DIABETES

The prevalence of Diabetes is on the rise ,more alarmingly in the developing nations.Ranked 7^th among the leading cause of death.Diabetes also known as Madhumeha which means rain of honey.The number of Diabetic patients in the world has crossed 175 million.This figures are contributed by mainly populous countries –India and China.

Every 5^th Diabetic in the world is an Indian and every 5^th Mumbaikar may be diabetic.

The presenting features of Diabetes vary widely.Age and nature at onset may be broadly indicative of the clinical type .Almost all the children ,adolescents present with the classical traid of polyuria ,polydipsia and polyphagia.Fatigue,lassitude and weight loss follow inspite of good appetite and adequate food intake.Aches,cramps and paraesthesiae (mostly in the lower limbs),dizziness and blurring of vision occur when treatment is delayed.Most middle age and elderly patients have insidious onset.They have complaint of unexplained weakness ,weight loss,aching or cramps in the legs.Delayed healing of wounds,recurrent crops of boils or appearance of carbuncle often calls for investigation.Not infrequently poor obstretic history and impotence indicates the possibility of Diabetes.Investigations in  the cases presenting with neurological deficits ,visual disturbances,or premature coronary or cerebrovascular diseases may reveal Diabetes for the first time.

There are mainly two types of Diabetes :Type I and Type II.

Type I Diabetes :Most of the patients present between the age group of 10-20yrs.Presents with polyuria,polydipsia and rapid weight loss.

Type II Diabetes:Most of the patients are above the age of 40 yrs and are obese.They present with polyuria and polydipsia.Hypertension,hyperlipidemia and atnerosclerosis are often associated.

 Patients with Type I Diabetes present with increased urination ,weight loss inspite of increased intake of food.There is loss of water and electrolytes hence there is a compliant of blurred vision,postural hypotension.Patient may complaint of parasthesias that is tingling numbness in the limbs for the first time.Patient may have wasting of muscles .Some times patient may land up in coma,due to repeated vomiting and dehydration which is also known as Diabetes ketoacedosis.

Patient with Type II Diabetes are asymptomatic initially or others may present with polyuria and increased thirst.Many patients are mainly obese and they get detected only during the routine laboratory tests either by increased blood sugar or sugar in the urine.Occasionally,Type II may present with cardiovascular or cerebrovascular complications.Chronic skin infections are common .Diabetes should be suspected in the patients who have delivered large babies,unexplained fetal loss.Diabetics seems to be more associated in males and females with localization of fat deposits on the upper body ,and relatively less on the appendages.

Role of Pathological Laboratory in managing and diagnosing diabetes:

1.URINE ANALYSIS:

A convenient and simple method is urine examination for glucose and ketone bodies.Any random urine or preferably fasting sample can be collected and given to the pathology alb for testing .This test is done at all the labs and does not need any specialized setup for this testing.

2.BLOOD SUGAR TESTING:

Measurement of blood glucose is the method of choice for diagnosis of Diabetes.If the fasting blood glucose value is more than 126 mg/dl,or the random or post lunch  blood glucose value is more than 200 mg/dl then it is considered to a case of diabetes.If this values or not in this range then another test is advised that is oral glucose tolerance test.

3.ORAL GLUCOSE TOLERANCE TEST(OGTT):

75 gms of glucose is given to a patient who is atleast 10 hrs fasting(not more than 16 hrs fasting) and then samples are withdrawn every 1 hrly for 3 hrs and then the readings are seen for the diagnosis of diabetes.

If the fasting blood glucose is more than 126 then further OGTT is not necessary,but if it is less than 126 in suspected cases OGTT is indicated.

4.GLYCOSYLATED HEMOGLOBIN:

It is single most useful monitoring tool in management of diabetic patient.

This a test which is done to moniter patients blood sugar and can give the average of three months blood sugar of the patient.This test reflects the state of glycemia for the past 10-12 weeks ,thereby providing an improved method for assessing diabetes control.Glycohemoglobins are extremely useful in monitoring the progress of the patient.Use of glycohemoglobins for screening of patient is useful.The advantage is patient need not be fasting for this test,it can be performed at any random time.Glcohemoglobin values are not affected by factors like intake of food ,timing of anti-diabetic drugs,exersion etc.In patients who moniter their blood glucose values on their own this a valuable check on the accuracy of monitoring.

Glycohemoglobin values are directly proportional to the macrovascular complications.Blood sugar values may be normal ,but glycohemoglobin  may be higher ,hence the patient may be at a higher risk for complications.

The measurement of Glycohemoglobin is the index for metabolic conversion of diabetes during preceding two to three months thus providing physician with an objective look at the patients diabetic control. 

Normal range of Glycohemoglobin is  4-6.3 %.

Glycohemoglobin                                            Degree of glucose control

5.URINE FOR MICROALBUMIN:

Microalbuminuria is seen in the urine of diabetics after prolonged duration Nephrotic syndrome may be associated.Occasionally it is associated with prediabetes.It is seen in 30% of type I diabetes and 4-20 % in type II diabetes.

Microalbumin is present 25% of patients with type I disease and 36% patients with type II patients.Patients with microalbuminuria have a greater risk for developing renal failure,vascular damage and risk for cardiovascular damage.

5.SELF MONITORING OF BLOOD GLUCOSE:

This forms a very useful tool in home blood glucose monitoring.it avoids the incovinence of requent laboratory visits for most of the patients.Capillary blood glucose that is blood drop from the finger tip is taken and the test is done on aportable battery operated glucometer.But this may require education of the patient in sampling and measuring procedures as well as calibration of the instruments.Bedside monitoring requires rigorous quality control and certification of the personel to avoid errors.