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Diabetes melitus is a group of metabolic disorder, involving carbohydrate, lipid and protein metabolism, characterised by chronic hyperglycaemia, as a result of defects in insulin secretion from the beta cells of pancreas or peripheral action of insulin (insulin resistance) or both.
Normally, our body breaks down the sugars and carbohydrates we eat into a special sugar called glucose. Glucose fuels the cells in our body. But the cells need insulin, a hormone, in our bloodstream in order to utilize the glucose and use it for energy. In diabetes melitus, either body doesn’t make enough insulin or it can’t use the insulin it produces or combination of both.
Since the cells can’t take in the glucose, it builds up in blood. High levels of blood glucose can damage the tiny blood vessels in kidneys, heart, eyes or nervous system. That’s why diabetes – if left untreated – can eventually cause heart disease, stroke, kidney disease, blindness and damage to nerves in the feet.
In the earlier part of development of diabetes, the patient may remain asymptomatic for a long period of time, on the other hand in the later part of the disease the features of long term complications of diabetes may manifest and become part of the diabetic syndrome.
Diabetes is a common disease and associated with significant morbidity and mortality. It has an asymptomatic phase that may be up to 7 to 10 years before the diagnosis is made. And if treated early, the long term complications may be preventable, so testing is rationale for screening diabetes. Both fasting plasma glucose FPG and 2 hours post meal Plasma glucose values PPBS are now used widely in clinical practice as well as in epidemiological studies. Though a casual plasma glucose more commonly called random plasma glucose 200 mg/dl or greater with symptoms is an established diagnostic criteria for diabetes but as a screening test for diabetes it is insensitive specially when the value is on the lower side.
Glycated haemoglobin of HbA1c is recommended for monitoring blood sugar control in diabetic patients.
A fraction of haemoglobin in the RBCs is found to be in a glycosylated form i.e. has glucose attached to it. The HbA1c level is proportional to average blood glucose concentration over the previous two or three months and therefore is an excellent indicator of how well the patient has managed his/her diabetes over the last four weeks to three months. It should be less than 7% for people with diabetes in general.
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