tolerance test: A test to determine the body's ability to handle glucose.

In the test, a person fasts overnight (at least 8 but not more than 16 hours). Then first, the fasting
plasma glucose is tested. After this test, the person receives 75 grams of glucose (100 grams for
pregnant women). Usually, the glucose is in a sweet-tasting liquid that the person drinks. Blood
samples are taken up to four times to measure the blood glucose.
For the test to give reliable results, the person must be in good health (not have any other
illnesses, not even a cold). Also, the person should be normally active (not lying down, for
example, as an inpatient in a hospital) and the person should not be taking medicines that could
affect the blood glucose. For 3 days before the test, the person should have eaten a diet high in
carbohydrates (150-200 grams per day). The morning of the test, the person should not smoke or
drink coffee.
The oral glucose tolerance test measures blood glucose levels 5 times over a period of 3 hours.
In a person without diabetes, the glucose levels rise and then fall quickly. In someone with
diabetes, glucose levels rise higher than normal and fail to come back down as fast.
People with glucose levels between normal and diabetic have what is termed "impaired glucose
tolerance" (IGT). People with IGT do not have diabetes. Each year, only 1-5% of people whose
test results show IGT actually develop diabetes. And with retesting, as many as half of the people
with IGT have normal oral glucose tolerance test results. Weight loss and exercise may help
people with IGT return their glucose levels to normal.
Oral glucose tolerance depends on a number of factors including the ability of the intestine to
absorb glucose, the power of the liver to take up and store glucose, the capacity of the pancreas
to produce insulin, the amount of "active" insulin it produces, and the sensitivity of the cells in the
body to the action of insulin.

Definition of Pancreas
Pancreas: A fish-shaped spongy grayish-pink organ about 6 inches (15 cm) long that stretches
across the back of the abdomen, behind the stomach. The head of the pancreas is on the right
side of the abdomen and is connected to the duodenum (the first section of the small intestine).
The narrow end of the pancreas, called the tail, extends to the left side of the body.

The pancreas makes pancreatic juices and hormones, including insulin. The pancreatic juices are
enzymes that help digest food in the small intestine. Insulin controls the amount of sugar in the
blood.
As pancreatic juices are made, they flow into the main pancreatic duct. This duct joins the
common bile duct, which connects the pancreas to the liver and the gallbladder. The common bile
duct, which carries bile (a fluid that helps digest fat), connects to the small intestine near the
stomach.
The pancreas is thus a compound gland. It is "compound" in the sense that it is composed of both
exocrine and endocrine tissues. The exocrine function of the pancreas involves the synthesis and
secretion of pancreatic juices. The endocrine function resides in the million or so cellular islands
(the islets of Langerhans) embedded between the exocrine units of the pancreas. Beta cells of
the islands secrete insulin, which helps control carbohydrate metabolism. Alpha cells of the islets
secrete glucagon that counters the action of insulin.

Insulin: A natural hormone made by the pancreas that controls the level of the sugar glucose in
the blood. Insulin permits cells to use glucose for energy. Cells cannot utilize glucose without
insulin.
Diabetes: The failure to make insulin or to respond to it constitutes diabetes mellitus. Insulin is
made specifically by the beta cells in the islets of Langerhans in the pancreas. If the beta cells
degenerate so the body cannot make enough insulin on its own, type I diabetes results. A person
with this type of diabetes must inject exogenous insulin (insulin from sources outside the body).

In type II diabetes, the beta cells produce insulin, but cells throughout the body do not respond
normally to it. Nevertheless, insulin also may be used in type II diabetes to help overcome the
resistance of cells to insulin.
By reducing the concentration of glucose in the blood, insulin is thought to prevent or reduce the
long-term complications of diabetes, including damage to the blood vessels, eyes, kidneys, and
nerves.
Learn more about diabetes mellitus.
History of Insulin: In 1921, Frederick Grant Banting and Charles H. Best discovered insulin while
they were working in the laboratory of John J.R. Macleod at the University of Toronto. Banting
and Best extracted material from the pancreas of dogs. They first used this material to keep
diabetic dogs alive and in 1922 they used it successfully on a 14-year-old boy with diabetes. In
1923, James B. Collip, a biochemist, discovered that purifying the extract prevented many of the
side effects.
In 1923, Banting and Macleod were awarded the Nobel Prize. Best and Collip were overlooked
but Banting and Macleod shared the prize money with them. The US Food and Drug
Administration (FDA) first approved insulin in 1939.
Insulin was the first hormone to be synthesized completely in the laboratory, a feat accomplished
in 1966 by the American worker Michael Katsoyannis and scientists in China. The first
recombinant human insulin was approved by the FDA in 1982.
Types of Insulin: Currently, insulin is available from bovine (beef), porcine (pork), and recombinant
(human) sources. Regular (rapid onset, short-acting) and NPH (slower onset, longer duration)
human insulin are the most commonly-used preparations. An ultrarapid-acting insulin analog,
insulin lispro injection (Humalog(r)) is a chemically-modified, natural insulin. It was approved by
the FDA in June, 1996.
Insulin is administered by injection via the subcutaneous (under the skin) route. Regular insulin
acts within 30 minutes, and its effects last 6 to 8 hours. The maximal effect occurs 1 to 3 hours
following the injection.
As compared to regular insulin, insulin lispro acts more rapidly, has an earlier maximal effect, and
a shorter duration action. Therefore, insulin lispro should be given within 15 minutes of a meal,
compared to regular insulin, which is given 30-60 minutes before meals.
NPH insulin is an insulin with an intermediate-duration of action. It has an onset of action about 2
hours following administration and a duration of action of 18 to 26 hours. Its maximal effect is 4 to
12 hours after administration.
Lente insulin also is an intermediate-acting insulin. It has an onset of action after 2 to 4 hours and
a duration of action of 18 to 26 hours. The peak activity of lente insulin occurs 6 to 12 hours
following administration.

Diabetes mellitus: Better known just as "diabetes" -- a chronic disease associated with
abnormally high levels of the sugar glucose in the blood. Diabetes is due to one of two
mechanisms:
(1) Inadequate production of insulin (which is made by the pancreas and lowers blood glucose) or
(2) Inadequate sensitivity of cells to the action of insulin.

The two main types of diabetes correspond to these two mechanisms and are called insulin
dependent (type 1) and non-insulin dependent (type 2) diabetes. In type 1 diabetes there is no
insulin or not enough of it. In type 2 diabetes, there is generally enough insulin but the cells upon
it should act are not normally sensitive to its action.
The signs and symptoms of both types of diabetes include increased urine output and decreased
appetite as well as fatigue. Diabetes is diagnosed by blood glucose testing, the glucose tolerance
test, and testing of the level of glycosylated hemoglobin (glycohemoglobin or hemoglobin A1C).
The mode of treatment depends on the type of the diabetes.
The major complications of diabetes include dangerously elevated blood sugar, abnormally low
blood sugar due to diabetes medications, and disease of the blood vessels which can damage
the eye, kidneys, nerves, and heart.

Definition of Hemochromatosis
Hemochromatosis: An inherited disorder in how the body absorbs and stores iron. The excess
iron gives the skin a bronze color and damages the liver and other organs. Diabetes is also a part
of the syndrome due to damage to the pancreas.

What is hemochromatosis?
Hemochromatosis is an inherited disorder of excessive body accumulation of iron. It is common
among the white population, affecting approximately 1 in 400 individuals of European ancestry.
Hemochromatosis patients are believed to absorb excessive amounts of iron from the diet. Since
the human body has limited ways of eliminating the absorbed iron, the iron accumulates over time
in the liver, bone marrow, pancreas, skin, and testicles. This accumulation of iron in these organs
causes them to function poorly.
What are the symptoms of hemochromatosis?
Patients with early hemochromatosis have no symptoms, and are unaware of their condition. The
disease may then be discovered when elevated iron blood levels are noted by routine blood
testing. In males, symptoms may not appear until 40-50 years of age. Iron deposits in the skin
cause darkening of the skin. Since females lose iron through menstrual blood loss, they develop
organ damage from iron accumulation 15- 20 years later than men on average.
Iron deposits in the pituitary gland and testicles cause shrinkage of the testicles and impotence.
Iron deposits in the pancreas cause a decrease in insulin production resulting in diabetes mellitus
(please read the Diabetes Mellitus article. Iron deposits in the heart muscle can cause heart
failure as well as abnormal heart rhythms. Iron accumulation in the liver causes scarring of the
liver (cirrhosis) and an increased risk of developing liver cancer. For further information on the
consequences of cirrhosis, please read the Cirrhosis article
Introduction
Pheochromocytoma is a very long word, even for someone who speaks medical language. If
you happen to be a fan of TV dramas involving young confused doctors, you may have heard the
word a few times. It is made up of four parts: pheo-chromo-cyt-oma.

If you are one of the few people who have had a personal experience or know someone who has
been suspected of having or has actually had a pheochromocytoma, I hope that this article helps
explain what this big word actually means to patients and their families.
What is a pheochromocytoma?
First, the basics and bit of anatomy is necessary to explain pheochromocytoma.
Pheochromocytomas are tumors of the adrenal glands. As the name implies the ad-renal glands
are located near the renal area. In other words, the adrenal glands are little glands that basically
sit on top of the kidneys. One adrenal gland sits on top of each of the two kidneys.
Despite their small size, the adrenal glands do big things. They are complex endocrine (hormone
secreting) glands. Depending on which area you focus on inside them, you find cells that do
different things. There is an area where the cells secrete cortisol, a hormone similar to cortisone.
There is another area where cells secrete a hormone called aldosterone which helps in water
regulation.
And there is yet another area where the cells secrete substances called catecholamines -epinephrine, norepinephrine and dopamine. These are flight or fight hormones. They are
responsible in part for that feeling of an ad-renal-ine rush you feel when you are afraid. It is
these cells that are involved in a pheochromocytoma. Basically, these cells secrete too much
epinephrine, norepinephrine and dopamine, and that causes the clinical signs and symptoms we
will discuss below.
Pheochromocytomas are, fortunately, quite rare and the vast majority of them are entirely benign.
Only very rarely is a pheochromocytoma malignant.

Addison's disease
Addison's disease is a rare condition that develops when the adrenal glands, located
above the kidneys, are not able to produce enough of the hormones cortisol and
aldosterone.
The adrenal glands release cortisol to help the body cope with stress from illness, injury,
surgery, childbirth, or other reasons. Aldosterone helps the body retain salt and water and
maintain blood pressure. Adrenal gland failure can be caused by a problem with the
body's immune system (autoimmune disease) or by infection, tumor, or injury.
Symptoms of Addison's disease include weakness, weight loss, nausea, vomiting,
diarrhea, darkening of the skin called hyperpigmentation, emotional distress, and a
decreased ability to tolerate cold.
People who have Addison's disease need to take medication for the rest of their lives to
replace cortisol and aldosterone. Treatment relieves symptoms and usually reverses any
darkening of the skin. Once proper treatment is started, most people with Addison's
disease can lead healthy lives. If Addison's disease is not treated, an adrenal crisis may
occur that can lead to death because of a severe drop in blood pressure.

Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not produce enough
thyroid hormone, which regulates the way the body uses energy.
A low thyroid level can cause symptoms of fatigue, weakness, lethargy, weight gain,
depression, memory problems, constipation, dry skin, intolerance to cold, coarse and
thinning hair, brittle nails, or a yellowish tint to the skin.
Hypothyroidism usually develops slowly. It often results from a problem in which the
body's own natural defense (immune) system attacks the thyroid gland (autoimmune
thyroiditis or Hashimoto's thyroiditis). Hypothyroidism may also develop following
radiation treatment or surgical removal of the thyroid.
Hypothyroidism is treated with medications to replace the thyroid hormone. Symptoms
usually disappear within a few months after treatment begins, but most people need to
continue taking thyroid hormones for life.
Hypothyroid: Deficiency of thyroid hormone which is normally made by the thyroid gland which
is located in the front of the neck:

Random blood sugar

What is a random blood sugar test?
This test measures your blood sugar without considering the last time you ate a meal, snack or beverage
containing calories.
What's normal?
If your random blood sugar is less than 100 mg/dL (5.55 mmol/L), it's normal.
What level suggests prediabetes?
If your random blood sugar is greater than 100 mg/dL (5.55 mmol/L) but less than 199 mg/dL (11.05
mmol/L), you may have prediabetes.
What level suggests type 1 or type 2 diabetes?
A blood glucose of 200 mg/dL (11.11 mmol/L) or higher suggests you have either type 1 or type 2 diabetes.

2-hour glucose tolerance test

What is a 2-hour glucose tolerance test?
A glucose tolerance test measures your body's response to sugar. You drink a liquid containing sugar and
then have blood withdrawn from a vein in your arm two hours later.
What's normal?
A normal level is less than 140 mg/dL (7.77 mmol/L).
What level suggests prediabetes?
If your two-hour glucose tolerance is 140 mg/dL (7.77 mmol/L) to 199 mg/dL (11.05 mmol/L), you may have
prediabetes.
What level suggests type 1 or type 2 diabetes?
A blood sugar of 200 mg/dL (11.11 mmol/L) or higher two hours after you drink the sugar solution indicates
you may have type 1 or type 2 diabetes. Your doctor may repeat this and other tests to confirm a diagnosis.

Glycated hemoglobin test

What is a glycated hemoglobin test?
A glycated hemoglobin test, also called a glycosylated hemoglobin test or hemoglobin A1C test, reflects your
average blood sugar level for the two- to three-month period before the test. This test isn't used for diagnosis
of prediabetes or diabetes. Instead, your doctor uses it to determine how well you're managing your blood
sugar if you have diabetes.
What's normal?
The normal range at Mayo Clinic is 4 percent to 6 percent. But this range will vary from lab to lab. Normal
standards haven't been established for this test.