Plasma Glucose

GlucoseGlucoseGlucose Glucose (MW: 180.16) is a very important (MW: 180.16) is a very important

fuel source to generate universal energy fuel source to generate universal energy molecules (ATP).molecules (ATP).

Blood glucose regulationBlood glucose regulationI- Role of liver in controlling blood glucose.I- Role of liver in controlling blood glucose.IIII- - Role of kidney in controlling blood glucose.Role of kidney in controlling blood glucose.III- Hormonal Regulation of Blood Glucose. III- Hormonal Regulation of Blood Glucose. Insulin.Insulin. Glucagon.Glucagon. Epinephrine.Epinephrine. Thyroid hormone. Thyroid hormone.

HyperglycemiaHyperglycemia Hyperglycaemia:Hyperglycaemia: is a condition in which an is a condition in which an

excessive amount of excessive amount of glucose circulates in the circulates in the blood plasma..

The normal range for most people The normal range for most people (fasting (fasting adults)adults) is about is about 80 to 11080 to 110  mg/dL.mg/dL.

A subject with a consistent range above A subject with a consistent range above

126126  mg/dLmg/dL is generally held to have is generally held to have

hyperglycemiahyperglycemia, whereas a consistent range , whereas a consistent range

below 50below 50  mg/dL is considered mg/dL is considered hypoglycemic..

WWHO Diabetes criteriaHO Diabetes criteriaNORMALNORMAL Fasting plasma glucose Fasting plasma glucose <110 mg/dl<110 mg/dl.. 2hrs plasma glucose 2hrs plasma glucose <140 mg/dl<140 mg/dl..

Impaired fasting glycaemia (IFG)(IFG) Fasting plasma glucose Fasting plasma glucose >>110 & <126 mg/dl.110 & <126 mg/dl. 2hrs plasma glucose <140 mg/dl.2hrs plasma glucose <140 mg/dl.

Impaired glucose tolerance (IGT)(IGT) FastingFasting plasma glucose plasma glucose >>110 & <126 mg/dl. 110 & <126 mg/dl. 2hrs plasma glucose 2hrs plasma glucose >>140 mg/dl & <200 mg/dl.140 mg/dl & <200 mg/dl. Diabetes Mellitus FastingFasting plasma glucose plasma glucose >>126 mg/dl126 mg/dl 2hrs plasma glucose 2hrs plasma glucose >>200 mg/dl200 mg/dl

Causes of plasma glucoseCauses of plasma glucose Diabetes mellitus.Diabetes mellitus.

DrugsDrugs Including Including beta blockers, , epinephrine..

Critical illnessCritical illness A high proportion of patients suffering an acute A high proportion of patients suffering an acute

stress such as stress such as stroke or or myocardial infarction may develop hyperglycemia. Hyperglycemia may develop hyperglycemia. Hyperglycemia occurs naturally during times of infection and occurs naturally during times of infection and inflammation. inflammation.

Physiological stressPhysiological stress When the body is stressed, endogenous When the body is stressed, endogenous

catecholamines are released. are released.

MeasurementMeasurement

Glucose levels are measured in either:Glucose levels are measured in either:

--Milligrams per deciliter (mg/dL)Milligrams per deciliter (mg/dL)..

--Millimoles per liter (mmol/L),Millimoles per liter (mmol/L), which which can be acquired by dividing (mg/dL) can be acquired by dividing (mg/dL) by factor of 18. by factor of 18.

SymptomsSymptoms Polyphagia - frequent hunger. - frequent hunger. Polydipsia - frequent thirst. - frequent thirst. Polyuria - frequent urination. - frequent urination. Blurred vision.Blurred vision. Fatigue (sleepiness). (sleepiness). Weight loss. . Poor Poor wound healing. healing. Dry Dry mouth. . Dry Dry skin Recurrent Recurrent infections. . hyperventilation: deep, rapid breathing. : deep, rapid breathing. Coma. .

TreatmentTreatment

Treatment of hyperglycemia Treatment of hyperglycemia requires requires elimination of the underlying elimination of the underlying causecause,, e.g.,e.g., treatment of diabetes treatment of diabetes when diabetes is the cause. when diabetes is the cause.

Acute and severe hyperglycemia can Acute and severe hyperglycemia can be treated by be treated by direct direct administration of administration of insulin insulin in most cases, under medical in most cases, under medical supervision.supervision.

Diabetes MellitusDiabetes Mellitus

Diabetes Mellitus:Diabetes Mellitus: is a condition in is a condition in which the body either does not which the body either does not produce enough, or does not respond produce enough, or does not respond to, to, insulin..

InsulinInsulin enables cells to absorb enables cells to absorb glucose in order to turn it into glucose in order to turn it into energy. energy.

ClassificationClassification

Diabetes mellitus type 1.. Diabetes mellitus type 2..

Prediabetes:Prediabetes: Impaired fasting glycaemia.Impaired fasting glycaemia. Impaired glucose tolerance. Impaired glucose tolerance.

DiagnosisDiagnosis

1.1. symptomssymptoms Polyuria and polydipsia. Polyuria and polydipsia. Weight loss. Weight loss. Diabetic ketoacidosis. Diabetic ketoacidosis.

2. Blood tests2. Blood tests Blood glucose is estimated enzymatically by Blood glucose is estimated enzymatically by

(spectrophotometry and personal (spectrophotometry and personal glucometer).glucometer).

Glucose tolerance test. Glucose tolerance test. Glycosylated hemoglobin.Glycosylated hemoglobin.

Serum or plasma glucose Serum or plasma glucose assayassay

PrinciplePrinciple::

Glucose is estimated Glucose is estimated spectrophotometricallyspectrophotometrically..

GODGOD

Glucose+ OGlucose+ O22 +H +H22O Gluconic acid +HO Gluconic acid +H22OO22

PODPOD

22 H H22OO2 2 + 4 AAP + phenol Quinoneimine dye +4 + 4 AAP + phenol Quinoneimine dye +4 HH22OO

GOD = Glucose oxidaseGOD = Glucose oxidase

POD = PeroxidasePOD = Peroxidase

AAP = 4-aminoantipyrineAAP = 4-aminoantipyrineGlucose concentration is proportional to optical density Glucose concentration is proportional to optical density

of processed sample.of processed sample.

Lab Procedure:Lab Procedure:

1)1)Centrifugation:Centrifugation: to separate plasma Of to separate plasma Of

blood sample Hemoglobin would interfere blood sample Hemoglobin would interfere

with the spectrophotometry of glucose, with the spectrophotometry of glucose,

thus it must be removed by centrifugation.thus it must be removed by centrifugation.

2)2)Enzymatic reaction: Enzymatic reaction: Glucose oxidation Glucose oxidation

and subsequent peroxidation start.and subsequent peroxidation start.

3)3)Incubation:Incubation: 20- 25 °C temperature for 20 20- 25 °C temperature for 20

min and measured at min and measured at 500 nm 500 nm wave length.wave length.

Plasma glucos

eMg/dL

180

80

0

Visual stripsVisual strips testtest

A medium cost method A medium cost method for monitoring for monitoring blood glucose. blood glucose.

A drop of blood,A drop of blood, usually taken from the usually taken from the fingertip, is placed on a test zone which is fingertip, is placed on a test zone which is located at one end of a strip of plastic. located at one end of a strip of plastic.

The test zone The test zone contains chemicals which contains chemicals which react with the sugar (glucose) in the blood, react with the sugar (glucose) in the blood, changing color according the concentration changing color according the concentration of glucose, which can then be read by of glucose, which can then be read by comparing the color with a chart on the comparing the color with a chart on the side of the test strip container.side of the test strip container.

Blood glucose monitoringBlood glucose monitoring

A blood glucose test is performed by A blood glucose test is performed by piercing the skin piercing the skin (typically, on the (typically, on the finger tip) to finger tip) to draw blooddraw blood, then placing , then placing the blood on a chemically active the blood on a chemically active disposable strip which indicates the disposable strip which indicates the result either by result either by changing colorchanging color, or , or changing an electrical characteristicchanging an electrical characteristic, , the latter being measured by the latter being measured by an an electronic meterelectronic meter..

Diabetes managementDiabetes management

Diabetic diet and exercise.Diabetic diet and exercise. Anti-diabetic drugs.Anti-diabetic drugs. Insulin.Insulin.