The clinical, biochemical laboratory procedures
including determination of glycosylated haemoglobin (HbA1c) and Insulin level are significant means for detection in diagnosis, staging, monitoring and evaluation of response to therapy and detection of control of the disease. The evaluation of normal routine fasting and post prandial blood sugar. Levels have been established by the standardised technique for several decades. Different groups of biochemical investigations have been tried and reported to be useful.
HbA1c in whole blood originates principally from RBC and measurement of these fractions is valuable for the identification of average blood glucose level of 120 days. The present study was undertaken to determine the role of HbA1c and other related biochemical parameters. Insulin and glucose along with the lipid study in the different stages in Type I and Type II diabetes in particular, therefore in the present plan of studies attempts have been made to elucidate the functional attributes of these tests for the early detection of diabetes and to monitor the management of the disease.
Obesity is an abnormal growth of adipose tissue due to an enlargement of fat cell size (Hypertrophic Obesity) or increase in fat cell number (Hyperplastic Obesity) or a combination of both. A body mass index of 25 or more in males and females.
The main source of energy for body tissue is glucose. A fixed range of glucose concentration in different body tissue is essential to maintain a normal metabolism of the related tissue as a raised or low concentration either affects the normal metabolism of tissue or is pathognomonic of certain diseases like increase in blood glucose levels reflecting the deficiency of glucose utilization resulting into the diabetes Mellitus.
It is well known fact that obesity is a cause and effect of insulin insufficiency either in the way of less insulin receptors or insulin synthesis. The main source of energy for body tissue is glucose. A fixed range of glucose concentration in different body tissue is essential to maintain a normal metabolism of the related tissue as a raised or low concentration either affects the normal metabolism of tissue or is pathognomonic of certain diseases like increase in blood glucose levels reflecting the deficiency of glucose utilization resulting into the diabetes mellitus.
The classification of diabetes mellitus adopted by WHO1,2 is as follows:
A) Diabetes Mellitus
- Insulin Dependent Diabetes Mellitus (Type I)
- Non-insulin Dependent Diabetes Mellitus (Type II)
- Malnutrition - Related Diabetes Mellitus
- Other types (secondary to pancreatic, hormonal, drug induced, genetic and other abnormalities).
B) Impaired Glucose Tolerance
C) Gestational Diabetes Mellitus
Material and Methods
50 healthy individuals properly scrutinized by the Physicians without any pathophysiological abnormalities. They were considered to obtain base line data for glucose insulin and glycosylated haemoglobin level.
Hundred patients suffering from carbohydrate intolerance were labelled as Group Obese Type I Diabetes mellitus. In accordance with the WHO. Guidelines and further divided into controlled (50) and Uncontrolled (50) Obese diabetic patients.
The following parameters were studied in both the groups on using ready to use kits.
1) Fasting blood sugar (GOD/POD method)3
2) Post prandial blood sugar (GOD/POD method)3
3) Fasting insulin level (Transasia Elisa reader)4
4) Post prandial insulin level (Transasia Elisa reader)4
5) Glycosylated haemoglobin (Column chromatography)5
Fig. 1 : Normal vs Type I obese uncontrolled and controlled diabetes.
Results obtained are shown in Table 1.
The data indicates elevation of about 1.5 times increased in fasting glucose level and 2 times increased in post prandial glucose level in Obese uncontrolled diabetic patients at the same time the fasting blood sugar and post prandial glucose level of obese controlled diabetic patients were found to be nearly same as that of the normal individuals. These increased values were statistically significant (p < 0.01). Similarly the study of glycosylated haemoglobin in Type I obese uncontrolled diabetic patients fasting insulin level and Post prandial insulin level were found to be increased by 1.5 times more than 2 times with respect to normal individuals and Type I Obese controlled diabetic patients.
These results revealed that the fat content of the adipose tissue can increase to unlimited amounts depending on the calories taken in. High insulin level observed suggest the positive decrement in insulin receptors and peripheral resistance against the insulin action. In these patients i.e. uncontrolled obese diabetic patients, probably exaggerate the same situation which result in high glucose levels and in turn increased HbA1c levels.
These findings fall in line with the previously reported research work carried out by various scientists.6-8
Summary and Conclusion
In diabetic Type I obese patients insulin level are noted which shows elevation as compared to normal data which is statistically significant (p < 0.01). These elevations are comparable with the data observed from previous other research work. Further followup study of these parameters in diabetes mellitus along with mean glucose levels and lipid profile, C-peptide, nutritional control and exercise will give additional information to the diabetology for controlling disease syndrome.
- WHO Technical. Rep Ser 1985; 727.
- King H, Reaven M. WHO Adhoc Diabetes Reporting Group. Global estimates for prevalence of diabetes mellitus and IGT in adults. Diabetes Care 1993; 16 : 157-77.
- Varley H, et al. Practical clinical Biochemical. 5th Edition, William, Heriemann Medical Books Ltd London. 1980; 1 : 665.
- Trinder P. Ann Clinical Biochemical 1969; 6 : 14.
- Batus HM. Lab Manag. 1978; 16.
- Osei K, Rhinesmith S, Gaillard T, Schuster D. Is glycoselated hemoglobin A1c a surrogate for metabolic syndrome in nondiabetic, first degree relatives of African - American patients with type 2 diabetes. J Clin Endocrinol Metab 2003; 88 (10) : 4596-601.
- Mokdad AH, Ford ES, Bowman BA. Prevalence of obesity, diabetes and obesity - related health risk factors 2001. JAMA 2003; 289 (1) : 76-79.
- Schauer UJW. Is there a metabolic syndrome in Type I diabetes. 2, Medizinische Kink, Helios Klinikum Erfurt, Germany.