Laboratory Diagnosis, Monitoring and Management of the Diabetic Patient - Essay Example

Diabetes Diabetes is a life long disease that once diagnosed promises to stay up to the end of life. Care takers of diabetic patients often require some sort of patience as they take care of them. Those individuals who care for diabetic patients also require perseverance and an understanding of humanity combined with a cautious optimism, to guide those with diabetes through the highs and lows in their lives (Fine, 2008). In addition, Diabetes is caused either by lack of insulin or because of the availability of factors that oppose the functionality of insulin. Increase in blood glucose concentration is the main reason behind the inability of insulin to function correctly. This disorder is known as hyperglycemia. Many other metabolic abnormalities occur, notably an increase in ketone bodies in the blood when there is severe lack of insulin (Jacobs, 1996). Glucose measurement in an accredited laboratory should be the rationale of ant diagnosis of diabetes. In the laboratory, glucose tolerance test is not norm ally required in regular clinical practice. It can only be carried out if uncertainty exists in younger patients, or to find out an exact diagnosis in pregnancy. For, results that can be counted on, glucose tolerance tests should be carried out in the morning after an overnight fast, with the patient being required to sit calmly and not smoking. In addition, the patient should have normal meals for the previous three days and should not have been dieting. Inaccurate results may be achieved if the patient has been ill recently or has had prolonged bed rest (Fine, 2008). During glucose tolerance test, blood glucose concentrations are determined and are measured fasting and then one and two hours after a drink of 75g of glucose in a volume of waster, approximately 250-350ml. it is recommended that the water be flavored, for example, with pure lemon juice. Further, urine tests should be carried out before the glucose drink and at one and two hours. According to WHO, ADA, and diabetes UK, the criteria for the diagnosis of diabetes states that: symptoms of diabetes plus casual venous plasma glucose11.1mmol/1. They define casual as any time of the day without regard to time since the last meal was taken. Some of the classic symptoms include polyuria, polydipsia, and unexplained weight loss. Secondly, fasting plasma glucose should be or whole blood. Fasting is defined as no calorie intake for at least eight hours. Another criterion for diagnosis is: 2 hour plasma glucose during oral glucose tolerance test using 75g glucose load. When there are no symptoms, these criteria should be verified by repeating testing on a different day. When the fasting or random values are not diagnostic, the 2 hour value post-glucose load should be used (Fischbach and Dunning, 2008). FPG Test Table 1. FPG test Plasma Glucose Result (mg/dL) Diagnosis 99 or below Normal 100 to 125 Pre-diabetes (impaired fasting glucose) 126 or above Diabetes* *Confirmed by repeating the test on a different day. Courtesy of the National Diabetes Information Clearinghouse (NDIC) 2-Hour Plasma Glucose Result (mg/dL) Diagnosis 139 and below Normal 140 to 199 Pre-diabetes (impaired glucose tolerance) 200 and above Diabetes* *Confirmed by repeating the test on a different day. Courtesy of the National Diabetes Information Clearinghouse (NDIC) Table 3. Gestational diabetes: Above-normal results for the OGTT* When Plasma Glucose Result (mg/dL) Fasting 95 or higher At 1 hour 180 or higher At 2 hours 155 or higher At 3 hours 140 or higher Note: Some laboratories use other numbers for this test. (OGTT) Oral glucose Tolerance Test. (FPG) Fasting Plasma Glucose Test Courtesy of the National Diabetes Information Clearinghouse (NDIC) Glucose, the main factor contributing to diabetes, is formed from carbohydrate digestion and conversion of glycogen to glucose. Digestion and conversion of glycogen to glucose takes place in the liver. There are two hormones responsible for the regulation of blood glucose, for example, glucagon and insulin. First, glucagon speeds glycogen breakdown in the liver, it then causes the blood glucose level to rise. Secondly, insulin is responsible for the increase in cell membrane permeability to glucose. In addition, insulin transports glucose into cells for metabolism. It also stimulates glycogen, and reduces blood glucose levels (Katsilambros, Diakoumopoulou and Loannidis, 2006). The movement of insulin into the cells requires insulin and insulin receptors. For example, after a meal, the pancreases releases insulin to be used in glucose metabolism provided there are enough insulin receptors. The process involves insulin binding to the receptors on the surface of target cells which are normally found in fat and muscle cells. When the cellular glucose metabolism is taking place, blood glucose levels fall. These hormones, andrenocorticotropic hormone (ACTH), andrenocorticosteroids, epinephrine, and thyroxin are very important in the process of glucose metabolism. It is important to note that American diabetes association (ADA) has began using the term pre-diabetes, which is also known as impaired glucose tolerance or impaired fasting glucose. The y state that persons with pre-diabetes shoe higher levels of blood plasma glucose (110-1245mg/dl or 6.1 to 6.9mmol/L) than normal subjects ( Read More