Glucose Indices

• Glucose is the major source of energy for all the

tissues including the brain.
• It acts as precursor for the synthesis of all other
carbohydrates in the body which have highly
specific functions, e.g., glycogen for storage,
ribose in nucleic acid, and galactose in lactose of
milk.
• Glucose homeostasis:
• 1.Glucose absorption via the small intestine.
• 2. Glucose production in the liver.
• 3. Consumption of glucose by nearly all tissues.
• Hormones (insulin, glucagon and catecholamines)
• Glucose fasting : 70–110 mg/dl & (4.0-5.9 mmol/L)
• Glucose tolerance is defined as the ability to dispose
a glucose load.
• Glucose measurement in (CSF) is used for evaluation
of meningitis, and other neurological disorders.
• Diabetes mellitus : metabolic diseases
characterized by hyperglycemia resulting from
defects in insulin secretion, insulin action, or both.
• Complication : failure of various organs,
especially the eyes, kidneys, nerves, heart, and
blood vessels.
• Clinical symptoms of hyperglycemia:
•
• Increased risk of diabetes:
• With a family history of DM.
• With cardiovascular disease.
• Who are obese or have a sedentary lifestyle.
• Who are hypertensive or hyperlipidemic.
• Who take antipsychotic medicines.
• Women with a history of gestational diabetes or
polycystic ovary syndrome.
• Type 1 diabetes accounts for approximately 15%
of all diabetic patients. It can occur at any age but
is most common in the young, with a peak
incidence between 9 and 14 years of age.
• The absolute lack of insulin is a consequence of
autoimmune destruction of insulin producing
beta cells.
• There may be an environmental precipitating
factor such as a viral infection.
• The presence of islet cell antibodies in serum
predicts future development of diabetes.
• Treatment.
• Type 2 diabetes accounts for approximately 85%
of all diabetic patients and can occur at any age.
• It is most common between 40 and 80 years but is
now being reported in adolescent and even
pediatric populations.
• In this condition there is resistance of peripheral
tissues to the actions of insulin, so that the insulin
level may be normal or even high.
• Obesity is the most commonly associated clinical
feature.
• Treatment .
 • laboratory diagnosis of diabetes
• 1) Random plasma glucose level ≥200mg/dl
• 2) Fasting blood glucose: ≥126 mg/dL is
diagnostic.
• 3- Postprandial blood glucose: ≥ 200 mg/dL
Postprandial blood glucose.
4-Glycosylated hemoglobin (HbA1c):
• Hyperglycaemia leads to the nonenzymatic
attachment of glucose to a variety of proteins
(glycation), which is virtually irreversible under
physiological conditions and the concentration of
glycated protein is therefore a reflection of mean
blood glucose level during the life of that protein.
• HbA1c assay reliably estimates average glucose
levels over the preceding 2-3 months before the
test does not require fasting or glucose loading
more specific for identifying individuals at
increased risk for diabetes.
 5-Plasma fructosamine level
• Serum fructosamine is a glycoprotein that
results from the covalent attachment between a
sugar (such as glucose or fructose) to total
serum proteins, primarily albumin, therefore
forming ketoamines.
• The degree of control of diabetes over the
preceding 2-3 weeks.
 6-Urine analysis
• Glycosuria
• Glucose oxidase (GOD), peroxidase (POD), and
dye O-toluidine (chromogen). In this reaction,
glucose is oxidized to gluconic acid and H2O2 by
the enzyme GOD.
• H2O2 formed is split into water and nascent
oxygen by POD enzyme, oxygen reacts with the
chromogen to form a colored product.
• 1. The container used for urine collection should
be clean and free from contaminants, particularly
disinfectants and detergents containing oxidizing
substances such as peroxides.
• 2. Do not touch the test area of the strip.
• Excretion of glucose in urine is called glycosuria.
• Normally glucose does not appear in urine until
the plasma glucose rises above 160-180 mg/dl.
• Detection of urinary ketones (Ketonuria).
• A normal subject as a result of simple prolonged
fasting
• Microalbuminuria:
• It is defined as an albumin excretion rate of 30-
300 mg/24 hours.
• The importance of microalbuminuria in the
diabetic patient is that it is useful to assist in
diagnosis of early stage of nephropathy and prior
• Lactose: It is found in the urine of lactating
woman and toward the later stage of pregnancy.
• Galactose : urine very rarely. occasionally in
lactation.
• Galactosuria occurs in infants in recessive
inherited disorder and is due to an inability to
metabolize galactose derived from lactose in milk.
• Fructose: It may be found in urine after taking
food rich in fructose (fruits, honey, syrup, and jams).
• It may be found in liver disease and in the urine
of diabetics along with glucose.
• 7-Oral glucose tolerance test (OGTT):
• Measures the ability of the body to tolerate,
metabolize or cope with a standard dose of glucose.
• The degree of tolerance to the glucose, as shown
by a change in the blood level, is mainly
dependent on the rate of glucose absorption and
on the insulin response.
• As the glucose is absorbed, the level of glucose in
the blood rises and the normal response is for
insulin to be released from pancreas to lower the
glucose level.
• Tolerance is reduced when insulin is insufficient or
absent.
 Indications of oral GTT
• 1) Diagnosis of impaired glucose tolerance
(borderline cases of diabetes mellitus).
• 2) Diagnosis of high risk cases to get diabetes
during pregnancy (gestational diabetes).
• 3) Diagnosis of alimentary (intestinal) glucosuria
and renal glucosuria.
• Preparation for a 75 g oral GTT
• 1) The patient is instructed not to restrict
carbohydrate intake for at least 3 days before the
test.
• 2) The patient should avoid any food or drink (10 -12
hours) fasting).
• Water only is permitted.
• 3) All medications taken by the subject must be
noted.
• 4) Smoking, coffee and strenuous exercise should be
avoided for a period of one day before the test.
• 5) The test should not be done during illness or stress.
 • Interpretation of OGTT results
• 1- In healthy non-pregnant adult:
• Fasting plasma glucose should be below 100 mg/dl.
• Peak value (attained 30- 60 minutes after glucose
load) is below or equal to 180 mg/dl (renal
threshold).
• The 2 hours glucose level should be 140 mg/dl or
less.
• A transient slight decline of glucose concentration
might occur due to insulin overshooting.
• All urine samples should be negative for glucose.
 2- Impaired glucose tolerance (prediabetes):
• Fasting plasma glucose:
100-125 mg/dl.
• 2 hours glucose level:
140-199 mg/dl.
• Change in lifestyles,
especially diet and
exercise, has been shown
to prevent or delay the
onset of T2DM and its
complications.
• 3- Diabetes mellitus:
• Fasting plasma glucose ≥126 mg/dl.
• 2 hours glucose level ≥ 200 mg/dl.
• 4-Renal glucosuria:
• Urine sample
• Plasma glucose level is still below the normal
renal threshold (<180 mg/dl).
• Causes:
• 1- Genetically inherited low renal threshold.
• 2- Tubular reabsorption defects
• e.g. Fanconi syndrome
• The ‘complete ’ or classical ’ Fanconi syndrome
may be defined as an impairment of proximal
tubule reabsorption of sodium, bicarbonate,
potassium, phosphate, glucose, amino acids, uric
acid and low-molecular-weight proteins, and
peptides, as well as other organic solutes.
• Diseases involving renal leak of some but not all
of these solutes are termed ‘ partial ’ Fanconi
syndromes.
• 5- Alimentary (intestinal) glucosuria
• A sharp rise in plasma glucose with early peak
values exceeding the renal threshold and
associated with glucosuria.
• The 2 hours post prandial level is much below the
fasting level. This is due to rapid glucose absorption
followed by a burst of insulin production which
over-compensate, resulting in hypoglycemia.
• This may be seen in:
• Some healthy individuals.
• Gastrectomy.
• Sever liver cirrhosis.
• 6- Flat response in OGTT:
• Plasma glucose levels fail to rise significantly after
an oral glucose load.
• These cases also show low fasting plasma glucose.
• It may be due to:
• Insulinoma
• Intestinal malabsorption syndrome.
• Some hormonal deficiencies e.g. hypopituitarism,
hypothyroidism, hypofunction of adrenal cortex.
 • Gestational diabetes
• Any degree of glucose intolerance with onset or
first recognition during pregnancy.
• Risk factors:
• Maternal obesity is a significant risk factor.
• Physical inactivity.
• Hypertension
• The preferred diagnostic test for gestational
diabetes is the 100 gram 3 hour OGTT.
• Although gestational diabetes may resolve after
delivery, these women often have a higher risk of
developing type 2 diabetes mellitus later.
• The American Diabetes Association (ADA)
suggests that at least 2 of the following 4 venous
plasma glucose levels must be attained or
exceeded to diagnose gestational diabetes:
 Blood Glucose Levels by Glucose
Oxidase(GOD) Method:
• The enzyme GOD oxidizes the plasma glucose to
gluconic acid with the liberation of H2O2, which is
converted to water and oxygen by the enzyme
POD(Glucose peroxidase)
• 4-aminoantipyrine, an oxygen acceptor, takes up
the oxygen and together with phenol forms a
pink-colored product which can be measured at
520 nm.