Glucose Analysis _ Diabetes Profle_HbA1c
Definition of glucose: (Glucose)
Glucose is the natural sugar in human blood and it is a source of energy. The normal ratio for it in the blood ranges between 70-120 mg, provided that the person has been fasting for a period of 8-10 hours, and this ratio rises to 120-150 mg per 100 milliliters of blood after a meal. Carbohydrates, and this is called the physiological rise in blood sugar (Physiological Hyperglycemia), and this rise does not soon return to the normal rate of fasting after two to three hours after eating.
During prolonged fasting (12-18 hours), the blood sugar level drops to 60-70 mg per 100 milliliters of blood. This condition is called physiological hypoglycemia.
Noticeable
The level of glucose in the blood is regulated between the hormone insulin on the one hand and the action of the anti-insulin hormones on the other, so insulin lowers the level of sugar in the blood, while the action of the anti-hormones leads to an increase in the level of sugar in the blood. If there must be a balance between the action of both insulin and the action of anti-insulin hormones. The reason for the increase is due to the following reasons:
Excessive function of any of the following glands: thyroid, adrenal, pituitary.
# In cases of kidney disease: diabetes mellitus - a defect in the pancreas gland
What is the pancreas gland?
The pancreas is located in the abdominal cavity behind the stomach, between the spleen and duodenum, and there are islets of Langerhans inside the pancreas and inside them are beta cells that secrete insulin
pancreas function
Pancreatic cells (beta cells from the islets of Langerhans) secrete insulin as a result of the high blood sugar level resulting from the digestion and absorption of food. Insulin facilitates the transfer of glucose from the blood to the cells of the body, where it is consumed as a main source of energy
Diabetes causes
# Destruction of the beta cells present in the islets of Langerhans in the pancreas. This destruction may be complete or partial, and the treatment does not depend on the amount of active cells remaining in the pancreas.
# Sometimes the amounts of insulin secreted by the pancreas are sufficient, but there are factors in the blood or the body that prevent insulin from doing its duty and thus keeps sugar high in the blood.
# Genetics, where a person is born with a predisposition to developing diabetes, especially in families with a family history of the disease.
Types of diabetes
- type 1 (insulin dependent)
- no endogenous insulin (or a very low level of it).
- Usually affects young people and may affect 15-20% of adults after the age of forty
- Completely dependent on exogenous insulin
- Diabetic coma recurs
- Patients often have normal weight or less than normal
Type II (non-insulin addicted) - The patient is Has the ability to produce insulin, but insufficiently - represents the majority of diabetes mellitus - often appears after the age of thirty, but insufficiently - affects families more prevalently - can be controlled by following a proper diet along with physical exercise - sometimes the patient needs To sugar-reducing pills or insulin
The diabetic ketoacidosis does not recur, and most patients suffer from
type 3 obesity (secondary diabetes).
This disease occurs as a secondary result of the use of cortisone tablets in large quantities and for a long time, or contraceptive pills or diuretics, or as a result of chronic pancreatitis, and it may also occur as a result of an increase in Secretion of anti-insulin hormones in some diseases such as pituitary tumors.
Type IV (gestational diabetes)
- Some women develop diabetes during the first three months of pregnancy, and this infection is often transient and is caused by a decrease in the percentage that the kidneys allow sugar to pass into the urine as a result of hormonal change during pregnancy.
- If the level of sugar is not controlled during pregnancy, this may lead to the birth of a large, heavy, and prone child to respiratory problems and low blood sugar.
To measure blood sugar, a sample from a vein or resulting from a finger prick is used with a special device, and blood sugar tests are performed.
Tests for sugar
1- Random blood glucose analysis (RBS) gives
a general idea of the patient’s blood sugar level. The sample is analyzed at any time during the day, whether for a diabetic or a healthy person, and the results of this analysis are taken to the doctor to diagnose the patient’s condition.
2- Fasting Blood Glucose Analysis: This
analysis is performed on the patient so that he is fasting for 6-8 hours , knowing that the normal level of sugar in the blood ranges between 70-110 mg per 100 milliliters of blood. If the ratio exceeds 120, this is an indication of injury In the future, if it exceeds 130, then this is considered a diabetic and this is confirmed by re-analysis for two or three consecutive times, at least, with an interval of one week between each measurement.
3- Sugar analysis two hours after eating (Post Prandial Sugar PPS)
This analysis is done on the patient after a normal meal or 75 grams of glucose, then we measure his blood sugar after two hours of eating and the benefit of this analysis is that it gives us an idea of the future of diabetes in this patient And will he need to analyze the sugar curve or not.
If the ratio exceeds 140 mg two hours after eating, this indicates that there is a defect in the return of sugar to its normal level.
4- Analysis of the glucose tolerance curve (Glucose Tolerance Test (GTT)
In some cases, a more specialized test called the Glucose Tolerance Test should be performed to diagnose pre-diabetes cases in which the fasting glucose level ranges between 100 mg and 126 mg.
This analysis is conducted when there is a suspicion of diabetes and gives us an idea of the possibility of diabetes or not.
When performing the analysis, he must be fasting for 6-8 hours, then we take a blood and urine sample, then the patient takes a glucose dose of 75 grams or 1 g per kilogram of the patient’s weight, then we take a blood and urine sample every half hour for 3 hours, and we measure the sugar in each A sample of blood and we reveal it in every sample of urine.
#Important note :-
The highest rate of glucose absorption and its transfer into the blood is an hour after eating a meal and it is called (absorption stage), followed by the stage of insulin secretion and glucose entry into the cell and it lasts for a full hour after the absorption process, that is, two hours after eating the previous meal for a period fasting.
Picture of the blood sugar curve for a normal person
1- Fasting blood sugar level that does not exceed 120 mg/dl
2- The blood sugar level after an hour does not exceed 140 mg/dl The
percentage of sugar returns to the fasting level two hours after eating a meal
A picture of the sugar curve for a diabetic person
1- Fasting sugar More than 120 mg/dl 2- An hour after breakfast, the sugar level exceeds 180 mg/dl in the blood and appears in the urine 3- Two hours after breakfast the percentage decreases, but slowly due to the lack of insulin secretion 4-The sugar rate does not return to the level Fasting because the percentage of insulin that was secreted is less than the required rate, which is called (deficiency in insulin production
5- Glycosylated Hemoglobin - HbA1c).
Definition:
Glycated hemoglobin: It is a protein (globulin) bound with iron in the group (Heam) and this protein (hemoglobin)
It is linked to glucose and there are many types of hemoglobin, but what concerns us is A1c because it is characterized by its association with glucose, where it is linked
A small percentage does not exceed 5-10% of hemoglobin in blood glucose and this bound part is called (HbA1c) .
The percentage of glucose binding to hemoglobin depends on its level in the blood. The higher the level of glucose, the higher the level of (HbA1c).
But this connection takes place slowly and slowly disintegrates, and the percentage of sugar carried on it is not affected by the diet, and it gives us an indication of the level of sugar in the blood during the life span of red blood cells, which is about 120 days, and the normal rate ranges between 5-8% and increases in disease Diabetes in the case of irregular treatment, as well as in type 1 diabetes, if the patient needs to increase the dose of insulin.
Hemoglobin test ( HbA1c ) is used to determine long-term blood sugar control (in a period of two to three months before the test) and it should be less than 6.5
6- Fructosamine
It is considered one of the latest and most accurate methods for detecting the level of sugar in the blood in the period of 15-20 days preceding the analysis in a diabetic patient.
This method is used to measure the percentage of glycosylated proteins by measuring the percentage of fructosamine bound to protein. This analysis is not affected by diet.
Blood sugar test results
The results differ from one lab to another, and in general, the normal results are as follows:
Fasting sugar: less than 110 mg per deciliter
Blood sugar two hours after breakfast: less than 140 mg per deciliter
Random blood sugar: less than 180 mg per deciliter