Diabetes

Date : 9-2-2010 Prepared by : Praveen Kumar Reddy.A

Diabetes : It is a Chronic (Long duration) Disease. It occurs when the pancreas does not produce enough insulin or when the body doesnot effectively utilizes the insulin it produced. Insulin is a Harmone produced in a Pancreas which enables body cells to absorb Glucose to turn in to energy. If the body cells do not absorb the Glucose , Glucose accumulates in the blood leading to various medical complications. They are many types of Diabetes. But only three types of Diabetes are regarded as a Significant one. 1. Type 1 diabetes 2. Type 2 diabetes 3. Gestational diabetes Type 1 diabetes : This type of diabetes results from bodys failure to produce insulin. Type 1 diabetes may occur to both Children and Adult. This diabetes is regarded as a "juvenile diabetes" as this will occurs frequently to children. Person affected with this type of disease has to take insulin. Main symptoms associated with Type 1 diabetes are 1. Excessive excretion of Urine (Polyuria) 2. Thirst (Polydipsia) 3. Constant Hunger 4. Weight loss 5. Vision changes etc., Type 2 diabetes : This type of diabetes results when body does not

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 to Type 1 diabetes but they are less marked. This type of symptoms are seen only in Adults , but recently these symptoms also appearing in children. Gestational diabetes : Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%5% of all Error: Reference source not found and may improve or disappear after delivery. Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%50% of affected women develop type 2 diabetes later in life.

In addition Pre diabetes is a condition that occurs when a persons blood glucose levels are higher than the normal level but not high enough to recognize it as a Type 2 diabetes. Many people spend in this state for many years before it get turned in to type 2 diabetes. Common consequences of Diabetes : Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves . 1.Diabetes increases the risk of heart disease and

stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke). 2. Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation. 3. Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in 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 kidney failure. 10-20% of people with diabetes die of kidney failure. 5. Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands. The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

Sugar levels for body : Normal level of Sugar in your blood before meal is 70 to 110 mg/dl . After food level will be rise in between 110 to 140 mg/dl. The increased level of sugar levels in blood above 140 mg/dl is considered to be symptoms of diabetics. Low level of sugar below 70 are also dangerous. It will leads

to faintness. They are Generally two types of tests conducted in order 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 after overnight fasting for 8 hours. If the sugar levels inside the body are greater than 140 mg/dl , then the test is positive. If it happens to occur twice then the candidate is suspected to have Diabetes. In the second test , person was under fasting (for not less than 10 hours) , Initial sugar levels is measured. After that a high amount of known Glucose is given to person. Sugar levels are monitored in regular intervals of time. If the person consists of Sugar levels more than 200 mg/dl after two hours , test is positive. Sugar levels are carefully monitored . Regular Sugar level monitoring in blood should not be practical to perform in labs. So Sugar levels of blood are monitored regularly. Regular monitoring tells you whether your lifestyle, your physical activity, meal plans, and medicines doing a good job controlling your diabetes. Also decision to decide insulin dosage requires regular monitoring of glucose levels in blood. They are two important self monitoring methods to test glucose levels in blood

1. Finger Stick method. 2. Noninvasive method. Finger stick method : Most equipment for checking blood sugar level involves pricking your finger with a tiny needle (lancet) to draw a drop of blood. Some draw the blood from your forearm. For reading your blood sugar level, you can use a blood glucose meter that will show the number on its screen. Noninvasive method : Any other blood sugar testing tool does not draw blood. You wear it on your wrist like a watch and it takes the reading through your skin. It uses a slight electrical current to pull fluid through the skin and into the machine, where it measures the sugar level. The watch can't replace your regular finger-stick test. But the watch lets you see trends in how your blood sugar changes over the course of the day.There are some guidelines to check your diabetes with noninvasive method. Finger stick method : Various types and brands of Glucometers are available today are based on following two principles First principle : A chemical is present on the test strip which on contact with glucose produces a colour. The meter measures this color intensity and the level of glucose present is expressed in mg/dl. Second principle :

The other type of glucometer measures the electric current in the blood, which depends on the amount of glucose present. When blood is put on the test strip, an enzyme transfers electrons from glucose to a chemical in the test strip and the meter measures the flow of the electrons as current. The amount of current depends on the amount of glucose present and the meter produces the reading in mg/dl. First principle is related to Colorometric method. Now we will concentrate on instruments based on the Second principle. Instruments based on Second principle : They are three important components regarding Glucometer 1. Hand held meter 2. Test Strip 3. Lancet

A hand held meter with Test strip is as shown in figure

Test strips are small disposable Electro chemical cells which is contacted with whole blood. It then produces, in conjunction with a test meter, an electrical current which is proportional to the blood glucose concentration. Typical currents are a few A. This electrical current is produced by the very selective oxidation of glucose in the blood sample, which is catalyzed by two reagents which are precoated inside the test strip: (i) an enzyme, which reacts directly with the glucose molecule to remove its two available electrons, and

(ii) a mediator molecule, which takes (either singly or 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 strip 1988 The mechanism happening in the Test strip is illustrated in the below figure

The below diagram shows some commercially available test strips

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

Accuracy of Self monitoring of Glucose levels : Glucometer Readings are some times different than Laboratory Readings because A 10-15% difference in readings - because laboratory uses plasma blood while glucometers uses whole blood.
1.

2. Meters use capillary blood while laboratory uses

venous blood. Capillary blood can give a slightly higher reading than venous blood. The accuracy of the Glucose System was assessed per the ISO 15197. Most meters have similar accuracy of plus or minus 10 to 15 percent when used as directed. However, a variety of factors can affect the accuracy of the reading. Accuracy can depend on proper calibration of the glucometer, high levels of certain drugs in the blood, the use of older test strips, proper cleaning of the meter itself and the size of the blood sample obtained for testing. Some models today have the ability to warn of inaccurate results 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 glucose readings: most meters give the result as how much glucose is dissolved in a given amount of whole blood. Whole blood is the red stuff that comes out of your finger. But many laboratories, and some meters, quote the result as how much glucose is in the blood plasma . Plasma is the name for the liquid part of your 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,

including tiny red blood cells which give the blood its red color. The clear liquid is called plasma, and has many nutrients, including glucose, dissolved in it. (Sometimes a serum value is used: serum is similar to plasma but has the blood clotting factors removed.) When a doctor takes a blood sample from you, and sends it to a laboratory, the lab may first extract just the plasma from the blood, and just test this for it's glucose content. They may do this by spinning it very fast in a centrifuge, so the blood cells go to one end, and the clear liquid to the other. The problem is that the clear plasma contains a different amount of glucose from the red whole blood. The plasma reading is very slightly higher than the whole blood reading. So when your doctor quotes a figure, you must check whether it's blood plasma, or whole blood being referred to. The whole blood figure is 12% lower than the plasma figure. Whole blood is the lower figure, so multiply it by 1.12 to get the equivalent plasma concentration; Plasma is the higher figure, so divide it by 1.12 to get the whole blood figure.