Seminary on glucose metabolism. Practical aspects In the clinical laboratory the diagnosis and the following of the treatment of diabetes mellitus needs.

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1 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

2 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

3 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

4 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 paper- strips 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

5 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)

6 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.

7 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.

8 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.

9 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

10 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

11 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

12 Tests from diabetes 2 60 éves férfi. Testsúlya az utolsó 5 évben 10 kg- val 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

13 Test from diabetes 3 60 éves férfi.Testsúlya az utóbbi 10 évben 15 hk-al fokozódott. Vérnyomása kezeletlenül 160/95 Hgmm Övátmérője 106 cm, testsúlya 95 kg. éves férfi. Testsúlya az utolsó 5 évben 10 kg-val 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