Transcript Seminary on glucose metabolism. Practical aspects

Seminary on glucose metabolism.
Practical aspects
In the clinical laboratory the diagnosis and the following
of the treatment of diabetes mellitus needs the
most frequent checking in the laboratory.
1.
In insulin treated patients daily 1-5 or more blood
glucose measurement is necessary
2.
. For the initial diagnosis the oral glucose
tolerance test also uses glucose determination.
3.
Every 3 month hemoglobin 1-AC is measured in
diabetic patients
4.
In type 1 diabetic patients during insulin
treatment, it is necessary to look for if here were a
remnant insulin production of the patient.It is
followed by the measuremen of C peptide in the
urine
5.
In order to check the complications and side
effects many examinations are done
Glukóz metabolizmus.
Praktikus szempontok
Klinikai laboratóriumokban a diabetes mellitus
diagnosztizálása és kezelésének követése a
leggyakoribbteendő.
1.
Inzulinnal kezelt pácienseknél napi 1-5 vagy több
d glukóz mérés szükséges
2.
Az alap-diagnózis megállapításához a glukóz
tolerancia teszt szintén mér glukóz
koncentrációkat.
3.
Diabeteses pácienseknél minden 3 hónapban
szükséges a hemoglobin 1-AC-t mérni.
4.
Typ 1 diabetes paciensnél inzulin kezelés esetén
szükséges mérni, hogy létezik-e valamennyi saját
inzulin termelése is. Ezt a vizelet C peptid
mérésével lehet követni.
5.
Abból a célból, hogy a komplikációkat és a
mellékhatásokat is vizsgáljuk, számos egyéb
many examinations are done
Measurement of blood- and urine
glucose content I.
• 1, Usually for glucose measurement the glucose
oxydase-peroxydase reaction is employed. For the
analysis
•
a. buffer and glucose oxydase solution is added to the
specimen. The enzyme oxydases he glucose to
glucoperoxyde
•
b.The next step: peroxydase is added to
• the system: it splits gluco- peroxyde to water and singlet
O. group.
•
c. This reactive singlet oxygen oxydases a colouring
reagent (o-dianysidin with NH2 groups)
•
d. The intensity of colour is proportional of glucose
Measurement of glucose from the
blood, urine or body fluids II.
• The glucose-oxydase peroxydase reaction is widely
used for body fluids, as well.
• Paper is impregnated with these reagents and the paperstrips can be used also.
• 2. A faster and more exact method is also used
sometimes:the hexokinase-glucose-6
• phosphate dehidrogenase method. Here the first reagen
is buffer and hexokinase.
• It transforms glucose to glucose-6-phosphate.
• The next reagent oxidizes (dehidrogenates) glucose 6
phosphate and the simultanously added NADH is
• reacting and forming NAD. This can directly measured
Glucose determination III.
• 3. Formerly o-toludine as reagent was also
• used in concentrated acetic acid. The method is
exact, cheap, but not comfortable because the
inevitable smell.
• 4. At the first half of the last century a
• iodometric titration method was used:
• Hagedorn-Jensen reaction
• 5. Rarely,if necessary, other sugars can also be
determined (fructose, pentoses,lactose)
Examinations in diabetes I.
Glucose measurements
• 1. Fasting glucose level
• In the morning, following a moderate eating in
the previous day, before any eating, glucose is
determined from the
• total blood. A sample from the finger tip is
enough for the paper-strip method.
• Normal value: 3.5-5.5 U. In the case of
moderately elevated levels glucose tolerance
test or profile measurement is performed.
Postprandial glucose measurement,
glucose profile
• 2.In type-1 diabetes patients frequently
postprandial glucose is measured. 2 hours after
the usual normal meal is the sample collected
• The patient gets the treatment (inzulin etc)
• In normal subjects glucose is: under 8.0 U
• Moderately elevated (IGT): 8.0-10 U
• In diabetes: over 10 U
• 3. Glucose profile. During the day at every 3
hours are samples collected, some of them
before meal, some after. Also gets all the usual
• Drugs.
Glucose tolerance test I.
• In order to distinguish healthy (but moderatly
high) values from mildly elevated but not
diabetic (formerly IGT) forms from type-2
diabetes, - the patient in the morning, after
fasting, (without of drugs) drinks 70 g glucose
diddolved in water and immediately a blood
glucose
• sample is collected. Thereafter at every 30
minutes up till 2 (sometimes 3) hours blood
specimen collected and glucose determined.
The results are discussed at the next slide.
Glucose tolerance test II.
•
0 30 60 90 120 min
• Healthy >6.5
>9-10
> 8.0
• IGT
>7-7.5
11-12
8-10
• Diabetes 7 - <
11< 11< 10-11<
• In some cases,as pregnant diabetes, the
measurement goes up till 180 min
Hemoglobin A 1 C
• The average value of the blood glucose
level in the last 100-120 days is expressed
• by the glycosilated hemoglobin
• Healthy below 5.5-6.0 U
• Diabetic over 7-7.5U
• Red blood cells are cenrifuged, thereafter
hemolysed and the glucose is either by
acid split from the protein and determined
Tests from diabetes topic 1
• 3 éves gyermek rosszul fejlődik, napi 3
liter vizet iszik.Éhgyomri vércukra 11,4 U
• Étkezés után: 18 U
• Valószínű diagnózis:
• 1. 1-típusu diabetes mellitus
• 2. 2-típusu diabetes mellitus
• 3. IGT
• 4. Diabetes insipidus
Tests from diabetes 2
• 60 éves férfi. Testsúlya az utolsó 5 évben 10 kgval fokozódott, jelenleg 95 kg
• Vérnyomása kezeletlenül 160/95. Ővátmérője
106 cm. Anginás panaszai vannak. Éhgyomri
vérglukóz: 7.8 U
• Valószínű diagnózis:
• 1.IGT
• 2. 1-Typ diabetes
• 3. Metabolikus szindróma
• 4. Diabetes insipidus
Test from diabetes 3
• 60 éves férfi.Testsúlya az utóbbi 10 évben 15 hk-al
férfi. Testsúlyakezeletlenül
az utolsó 5 évben
10
fokozódott.éves
Vérnyomása
160/95
Hgmm
kg-val fokozódott, jelenleg 95 kg
• ÖvátmérőjeVérnyomása
106 cm, testsúlya
95 kg.
kezeletlenül 160/95.
Ővátmérője 106 cm. Anginás panaszai
vannak. Éhgyomri vérglukóz: 7.8 U
Valószínű diagnózis:
1.IGT
2. 1-Typ diabetes
3. Metabolikus szindróma
4. Diabetes insipidus