Blood Sugar Measurement

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Presentation transcript:

Blood Sugar Measurement Hossein Piri Department of Biochemistry and Genetics, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran September 2014

هیپرگلیسمی ديابت ملیتوس سرطان پانکراس بيماري پانكراتيت اختلالات اندوكرين افزایش تیروکسین تیروتوکسیکوز (Thyrotoxicosis) افزایش اپی نفرین (Pheochromocytoma) افزایش هورمون رشد (Acromegaly) افزایش کورتیزول (Cushing's syndrome) Glucagonoma آنتي بادي بر عليه گيرنده انسولين 11/20/2018

هیپوگلیسمی افزایش انسولین بر اثر تزریق تومور اختلالات پانكراس(تومور- كمبود گلوكاگون) اختلالات شديد كبدي کاهش اپی نفرین کاهش کورتیزول (آدیسون) کاهش ACTH کاهش هورمون رشد كارسينوماي معده نقص آنزيمي بيماريهاي ذخيره گليكوژن (GSD) اختلال در متابوليسم گالاكتوز و فروكتوز مصرف اتانل 11/20/2018

Diabetes Mellitus(DM) Typ I DM Typ II DM Secondary DM GDM 11/20/2018

دیابت ملیتوس (DM) هیپرگلیسمی علائم: گلوکزاوری پلی اوری (Polyuria)، پلی دیپسی (Polydipsia)، پلی فاژی (Polyphagia) 11/20/2018

دیابت ملیتوس (DM) عوارض زود رس (حاد) عوارض دیر رس (مزمن) 11/20/2018

Blood Sugar (BS) Is defined as any time of day without regard to time since last meal > 200 mg/dl Confirm on subsequent visit with FBS or OGTT 11/20/2018

Fasting Plasma Glucose test (or FBS) Fast for at least 8 hours Normally: Should be less than 100 mg/dL On at least two separate occasions: More than 126 mg/dL indicates diabetes 100 to 125 mg/dL indicates: Impaired glucose tolerance (prediabetes) 11/20/2018 3:54 PM Carbohydrates Metabolism H.Piri

Oral Glucose Tolerance Test (OGTT) Drink 75 g of glucose dissolved in water Measuring after 2 hours A blood glucose of: Less than 139 mg/dL (normal) 140 to 199 mg/dL (prediabetes or IGT) More than 200 mg/dL (diabetes) 11/20/2018 3:54 PM Carbohydrates Metabolism H.Piri

معیارهای تعیین خطر ابتلا به GDM خطر پایین سن زیر 25 وزن طبیعی قبل از بارداری عدم وجود سابقه در بستگان درجه اول نداشتن سابقه IGT خطر متوسط خطر بالا چاقی برجسته سابقه شخصی GDM گلوکوزوری سابقه خانوادگی قوی دیابت 11/20/2018

Diagnostic tests for GDM FBS >126 Glucose Challenge Test (GCT) Drink 50g of glucose dissolved in water Measuring after 1 h <140 mg/dL (normal) > 140 mg/dL (do the GTT) GTT Drink 100g of glucose dissolved in water Fasting (<95) 1 h (<180) 2 h (<155) 3 h (<140) Diagnostic criteria: at least 2 abnormal results 11/20/2018

Hemoglobin A1c (glycated hemoglobin) Average lifespan of RBC ~ 120 days (4 months) Glycosylation of blood proteins in proportion to blood glucose concentration Normal: 5-8% Goal for diabetics: 10-22% 11/20/2018

Nonenzymic addition of glucose to hemoglobin Lippincott’s Illustrated Reviews: Biochemistry Fifth Edition

عوامل موثر بر GHb کاهش: اثر بیماری های همولیتیکی ویتامین C و E عوامل کاهنده بقاء RBC بیوشیمی بالینی تیتز

عوامل موثر بر GHb افزایش: اثر کم خونی فقر آهن اثر هموگلوبین کربامیله (اورمی) سالیسیلات ها (استیلاسیون) بیوشیمی بالینی تیتز

روش های اندازه گیری HbA1c تکنیک های بر پایه بار الکتریکی کروماتوگرافی تعویض یونی HPLC الکتروفورز و ایزوفوکوسینگ تکنیک های بر پایه اختلافات ساختاری کروماتوگرافی تمایلی سنجش ایمنی تکنیک های بر پایه اختلاف جرم طیف سنجی جرمی

کروماتوگرافی تعویض یونی استفاده از ریز ستون های تعویض یونی (کاتیونی) ریز ستون حاوی بار منفی هموگلوبین دارای بار مثبت

جمع آوری و نگهداری نمونه عدم نیاز به ناشتایی جمع آوری خون وریدی در لوله های حاوی EDTA یا فلوراید یا اگزالات خون در دمای °C4 بیش از یک هفته

روشهاي اندازه گيري گلوكز روشهاي شيميايي روش Folin-Wu روش Somogi-Nelson روش Benedict روش ارتوتولوئيدين روشهاي آنزيمي 11/20/2018

2- روشهاي آنزيمي روش گلوكز دهيدروژناز: NAD+ + گلوكز روش هگزوكيناز: ATP+ گلوكز NADH+H + گلوكونولاكتون هگزوكيناز َِ+ ADP گلوكز 6-فسفات G6PD َِ+ NAD+ گلوكز 6-فسفات NADH+H + 6- فسفوگلوكونات 11/20/2018

2- روشهاي آنزيمي روش گلوكز اكسيداز: O2+ گلوكز 2H2O2 + 4-Aminoantipyrine گلوكزاكسيداز +H2O2اسيد گلوكونيك پراكسيداز Quinoneimine + 4H2O 11/20/2018

روش انجام آزمايش بلانك استاندارد تست 10ميكروليتر سرم آب مقطر 1000 معرف پس از مخلوط نمودن 20 دقيقه در دماي اتاق يا 10 دقيقه در دماي 37 درجه انكوبه نموده سپس جذب نوري تست و استاندارد را در مقابل بلانك در طول موج 546 قرائت نمائيد. جذب تست = غلظت گلوكز x غلظت استاندارد جذب استاندارد 11/20/2018

11/20/2018