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Chemical Pathology [Link] Zahoor Ahmed Siddiqui
بسم ہللا الرحمن الرحیم
Lecture No 2
Blood glucose (sugar)
Blood glucose (sugar) estimation is required to help in the diagnosis of diabetes mellitus of any
other condition in which there is abnormal carbohydrate metabolism. In diabetes mellitus there is
a deficiency of the hormone insulin, which controls sugar metabolism in the body. In this disease
glucose is usually found in the urine. CSF sugar estimation is required to help in the diagnosis of
meningitis.
Most carbohydrates in the foods are digested to form glucose and to some extent
fructose, which is later converted into glucose by the liver, and is completely resorted by the
renal tubules. It is the principal source of energy, and in clinical practice the estimation is done to
assess the abnormalities of carbohydrate metabolism.
Symptoms:-
The classical syrnptoms of diabetes are
1-Polyuria
2-Polydipsia
3-Glycosuria
4-Weight loss
5-Hyperglycaemia
6-Delay in healing of wounds
The chronic hyperglycemia is associated with long tern damage, dysfunction and failure of
various organs especially the eyes, Kidneys, nerves, heart and blood vessels. Impairment of
growth and susceptibility to infections may chronic hyperglycemia.
Complications:-
The major complications of diabetes are:
1- Angiopathy
2- Neuropathy
3- Retinopathy
4- Nephropathy
5- Hyperlipidaemia
CLASSIFICATION
Diabetes is classified into three major categories as follows-
1- Primary Diabetes
2-Secondary Diabetes
3-Other abnormalities of glucose tolerance
1-Primary diabetes:-
The primary diabetes is caused by:
1-Production of abnormal form of insulin.
2-Inability of Pancreas to produce sufficient insulin.
3- Certain substances inhibiting or interfering the action of insulin in blood.
Primary diabetes is divided into two groups as follows:-
a-Type I Diabetes (IDDM):-
It is also known as insulin dependent diabetes mellitus (IDDM) or ketosis prone diabetes
mellitus. It is the most severe and potentially lethal form of diabetes due to an absolute lack of
میڈیکل لیب ٹیکنالوجست-سی-ایس-ہومیوپیتھک ڈاکٹر ملک ظہور احمد صدیقی ہومیوفزیشن اینڈ بی
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Chemical Pathology [Link] Zahoor Ahmed Siddiqui
insulin following the destruction of islet cells (Beta cells) in pancreas possibly by viruses,
production of autoimmune antibodies which destroy islet cells, or by genetic factors.
This type was formerly referred to as juvenile diabetes because it was thought to occur in
patients with less than 30 years of age. However it can occur at any age (new concept). Ketosis is
common in this type and the patients are absolutely dependent on exogenous insulin for their
survival.
b-Type II Diabetes(NIDDM):-
It is also known as non insulin dependent diabetes mellitus (NIDDM) or non-ketosis prone
diabetes mellitus. It was also known as adult onset. It comprises 90% of total diabetic population.
Patients in this category may be sub grouped as obese and non-obese. The disease is usually less
acute than IDDM and insulin is not essential for the treatment of this group. Inherited factors are
of great etiological significance than in IDDM.
The concentration of insulin in blood may be normal but it cannot perform its function due to
certain reasons, e.g. Target cell (Insulin receptor) deficiency, impaired conversion of pro-insulin
to insulin, post receptor dysfunction, decreased synthesis by beta cells of Pancreas.
2-Secondary Diabetes: -
The secondary diabetes is caused as a result of:
i-Pancreatic diseases such as pancreatitis.
ii-Endocrine disorders in which there is abnormal secretion of harmones that makes insulin
action ineffective.
iii- Drugs that interfere with carbohydrate metabolism, e.g. beta blockers, thiazide diuretics etc.
iv- Occasionally genetic disorders.
3-Other abnormalities of Glucose Tolerance as followed
i-Gestational diabetes mellitus (GDM): GDM is defined as any degree of glucose intolerance
with first recognition during pregnancy. It is screened by Spot test.
ii-Previous abnormality of Glucose Tolerance.
iii-Potential abnormality of Glucose Tolerance
iv-Impaired Glucose Tolerance which can be described as an intermediate state of glucose
tolerance which is asymptomatic and requires no treatment.
Interpretation
Hyperglycaemia:
Hyperglycaemia is considered when the fasting blood glucose level is above 120mg/dl and
random blood glucose level is more than 170mg/dl. Hyperglycaemia may be found in the
following clinical situations:
1. Diabetes Mellitus:
2. Thyrotoxicosis:
3. Excessive Growth harmones
4. Excessive Glucocorticoid
5. Chronic Pancreatitis.
میڈیکل لیب ٹیکنالوجست-سی-ایس-ہومیوپیتھک ڈاکٹر ملک ظہور احمد صدیقی ہومیوفزیشن اینڈ بی
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