information regarding diabetes

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Diabetes

Date : 9-2-2010Prepared by : Praveen Kumar

Reddy.A


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Diabetes :It is a Chronic (Long duration) Disease. It occurswhen the pancreas does not produce enoughinsulin or when the body doesnot effectivelyutilizes the insulin it produced. Insulin is a Harmoneproduced in a Pancreas which enables body cells toabsorb Glucose to turn in to energy. If the bodycells do not absorb the Glucose , Glucoseaccumulates in the blood leading to variousmedical complications.

They are many types of Diabetes. But only threetypes of Diabetes are regarded as a Significantone.1. Type 1 diabetes2. Type 2 diabetes3. Gestational diabetes

Type 1 diabetes :This type of diabetes results from bodys failure toproduce insulin. Type 1 diabetes may occur to bothChildren and Adult. This diabetes is regarded as a"juvenile diabetes" as this will occurs frequently tochildren. Person affected with this type of diseasehas to take insulin.

Main symptoms associated with Type 1 diabetesare1. Excessive excretion of Urine (Polyuria)2. Thirst (Polydipsia)3. Constant Hunger4. Weight loss5. Vision changes etc.,

Type 2 diabetes :This type of diabetes results when body does not


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properly utilizes insulin produced inside the body.Nearly 90% of diabetes cases are Type 2 diabetes.

This is regarded as a common diabetes.

All the symptoms of Type 2 diabetes are similar toType 1 diabetes but they are less marked. This typeof symptoms are seen only in Adults , but recentlythese symptoms also appearing in children.

Gestational diabetes :

Gestational diabetes mellitus (GDM) resemblestype 2 diabetes in several respects, involving acombination of relatively inadequate insulinsecretion and responsiveness. It occurs in about2%5% of all Error: Reference source not foundand may improve or disappear after delivery.Gestational diabetes is fully treatable but requirescareful medical supervision throughout the

pregnancy. About 20%50% of affected womendevelop type 2 diabetes later in life.

In additionPre diabetes is a condition that occurs when apersons blood glucose levels are higher than thenormal level but not high enough to recognize it as

a Type 2 diabetes. Many people spend in this statefor many years before it get turned in to type 2diabetes.

Common consequences of Diabetes :Over time, diabetes can damage the heart, bloodvessels, eyes, kidneys, and nerves .

1.Diabetes increases the risk of heart disease and


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stroke. 50% of people with diabetes die ofcardiovascular disease (primarily heart diseaseand stroke).

2. Combined with reduced blood flow, neuropathyin the feet increases the chance of foot ulcersand eventual limb amputation.

3. Diabetic retinopathy is an important cause ofblindness, and occurs as a result of long-termaccumulated damage to the small blood vesselsin the retina. After 15 years of diabetes,approximately 2% of people become blind, and

about 10% develop severe visual impairment.4. Diabetes is among the leading causes of kidneyfailure. 10-20% of people with diabetes die ofkidney failure.

5. Diabetic neuropathy is damage to the nervesas a result of diabetes, and affects up to 50% ofpeople with diabetes. Although many different

problems can occur as a result of diabeticneuropathy, common symptoms are tingling,pain, numbness, or weakness in the feet andhands.

The overall risk of dying among people withdiabetes is at least double the risk of their peerswithout diabetes.

Sugar levels for body :Normal level of Sugar in your blood before meal is70 to 110 mg/dl . After food level will be rise inbetween 110 to 140 mg/dl. The increased level ofsugar levels in blood above 140 mg/dl is

considered to be symptoms of diabetics. Low levelof sugar below 70 are also dangerous. It will leads


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to faintness.

They are Generally two types of tests conducted inorder to determine sugar levels in blood.1. Fasting plasma Glucose test.2. An Oral Glucose Tolerance test

In the first test , Sugar levels are monitored afterovernight fasting for 8 hours. If the sugar levelsinside the body are greater than 140 mg/dl , thenthe test is positive. If it happens to occur twicethen the candidate is suspected to have Diabetes.

In the second test , person was under fasting (fornot less than 10 hours) , Initial sugar levels ismeasured. After that a high amount of knownGlucose is given to person. Sugar levels aremonitored in regular intervals of time. If the personconsists of Sugar levels more than 200 mg/dl aftertwo hours , test is positive.

Sugar levels are carefully monitored . RegularSugar level monitoring in blood should not bepractical to perform in labs. So Sugar levels ofblood are monitored regularly. Regular monitoringtells you whether your lifestyle, your physicalactivity, meal plans, and medicines doing a good

job controlling your diabetes.

Also decision to decide insulin dosage requiresregular monitoring of glucose levels in blood.

They are two important self monitoring methods totest glucose levels in blood


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1. Finger Stick method.2. Noninvasive method.

Finger stick method :Most equipment for checking blood sugar levelinvolves pricking your finger with a tiny needle(lancet) to draw a drop of blood. Some draw theblood from your forearm. For reading your bloodsugar level, you can use a blood glucose meterthat will show the number on its screen.

Noninvasive method :

Any other blood sugar testing tool does not drawblood. You wear it on your wrist like a watch and ittakes the reading through your skin. It uses a slightelectrical current to pull fluid through the skin andinto the machine, where it measures the sugarlevel.

The watch can't replace your regular finger-stick

test. But the watch lets you see trends in how yourblood sugar changes over the course of theday.There are some guidelines to check yourdiabetes with noninvasive method.

Finger stick method :

Various types and brands of Glucometers are

available today are based on following twoprinciples

First principle :

A chemical is present on the test strip which oncontact with glucose produces a colour. The metermeasures this color intensity and the level of

glucose present is expressed in mg/dl.Second principle :


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The other type of glucometer measures the electriccurrent in the blood, which depends on the amountof glucose present. When blood is put on the teststrip, an enzyme transfers electrons from glucoseto a chemical in the test strip and the metermeasures the flow of the electrons as current. Theamount of current depends on the amount ofglucose present and the meter produces thereading in mg/dl.

First principle is related to Colorometric method.

Now we will concentrate on instruments based onthe Second principle.

Instruments based on Second principle :

They are three important components regardingGlucometer

1. Hand held meter

2. Test Strip

3. Lancet

A hand held meter with Test strip is as shown infigure


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Test strips are small disposable Electro chemicalcells which is contacted with whole blood. It thenproduces, in conjunction with a test meter, anelectrical current which is proportional to the bloodglucose concentration. Typical currents are a fewA.

This electrical current is produced by the veryselective oxidation of glucose in the blood sample,which is catalyzed by two reagents which areprecoated inside the test strip:

(i) an enzyme, which reacts directly with theglucose molecule to remove its two available

electrons, and
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(ii) a mediator molecule, which takes (either singlyor as a pair) the two electrons from the enzyme,and transports them to the working electrode,where they can be measured.

First Electro chemical blood glucose test strip1988

The mechanism happening in the Test strip isillustrated in the below figure
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The below diagram shows some commerciallyavailable test strips

Lancet is used to puncture the finger to take bloodsample. The meter undergo analysis and will giveresult with in a few seconds. ( typically 5 to 15seconds).

Accuracy of Self monitoring of Glucoselevels :Glucometer Readings are some times differentthan Laboratory Readings because

1.A 10-15% difference in readings - becauselaboratory uses plasma blood while glucometersuses whole blood.

2. Meters use capillary blood while laboratory uses


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venous blood. Capillary blood can give a slightlyhigher reading than venous blood.

The accuracy of the Glucose System was assessedper the ISO 15197.

Most meters have similar accuracy of plus or minus10 to 15 percent when used as directed. However,a variety of factors can affect the accuracy of thereading. Accuracy can depend on propercalibration of the glucometer, high levels of certaindrugs in the blood, the use of older test strips,proper cleaning of the meter itself and the size ofthe blood sample obtained for testing. Somemodels today have the ability to warn of inaccurateresults with error messages.

They are two types of Units in Glucose Reading 1.

mmol/liter , mg/dl.

To convert mmol/liter to mg/dl we multiply with 18.

To convert mg/dl to mmol/liter we divide it with 18.

Here is a further problem with blood glucosereadings: most meters give the result as how much

glucose is dissolved in a given amount of wholeblood. Whole blood is the red stuff that comes outof your finger.

But many laboratories, and some meters, quotethe result as how much glucose is in the bloodplasma . Plasma is the name for the liquid part ofyour blood. Blood is not just a red liquid. The"liquid" in your blood is actually clear, like water.Floating around in the liquid are various things,


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including tiny red blood cells which give the bloodits red color. The clear liquid is called plasma, andhas many nutrients, including glucose, dissolved init. (Sometimes a serum value is used: serum issimilar to plasma but has the blood clotting factorsremoved.)

When a doctor takes a blood sample from you, andsends it to a laboratory, the lab may first extract

just the plasma from the blood, and just test thisfor it's glucose content. They may do this byspinning it very fast in a centrifuge, so the blood

cells go to one end, and the clear liquid to theother.

The problem is that the clear plasma contains adifferent amount of glucose from the red wholeblood. The plasma reading is very slightly higherthan the whole blood reading. So when your doctorquotes a figure, you must check whether it's bloodplasma, or whole blood being referred to.

The whole blood figure is 12% lower than theplasma figure.

Whole blood is the lower figure, so multiply it by1.12 to get the equivalent plasma concentration;

Plasma is the higher figure, so divide it by 1.12 toget the whole blood figure.

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