DIABETES MELLITUS:
The new guidelines issued by the American Diabetes Association changed the definition of diabetes into:
Anyone with fasting glucose > 125 mg/dL now qualifies as diabetic (the old threshold was 140) and any reading over 110 is considered dangerous
MONITORING & FOLLOW UP OF DIABETIC PATIENTS :
Monthly *Blood & Urine glucose + Fructosamine .
3 Monthly *Glycosylated Hemoglobin + Microalbuminuria .
Yearly *Liver & Kidney functions + Lipid profile .
GLYCOSYLATED HEMOGLOBIN (HbA1c) :
HbA1c is formed by addition of a glucose molecule to the beta chain of hemoglobin . This process is formed progressively and irreversibly inside the red cells and is directly dependant on the blood glucose concentration.
HBA1c is probably the best single measure for monitoring diabetes over a three month period especially if the physician plans to alter or stop therapy.
However, this test does not give information about same day variations in blood glucose. It can also be falsely low in anaemic patients and falsely high in patients with hemoglobinopathies.
FRUCTOSAMINE :
Fructosamine is formed by glucose linkage to albumin or other proteins. It has the advantage over (HbA1C) of having a shorter half life hence is more useful in monitoring diabetes over a one month period.
This test may give false results in patients showing plasma protein fluctuations as in hemodialysis.
MICROALBUMINURIA
Microalbuminuria is the elevated excretion of urine albumin above the normal amount and below that detected by conventional urinary protein tests.
REF. RANGES: Normal < 20mg albumin / gm creatinine.
Microalbuminuria 20-200 mg albumin /gm creatinine.
Persistent proteinuria > 200 mg albumin /gm creatinine.
APPLICATIONS :
1) Nephropathy whether due to diabetes or hypertension.
2) To monitor the efficacy of therapy in controlling diabetes or hypertension.
3) Microvasculature complications leading to nephropathy, retinopathy and neuropathy.
4) Complications affecting the macrovasculature and leading to coronory heart disease (CHD), cerebrovascular disease and peripheral arterial disease.
DRAWBACKS OF THE COMMERCIAL STRIPS :
A) Not specific to albumin.
B) Insufficiently sensitive.
C) Results are qualitative, that is to say, the final result is not a single figure but a wide range.
D) Reading the strips is based on color development which is subjective i.e. two persons may read the same strip sperately but report different readings due the narrow color range.
INSULIN & C-PEPTIDE :
Proinsulin is cleaved into Insulin and the biologically inactive C-peptide which are useful parameters in the following conditions :
• True hypoglycemia & Insulinoma : both Insulin & C-peptide are elevated.
• Factitious hypoglycemia : Insulin is elevated & C-peptide is decreased .
• Residual B cell function in Insulin dependant diabetics: many of those patients have antibodies that interfere with the Insulin assay; hence C-peptide is the parameter of choice .
INSULIN ANTIBODIES :
They develop from impurities in animal Insulin .
Presence of Insulin antibodies suggests one or more of the following ;
• Exogenous intake of animal Insulin .
• Insulin Autoimmune Hypoglycemia .
• Insulin resistance especially if associated with high titres >1:64 .
LIPID PROFILE:
Hyperlipidemia is suggested if
Triglycerides >180mg%
Total Cholesterol >200mg%
The risk of cardiac and vascular complications are increased if
HDL Cholesterol <35mg%
LDL Cholesterol >160mg%
All patients who perform these tests should be fasting for 12-14 hours .
The new guidelines issued by the American Diabetes Association changed the definition of diabetes into:
Anyone with fasting glucose > 125 mg/dL now qualifies as diabetic (the old threshold was 140) and any reading over 110 is considered dangerous
MONITORING & FOLLOW UP OF DIABETIC PATIENTS :
Monthly *Blood & Urine glucose + Fructosamine .
3 Monthly *Glycosylated Hemoglobin + Microalbuminuria .
Yearly *Liver & Kidney functions + Lipid profile .
GLYCOSYLATED HEMOGLOBIN (HbA1c) :
HbA1c is formed by addition of a glucose molecule to the beta chain of hemoglobin . This process is formed progressively and irreversibly inside the red cells and is directly dependant on the blood glucose concentration.
HBA1c is probably the best single measure for monitoring diabetes over a three month period especially if the physician plans to alter or stop therapy.
However, this test does not give information about same day variations in blood glucose. It can also be falsely low in anaemic patients and falsely high in patients with hemoglobinopathies.
FRUCTOSAMINE :
Fructosamine is formed by glucose linkage to albumin or other proteins. It has the advantage over (HbA1C) of having a shorter half life hence is more useful in monitoring diabetes over a one month period.
This test may give false results in patients showing plasma protein fluctuations as in hemodialysis.
MICROALBUMINURIA
Microalbuminuria is the elevated excretion of urine albumin above the normal amount and below that detected by conventional urinary protein tests.
REF. RANGES: Normal < 20mg albumin / gm creatinine.
Microalbuminuria 20-200 mg albumin /gm creatinine.
Persistent proteinuria > 200 mg albumin /gm creatinine.
APPLICATIONS :
1) Nephropathy whether due to diabetes or hypertension.
2) To monitor the efficacy of therapy in controlling diabetes or hypertension.
3) Microvasculature complications leading to nephropathy, retinopathy and neuropathy.
4) Complications affecting the macrovasculature and leading to coronory heart disease (CHD), cerebrovascular disease and peripheral arterial disease.
DRAWBACKS OF THE COMMERCIAL STRIPS :
A) Not specific to albumin.
B) Insufficiently sensitive.
C) Results are qualitative, that is to say, the final result is not a single figure but a wide range.
D) Reading the strips is based on color development which is subjective i.e. two persons may read the same strip sperately but report different readings due the narrow color range.
INSULIN & C-PEPTIDE :
Proinsulin is cleaved into Insulin and the biologically inactive C-peptide which are useful parameters in the following conditions :
• True hypoglycemia & Insulinoma : both Insulin & C-peptide are elevated.
• Factitious hypoglycemia : Insulin is elevated & C-peptide is decreased .
• Residual B cell function in Insulin dependant diabetics: many of those patients have antibodies that interfere with the Insulin assay; hence C-peptide is the parameter of choice .
INSULIN ANTIBODIES :
They develop from impurities in animal Insulin .
Presence of Insulin antibodies suggests one or more of the following ;
• Exogenous intake of animal Insulin .
• Insulin Autoimmune Hypoglycemia .
• Insulin resistance especially if associated with high titres >1:64 .
LIPID PROFILE:
Hyperlipidemia is suggested if
Triglycerides >180mg%
Total Cholesterol >200mg%
The risk of cardiac and vascular complications are increased if
HDL Cholesterol <35mg%
LDL Cholesterol >160mg%
All patients who perform these tests should be fasting for 12-14 hours .
تعليق