Diabetic Profile Ravi Kumudesh MScBScDipMLT Sri Lanka Society

Diabetic Profile Ravi Kumudesh MSc/BSc/Dip(MLT) Sri Lanka Society for Medical Laboratory Science slsmls. org / kumudeshr@gmail. com

Diabetes Mellitus • It is a chronic disease due to disorder of carbohydrate metabolism, due to insulin deficiency results in hyperglycemia (increased blood glucose level) & glucourea (presence of glucose in urine). • Associated with several changes in metabolism; such as metabolism of proteins & fats. slsmls. org / kumudeshr@gmail. com

Clinical Biochemical Findings in Diabetes • Glucosuria. • Large volume of urine • increase urination frequency (Polyuria) • Polyphagia (eats more frequently) • Several metabolic changes slsmls. org / kumudeshr@gmail. com

Metabolic changes in diabetes Include increase in: § Fat catabolisim leads to increase in FFAs in blood & liver. § Acetyl. co. A leads to increase formation of cholesterol & risk of atherosclerosis. § ketone bodies generation in blood and urine leads to acidosis. § catabolism of tissue protein due to energy requirement (because glucose can't uptake by cells) lead to weight loss and increase in level of amino acids in blood & more formation of urea by deamination of amino acid. slsmls. org / kumudeshr@gmail. com

Types of diabetes • Type I diabetes mellitus (TIDM) • Type 2 diabetes mellitus (TIIDM) • Gestational diabetes mellitus (GDM) • Other "due to drugs or chemicals" slsmls. org / kumudeshr@gmail. com

Diabetic profile: Is group of tests that are used to diagnose diabetes or its complications , it includes: Ø Blood glucose 4 types: FBS, PPBS, RBS, OGGT Ø Urine Analysis Urine Sugar / Urine Protein /Urine Microalbumin / Ketones Ø Ø Hb. A 1 C Insulin ICA (islent cell antibody) for type I C-peptide slsmls. org / kumudeshr@gmail. com

Urine Analysis slsmls. org / kumudeshr@gmail. com

1. Urine Sugar Detection of urinary glucose (Glucosuria) slsmls. org / kumudeshr@gmail. com

Glucosuria o First-line screening test for diabetes mellitus o Normally glucose does not appear in urine until the plasma glucose rises above 160180 mg/dl. o In certain individuals due to low renal threshold glucose may be present despite normal blood glucose levels. o Conversely renal threshold increases with age so many diabetics may not have Glycosuria despite high blood sugar levels. Positive Benedict’s test

o A specific and convenient method to detect glucosuria is the paper strip impregnated with glucose oxidase and a chromogen system (Clinistix, Diastix), which is sensitive to as little as 0. 1% glucose in urine. o Diastix can be directly applied to the urinary stream, and differing color responses of the indicator strip reflect glucose concentration. o Benedict’s and Fehling’s test can also detect glucosuria. Diastix. Reagent strips

2. Urine Microalbuminuria slsmls. org / kumudeshr@gmail. com

o The importance of microalbuminuria in the diabetic patient is that it is a signal of early reversible renal damage. o Performing an albumin-tocreatinine ratio is probably easiest. o Microalbuminuria is a common finding (even at diagnosis) in type 2 diabetes mellitus and is a risk factor for macro vascular (especially coronary heart) disease. Microalbuminuria Gradation of turbidity is linked to protein concentration slsmls. org / kumudeshr@gmail. com

Microalbuminuria o May be defined as an albumin excretion rate intermediate between normality (2. 5 -25 mg/day) and macroalbuminuria (250 mg/day). o The small increase in urinary albumin excretion is not detected by simple albumin stick tests and requires confirmation by careful quantization in a 24 hr urine specimen.

Assays for Microalbuminurea Qualitative § Dipstick method Quantitative § Enzyme linked Immunosorbant assay § Radioimmuno assay § Immunoturbidometric assay slsmls. org / kumudeshr@gmail. com

Specimen Collection for Microalbimin • Collect freshly voided urine in a clean, dry container • Preservatives should be avoided • Samples which cannot be tested within 3 days of collection should be refrigerated • Samples should not be frozen • The test should be free from significant interference from glucosuria, p. H, ketonuria or bacterial contamination slsmls. org / kumudeshr@gmail. com

MICRAL Strips § Micral strip screening tests offer a costeffective method of screening § Dip sticks show acceptable sensitivity (95%) and specificity (93%) § All positive tests should be confirmed by more specific methods slsmls. org / kumudeshr@gmail. com

False Positives § Hyper filtration (Newly diagnosed diabetes) § Exercise § Marked hypertension § Congestive Heart Failure § Urinary Tract Infection § Acute febrile illness slsmls. org / kumudeshr@gmail. com

3. Urine Ketone Bodies Ketonuria slsmls. org / kumudeshr@gmail. com

What Are Ketones? § Acids that result when the body does not have enough insulin and uses fats for energy § May occur when insulin is not given, during illness or extreme bodily stress, or with dehydration § Can cause abdominal pain, nausea, and vomiting § Without sufficient insulin ketones continue to build up in the blood and result in diabetic ketoacidosis (DKA) slsmls. org / kumudeshr@gmail. com

Why Test for Ketones? § DKA is a critical emergency state § Early detection and treatment of ketones prevents diabetic ketoacidosis (DKA) and hospitalizations due to DKA § Untreated, progression to DKA may lead to severe dehydration, coma, permanent brain damage, or death § DKA is the number one reason for hospitalizing children with diabetes slsmls. org / kumudeshr@gmail. com

When Should Ketones Be Checked? The DMMP should specify, generally: When blood glucose remains elevated § During acute illness, infection or fever § Whenever symptoms of DKA are present § ü ü ü ü § Nausea Vomiting or diarrhea − Abdominal Pain Fruity breath odor Rapid breathing Thirst and frequent urination Fatigue or lethargy Common symptoms including fruity odor to breath, nausea, vomiting, drowsiness, abdominal pain slsmls. org / kumudeshr@gmail. com

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