Diabetes mellitus is a disorder of high glucose levels in blood due to defects in production or action of

insulin secreted by beta cells of pancreas. It may be of different types such as juvenile (type 1) ,
adult(type 2) or gestational(related to pregnancy).

Since diabetes is a chronic disease, lifelong control on diet, exercise & medication is needed. Estimation
of blood glucose level is done regularly by the physician to check the situation. As the blood glucose
levels depend on various factors & may temporarily fall down they are not 100%reliable and sometimes
the patient tries to manipulate them.

HOW PATIENT TRIES TO MANIPULATE THE GLUCOSE RESULTS:-

Consider a diabetic person who is not following a proper diet & medication regime. He might fear if the
blood glucose report is abnormal the physician may scold him and impose stricter guidelines of diet and
medication. To avoid this he needs a normal blood glucose report. He may fool the physician in one of
the following three ways:-

1. Taking extra doses of diabetes medication on the previous or same day of testing.
2. Eating very little or totally fasting on the previous or same day of testing.
3. Exercising heavily for some days before the day of testing.
HbA1c test (GHB test);-Here comes the science to solve the problem through GHB/HbA1c
testing.
This is a fool proof method useful in detecting the exact intensity of glucose molecules. The
principle of the test is as follows.
Normal life span of RBC is 100 to 120 days. During its life time hemoglobin (Hb) in the RBC is
constantly exposed to glucose molecules. Some molecules are attached to Hb in a non
enzymatic manner resulting in the formation of glycated Hb(Glycosylated Hb or HbA1c) Once
formed the molecules permanently remain as HbA1c as the reaction is non-enzymatic and
irreversible. This reflects the average glucose molecules to which the Hb is exposed in the past
100 days. If glucose molecules are high the HbA1c levels are elevated. HbA1c levels are not
affected by sudden/temporary changes in diet/exercise as the process is slow and irreversible
his gives the physician a chance to know the exact situation of the patient.

Estimation of the HbA1c levels can be done in many ways. For example
1. Immunoturbidometry---Roche cobras instrument
2. HPLC-------------------------Bio rad variant instrument

“If blood glucose levels are normal and the GHB is abnormal then the physician may suspect the
manipulation of blood glucose by the patient.”

Lastly by manipulating the blood glucose levels the patient is not fooling the physician but
himself by worsening the situation.