1. Plasma Glucose

2. Glucose Glucose (MW: 180.16) is a very important fuel source to generate universal energy molecules (ATP). Blood glucose regulation I- Role of liver in controlling blood glucose. II- Role of kidney in controlling blood glucose. III- Hormonal Regulation of Blood Glucose. Insulin. Insulin. Glucagon. Glucagon. Epinephrine. Epinephrine. Thyroid hormone. Thyroid hormone.

3. Hyperglycemia Hyperglycaemia: is a condition in which an excessive amount of glucose circulates in the blood plasma. Hyperglycaemia: is a condition in which an excessive amount of glucose circulates in the blood plasma.glucose blood plasmaglucose blood plasma The normal range for most people (fasting adults) is about 80 to 110 mg/dL. The normal range for most people (fasting adults) is about 80 to 110 mg/dL. A subject with a consistent range above 126 mg/dL is generally held to have hyperglycemia, whereas a consistent range below 50 mg/dL is considered hypoglycemic. A subject with a consistent range above 126 mg/dL is generally held to have hyperglycemia, whereas a consistent range below 50 mg/dL is considered hypoglycemic.hypoglycemic

4. W HO Diabetes criteria NORMAL Fasting plasma glucose <110 mg/dl. Fasting plasma glucose <110 mg/dl. 2hrs plasma glucose <140 mg/dl. 2hrs plasma glucose <140 mg/dl. Impaired fasting glycaemiaImpaired fasting glycaemia (IFG) Impaired fasting glycaemia Fasting plasma glucose >110 & 110 & <126 mg/dl. 2hrs plasma glucose <140 mg/dl. 2hrs plasma glucose <140 mg/dl. Impaired glucose toleranceImpaired glucose tolerance (IGT) Impaired glucose tolerance Fasting plasma glucose >110 & 110 & <126 mg/dl. 2hrs plasma glucose >140 mg/dl & 140 mg/dl & <200 mg/dl. Diabetes Mellitus Diabetes Mellitus Fasting plasma glucose >126 mg/dl Fasting plasma glucose >126 mg/dl 2hrs plasma glucose >200 mg/dl 2hrs plasma glucose >200 mg/dl

5. Causes of plasma glucose  Diabetes mellitus.  Drugs Including beta blockers, epinephrine. Including beta blockers, epinephrine.beta blockersepinephrinebeta blockersepinephrine  Critical illness A high proportion of patients suffering an acute stress such as stroke or myocardial infarction may develop hyperglycemia. Hyperglycemia occurs naturally during times of infection and inflammation. A high proportion of patients suffering an acute stress such as stroke or myocardial infarction may develop hyperglycemia. Hyperglycemia occurs naturally during times of infection and inflammation.strokemyocardial infarctionstrokemyocardial infarction  Physiological stress When the body is stressed, endogenous catecholamines are released. When the body is stressed, endogenous catecholamines are released.catecholamines

6. Measurement Glucose levels are measured in either: -Milligrams per deciliter (mg/dL). -Millimoles per liter (mmol/L), which can be acquired by dividing (mg/dL) by factor of 18.

7. Symptoms Polyphagia - frequent hunger. Polyphagia - frequent hunger. Polyphagia Polydipsia - frequent thirst. Polydipsia - frequent thirst. Polydipsia Polyuria - frequent urination. Polyuria - frequent urination. Polyuria Blurred vision. Blurred vision. Fatigue (sleepiness). Fatigue (sleepiness). Fatigue Weight loss. Weight loss. Weight loss Weight loss Poor wound healing. Poor wound healing.wound Dry mouth. Dry mouth.mouth Dry skin Dry skinskin Recurrent infections. Recurrent infections.infections hyperventilation: deep, rapid breathing. hyperventilation: deep, rapid breathing. hyperventilation Coma. Coma. Coma

8. Treatment Treatment of hyperglycemia requires elimination of the underlying cause, e.g., treatment of diabetes when diabetes is the cause. Treatment of hyperglycemia requires elimination of the underlying cause, e.g., treatment of diabetes when diabetes is the cause. Acute and severe hyperglycemia can be treated by direct administration of insulin in most cases, under medical supervision. Acute and severe hyperglycemia can be treated by direct administration of insulin in most cases, under medical supervision.

9. Diabetes Mellitus Diabetes Mellitus: is a condition in which the body either does not produce enough, or does not respond to, insulin. Diabetes Mellitus: is a condition in which the body either does not produce enough, or does not respond to, insulin.insulin Insulin enables cells to absorb glucose in order to turn it into energy. Insulin enables cells to absorb glucose in order to turn it into energy.

10. Classification Diabetes mellitus type 1. Diabetes mellitus type 1. Diabetes mellitus type 1 Diabetes mellitus type 1 Diabetes mellitus type 2. Diabetes mellitus type 2. Diabetes mellitus type 2 Diabetes mellitus type 2 PrediabetesPrediabetes: Prediabetes  Impaired fasting glycaemia.  Impaired glucose tolerance. Impaired glucose tolerance Impaired glucose tolerance

12. Diagnosis 1. symptoms Polyuria and polydipsia. Polyuria and polydipsia. Weight loss. Weight loss. Diabetic ketoacidosis. Diabetic ketoacidosis. 2. Blood tests Blood glucose is estimated enzymatically by (spectrophotometry and personal glucometer). Blood glucose is estimated enzymatically by (spectrophotometry and personal glucometer). Glucose tolerance test. Glucose tolerance test. Glucose tolerance test Glucose tolerance test Glycosylated hemoglobin. Glycosylated hemoglobin. Glycosylated hemoglobin Glycosylated hemoglobin

13. Serum or plasma glucose assay Principle: Glucose is estimated spectrophotometrically. GOD GOD Glucose+ O 2 +H 2 O Gluconic acid +H 2 O 2 POD POD 2 H 2 O 2 + 4 AAP + phenol Quinoneimine dye +4 H 2 O GOD = Glucose oxidase POD = Peroxidase AAP = 4-aminoantipyrine Glucose concentration is proportional to optical density of processed sample.

14. Lab Procedure: 1) Centrifugation: to separate plasma Of blood sample Hemoglobin would interfere with the spectrophotometry of glucose, thus it must be removed by centrifugation. 2) Enzymatic reaction: Glucose oxidation and subsequent peroxidation start. 3) Incubation: 20- 25 °C temperature for 20 min and measured at 500 nm wave length.

15. Plasma glucose Mg/dL 180 80 0

16. Visual strips test A medium cost method for monitoring blood glucose. A medium cost method for monitoring blood glucose. A drop of blood, usually taken from the fingertip, is placed on a test zone which is located at one end of a strip of plastic. A drop of blood, usually taken from the fingertip, is placed on a test zone which is located at one end of a strip of plastic. The test zone contains chemicals which react with the sugar (glucose) in the blood, changing color according the concentration of glucose, which can then be read by comparing the color with a chart on the side of the test strip container. The test zone contains chemicals which react with the sugar (glucose) in the blood, changing color according the concentration of glucose, which can then be read by comparing the color with a chart on the side of the test strip container.

17. Blood glucose monitoring A blood glucose test is performed by piercing the skin (typically, on the finger tip) to draw blood, then placing the blood on a chemically active disposable strip which indicates the result either by changing color, or changing an electrical characteristic, the latter being measured by an electronic meter. A blood glucose test is performed by piercing the skin (typically, on the finger tip) to draw blood, then placing the blood on a chemically active disposable strip which indicates the result either by changing color, or changing an electrical characteristic, the latter being measured by an electronic meter.

19. Diabetes management Diabetes management  Diabetic diet and exercise.  Anti-diabetic drugs.  Insulin.