GLUCOSE TOLERANCE TEST

BIOCHEMISTRY
2nd YEAR
HORMONES

SHINI VERMA
ROLL NO.-804
CONTENTS
Glucose and its homeostasis
Diabetes

Types of diabetes- type-1; type-2; gestational

diabetes
Glycemic index

Glucose tolerance test

Glucometer

Other tests- OGTT; HbA1C; urine glucose test

References
GLUCOSE AND ITS HOMEOSTASIS
Glucose is a simple sugar which has a molecular formula of
C6H12O6.It circulates in blood of animals and humans as blood
sugar. It is a permanent and intermediate source of energy.
Glucose in blood i s obtained from the food you eat. It gets
absorbed by the intestines and distributed to all of the cells of
the body through bloodstream and breaks it down for energy.
Body tries to maintain a constant blood glucose concentration
by maintaining a constant blood supply to the cells.
The concentration of glucose in blood is expressed in mg/dl
and is defined as glycemia.
The normal blood glucose levels are 70-110 mg/dl in humans.
Blood glucose levels are regulated by the two pancreatic
endocrine hormones, glucagon and insulin; which are secreted
by the islet cells of pancreas.
 Insulin and glucagon act antagonistically.
When the blood glucose levels are high, insulin is secreted
which causes liver to convert more glucose molecules to
glycogen.
When the blood glucose levels are low, glucagon is secreted
which act on liver cells to promote the glycogen breakdown
to produce more glucose molecules.
Essentially blood glucose levels determine the time of
secretion of these hormones.
The blood glucose level is easily influenced by some
external factors such as body composition, age, sex and
physical activity.
 DIABETES

Diabetes is a disease related to abnormal blood glucose levels

due to abnormal metabolism of blood sugar and defective
insulin production or recognition by the body.
Condition in which there is too much sugar in the bloodstream
is called hyperglycemia.
Condition in which there is a drop in blood sugar level below
the normal range is called hypoglycemia which is possibly due
to side effect of medications.
TYPES OF DIABETES
DIABETES MELLITUS TYPE-1

It is a form of diabetes mellitus in which not enough insulin is

produced. The underlying mechanism involves an autoimmune
destruction of the insulin producing beta cells in pancreas.
It is known as Insulin Dependent Diabetes Mellitus (IDDM).
Symptoms : frequent urination
increased thirst
increased hunger
weight loss
Complications : diabetic ketoacidosis
non-ketotic hyperosmolar coma
poor healing
cardiovascular disease
damage to the eyes
Diagnosis : blood sugar and A1c
 Treatment : insulin therapy
diabetic diet
exercise
Frequency : ~7.5% of diabetes cases

DIABETES MELLITUS TYPE-2 :

It is a long term metabolic disorder which primarily occurs as a result
of obesity or lack of exercise. The insulin is produced but is not
detected by the body as the insulin receptors are dysfunctional.
It is characterized by high blood sugar, insulin resistance and relative
lack of insulin.
It is known as Non-Insulin Dependent Diabetes Mellitus (NIDDM).
It is common in older people.
 Symptoms : increased thirst
frequent urination
unexplained weight loss
increased hunger
feeling tired
non healing sores
Complications : long term- heart disease, strokes, diabetic
retinopathy, amputations.
short term-hyperosmolar hyperglycemic state
ketoacidosis(uncommon)
Diagnosis : blood test
Treatment : dietary changes
exercise
Frequency : 392 million (2015)
GESTATIONAL DIABETES :
A woman without diabetes develops high blood sugar levels
during 24-26 weeks of pregnancy.
The placental hormones produced during pregnancy can lead
to a build up of sugar in your blood.
Usually pancreas can make enough insulin to handle that but
if not, then blood sugar levels can increase and lead to
gestational diabetes.
Symptoms: generally none.
Complications: pre-eclampsia, still birth, depression, increased
risk of caesarean section, overweight, PCOS.
Diagnosis: screening blood tests
Prevention : healthy weight maintenance and exercise before
pregnancy.
Treatment : diabetic diet, exercise, insulin injections (if
required)
 For those who are at normal risk, blood test is recommended
between 24-28 weeks of gestation.
At higher risk- first prenatal visit.
Frequency : 3-9% of pregnancies.
 GLYCEMIC INDEX
Glycemic index is a relative ranking of carbohydrate in foods
according to how they affect blood glucose levels.
It represents the rise in blood sugar level two hours after the
consumption of food.
GI is the ratio of time taken by 50g of carbohydrate to bring
glucose to blood to time taken by 50g of glucose itself.
A value of 100 represents the standard, an equivalent amount
of pure glucose.
GI ratings : 55 or less is low; 56-69 (inclusive) is medium; 70 or
more is high.
Limitation : it does not measure insulin production due to rises
in blood sugar i.e. two foods could have same GI value but
produce different insulin.
 GLUCOSE TOLERANCE TEST

A glucose tolerance test is a medical test which measures how

well the blood glucose is absorbed by the cells of body, or, the
ability of body to clear the glucose from blood.
These measurements can be done as:
Fasting levels : overnight fasting or atleast 6-8 hours of fasting
is required for this. The normal fasting blood glucose levels are
70-110mg/dl.
Post prandial : glucose levels measured after intake of food,
mainly 2hrs after a meal. Normally the post prandial glucose
levels should be less than 140mg/dl taken 2hrs after meal.
Random levels can also be checked.
GTT BLOOD SUGAR LEVELS

S.NO CONDITION FASTING(mg/dl) JUST ATE PP(mg/dl)

(mg/dl)
1. NORMAL 70-110mg/dl 170-200mg/dl 120-140mg/dl

2. PRE-DIABETIC 101-125mg/dl 190-230mg/dl 140-160mg/dl

3. DIABETIC 126+ mg/dl 220-300mg/dl 200+ mg/dl

 500
Glucose concentration (mg/dl)
450
400
350
300
DIABETIC
250 NORMAL
200
150
100
50
0
30 60 TIME(min)
90 120 150 180
 GLUCOMETER

Glucometer is the device used to measure the blood glucose

levels.
A strip is taken and inserted in the required slit in glucometer.
Blood is dropped over it and then the screen displays the blood
glucose levels.
Glucometer employ the oxidation of glucose to gluconolactone
catalysed by glucose oxidase (GOD) or glucose dehydrogenase
(GDH).
GDH is more sensitive.
 Today glucometers use electrochemical method in which-
Test strip contain capillary that sucks a reproducible
amount of blood.

Glucose reacts with GOX electrode, enzyme is reoxidised by

an excess of mediator reagent ferricyanide ion, which in
turn is reoxidised by reaction at electrode which generates
an electric current.
The total charge passing through the electrode is
proportional to the amount of glucose in blood which reacts
with the enzyme.
OTHER TESTS TO MEASURE BLOOD
GLUCOSE CONCENTRATION
OGTT : ORAL GLUCOSE TOLERANCE TEST
In this, amount of glucose is given to a person prior to testing,
at different intervals of time.
Glucose is given orally in this.
It is a gold standard to diagnose type-2 diabetes, but not used
anymore for this.
But it is used commonly to diagnose gestational diabetes.

S.NO CONDITION GLC CONCENTRATION

(mg/dl)
1. HEALTHY 139 and below

2. PRE-DIABETIC 140-199

3. DIABETIC 200and above

 HBA1C : GLYCATED HAEMOGLOBIN TEST
Glycated hemoglobin forms when Hb joins with glucose in blood.
By measuring glycated Hb (HbA1C), clinicals are able to get an
overall picture of what our blood glucose levels have been over
a period of weeks/months.
This test shows how well the diabetes is being controlled.
For people with diabetes, this is important, as higher HbA1C ,
the greater risk and complications.
The amount of glucose in blood is directly proportional to the
amount of HbA1C formed as the glucose present in blood
combines with Hb.
 HBA1C LEVELS

S.NO CONDITION CONCENTRATION OF HbA1C

(mmol/mol)
1. NORMAL Below 42

2. PRE-DIABETIC 42-47

3. DIABETIC 48 or more
 URINE GLUCOSE TEST
A urine glucose test measures the level of glucose/sugar in
urine.
It is less invasive than a blood test but it also tends to be less
accurate.
High urine glucose often indicate diabetes.
Test involves a sample of urine and a dipstick that changes
color depending on the amount of glucose present in urine.
High amount of glucose in urine can also be due to pregnancy.
S.NO. CONDITION GLUCOSE CONCENTRATION IN URINE
(mmol/L)
1. NORMAL 0-0.8

2. DISEASED >0.8
 REFERENCES
Lehninger principles of biochemistry
Textbook of biochemistry: with clinical correlations- Thomas M.
Devlin
Harpers illustrated biochemistry- Robert K. Murray
NCBI
THANK YOU.