estimation of blood glucose in diabetes mellitus
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Estimation of blood glucose in diabetes
mellitus
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Blood glucose
Blood glucose is normally maintained within a narrow range under various conditions insulin and glucagon, and other hormones as growth hormone and cortisol.
The most common disorder of carbohydrate metabolism is diabetes mellitus characterized by high blood glucose level
Measurement of blood glucose is one of the most commonly performed tests in clinical biochemistry labs of hospitals
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Diabetes Mellitus: Common signs, symptoms and Lab
results
Hyperglycemia
Polyuria and glucosuria
Polydipsia
Polyphagia
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Laboratory tests for glucose
Fasting plasma glucose is measurement of plasma glucose after 8 hours of fasting (no caloric intake)
Normal level: 3.9-5.6 mmol/l (70-100 mg/dL).
OGTT (Oral Glucose tolerance Test) and
2-hour post-prandial test:Serial measurement of plasma
glucose before and after a specific amount of glucose given orally (75g glucose)
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Impaired glucose tolerance
When fasting plasma glucose or 2-hour postprandial glucose level is above normal but below diabetic level
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Criteria for Diagnosis of DM*
*American Diabetes Association (ADA), 2015
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Hemoglobin A1C (A1C) is produced due to non-enzymatic glycosylation of hemoglobin
It is used to estimate glycemic control in the last 1-2 months
Recommended for the detection of type 2 DM
HBA1C and fasting plasma glucose are effective in diagnosing diabetes
Cut-off point of 6.5 % is used to diagnose diabetes
HEMOGLOBIN A1C
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Comparison of type 1 and type 2 DM
Type 1 Diabetes Type 2 Diabetes
Age of onset Usually during childhood or puberty
Frequently after age 35
Prevalence % 10% of diagnosed diabetics
90% of diagnosed diabetics
Defect or deficiency
β cells are destroyed, eliminating insulin production
Insulin resistance combined with inability of β cells to produce appropriate quantities of insulin
Ketoacidosis Common rare
Plasma Insulin Low to absent High early in disease; low in disease of long duration
Treatment Insulin is always necessary
Diet, exercise, oral hypoglycemic drugs, +/- insulin
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Acetone (excreted by lungs, characteristic smell in diabetic ketoacidotic patients)
Acetoacetate
β-Hydroxybutyrate
Produced by the liver and utilized for
energy production by peripheral tissues
Ketone Bodies
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Blood glucose Assay
Blood glucose is detected by a series of enzymatic reactions that ultimately form a colored product.
The intensity of color is proportional to the amount of glucose present in blood
Color intensity is determined spectrophotometerically by measuring the absorbance of the colored solution at a wavelength of 546nm
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Procedure
Test Standard Blank
Reagent 2.5 ml 2.5 ml 2.5 ml
sample 25 l - -
Standard - 25 l -
H2O - - 25 l
Mix and incubate for 10 minutes at room temperatureMeasure absorbance at 546 nm
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Calculation
Glucose conc (mmol/l) =
Abs of sample
Abs of standardX Conc of standard (5.6
mmol/l)
Plasma Glucose: …………………………………………
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Normal blood glucose range
3.9–5.6 mmol/L (70–100 mg/dL )
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Urine analysis using dipstick:
Principle:Dipsticks are plastic strips impregnated with chemical reagents which react with specific substances in the urine to produce color-coded visual results
They provide quick determination of pH, protein, glucose and ketones. The depth of color produced is proportional to the conc. of the substance in urine
Color controls are provided against which the actual color produced by the urine sample can be compared
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Procedure:
Dip the dipstick in the urine sample provided
Remove it immediately
Wipe off the excess urine
Read the color produced within 60 seconds
Compare color changes with the control charts provided
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Item Observation CommentProtein
Glucose
Ketones
pH
Chemical Properties: