INTERPRETATION OF BLOOD
SUGAR VALUES
DR.V.SEKAR
COIMBATORE DIABETES
FOUNDATION
HYPERGLYCEMIA IS THE
HYPERGLYCEMIA
IS
THE
HALLMARK OF DIABETES
HALLMARK OF DIABETES
DIABETES
TREATMENTISISTHE
BASED
HYPERGLYCEMIA
ON THE
NUMBER IN OF
MILLIGRAMS
HALLMARK
DIABETES
BEFORE WE DECIDE WHETHER
BLOOD SUGAR IS
NORMAL , HIGH OR LOW
HYPERGLYCEMIA
IS THEIS
HOW
THE BOOLD SUGAR
HALLMARK
OF
DIABETES
DERIVED FROM WHERE,WHAT
METHOD IS CRITICAL
THE MOST CRITICAL ISSUE IS
CLINICAL CORELATION
HYPERGLYCEMIA IS THE
BLOOD SUGAR SHOULD NOT
BE TREATED
HALLMARK
OF DIABETES
THE PERSON WITH BLOOD
SUGAR SHOULD BE
TREATED
SOURCE OF BLOOD
CAPILLARY OR VENOUS PLASMA
WHAT METHOD?
WHICH MACHINE?
MANUAL,SEMI AUTOMATED,
FULLY AUTOMATED
STEPS FOR INTERPRETATING
BLOOD SUGAR VALUE
•PRE ANALYSIS
•ANALYSIS
•POST ANALYSIS
PRE ANALYSIS
•BLOOD COLLECTION
•LABELLING
•ANTI COAGULANT
•CENTRIFUGE
BLOOD COLLECTION
ANTI COAGULANT
LABELLING
CENTRIFUGATION
VIDEO
PLASMA
PIPETING
1 ML OF REAGENT
10 MICRO LITER OF PLASMA
TYPES OF MACHINE
•TOTALLY MANUAL
•SEMI AUTOMATED
•FULLY AUTOMATED
ANALYSIS
TYPES OF TESTING
GLUCOSE OXIDATES
DEHYDROGENASE
METHOD (GOD)
HEXOKINASE METHOD
TYPE OF REAGENTS
1. END POINT METHOD
2. KINETIC METHOD
TESTING
VIDEO
TIME OF TESTING
BLOOD COLLECTION TIME
TESTING TIME
REPORT RELEASING TIME
IS MORE IMPORTANT
EVERY ONE HOUR THERE IS A FALL
OF 10 – 15 MILLIGRAMS
SAMPLE
STORAGE
ONLY FOR 24 HRS
AT
2 – 8 DEGREE
POST ANALYSIS
REPORT RELEASING
VERIFICATION
RECHECKING
CLINICAL CORRELATION
CALIBERATION
QUALITY CONTROL
WHY FASTING IS HIGH ?
Basal Insulin Deficiency:
Pre Dinner / Post Dinner Blood Sugar Abnormality:
CHO Load:
Glycaemic Index:
Fibre Content of Food:
Time of Food:
 High Low Medium
 High Low
 High Low Medium
Untimely Food Timely Food
Somyogi:
Dawn Phenomenon:
Medication:
Check Insulin Vial
Checked
Storage Area
Check Syringe
Check OHA
Time of Insulin
Insulin Meal Mismatch:
Clear
Turbid
Refrigerator
U 40
Less dose
Room Temp
U100
Correct dose
Correct Time
Untime
Expiry
 High
dose
WHY POST PRANDIAL IS HIGH ?
Basal Insulin Deficiency:
Pre Dinner / Post Dinner Blood Sugar Abnormality:
CHO Load:
 High Low Medium
Glycaemic Index:
 High Low
Fibre Content of Food:
 High Low Medium
Time of Food:
Untimely Food Timely Food
Somyogi:
Dawn Phenomenon:
Medication:
Check Insulin Vial
Clear Turbid Expiry
Checked Storage Area
Refrigerator Room Temp
Check Syringe
U 40
U100
Check OHA
Less dose Correct dose
 High dose
Time of Insulin
Correct Time Untime
Insulin Meal Mismatch:
PERSISTANTLY A1C
1.Diet factor:
High CHO Load
Glycaemic index
 High, Low
Fibre content of the food
 High, Low,
Medium
Timely food,
Untimely food
Time of Food
2. Exercise :
Frequency
Intensity
Time
Type
Aerobics gym yoga exercise
CONT’
6. Co morbid conditions:
HT MAU LIPIDS
BDR
7. Complication:
IHD PDR NEPHROPATHY
NEUROPATHY DFS PVD
8.Doctor factor:
Clinical Inertia
Selection of drug
Dosage
HBA1C MAJESTIC IN THE MANAGEMENT OF
DIABETES IN THE
HBA1C MAJESTIC
MANAGEMENT OF DIABETES
DIABETES
MEANS
DIABETES
MEANS CHRONIC
HYPERGLYCEMIA
CHRONIC HYPERGLYCEMIA
WHAT WE TREAT IS ONLY ACUTE
HYPERGLYCEMIA?
WHAT WE TREAT IS ONLY
ACUTE HYPERGLYCEMIA
BLOOD SUGAR TELLS YOU
BLOOD SUGAR TELLS YOU THE DAY TO DAY
THE DAY VARIATION
TO DAY VARIATION
HBA1C IDENTIFIES
THE OVER ALLTHE
FLUCCATION
HBA1C IDENTIFIES
OVER OF
ALL FLUCCUATION OF BLOOD
SUGARBLOOD SUGAR
CLINICAL CASE STUDY
MR.SANKARANARAYANAN 60YRS
C/O SWELLING IN LEGS
HIS HBA1C IS 11.0% CREA 2.4
WITH BDR ON THE DAY OF TESTING
CLINICAL CASE STUDY
MRS.PADMINI 60 YRS ON THE DAY
OF TESTING HAD BREAKFAST IN
HOTEL HER FASTING WAS 140
POST PRANDIAL 260 & HBA1C 6.0%
HBA1C HELPS TO DECIDE ABOUT
DIABETES IS UNDER CONTROL OR
NOT
PREDICTS FUTURE COMPLICATIONS
HELPS TO DECIDE THE DIABETES
MANAGEMENT
BLOOD SUGAR IS DYNAMIC KEEPS
CHANGING
WITH EACH MEAL BLOOD SUGAR GOES UP
3 TIMES A DAY 90 TIMES IN A MONTH
WE CHECK BLOOD SUGAR ONCE IN A
MONTH / FEW MONTHS &
DIABETES IS TREATED ON PARTICULAR
VALUE UNSCIENTIFIC NOT LOGIC
ROLE OF HBA1C
•CONTROL < 7 %
•NOT UNDER CONTROL > 7 %
•PREDICTS FUTURE
COMPLICATION
DCCT , UKPDS STUDY DECIDE ABOUT
THE DIABETES MANAGEMENT
< 7%
UNDER CONTROL
>7%
NOT UNDER CONTROL
7–8%
NEEDS ACTION
>8%
CHANGING THE MEDICATION OR
ADDING THE DOSE
>10 %
MAY REQUIRE INSULIN
LEVEL OF DECREASE IN HBA1C
LIFE STYLE
MODIFICATION
METFORMIN
SULFONYLUREA
GLITAZONES
SITAGLIPTIN
INSULIN
0.5 – 1
1 – 1.5
1 – 1.5
0.5 – 1.0
0.5 – 1.0
ANY NUMBER
CLINICAL DECESION
MAKING
1.SYMPTOMS
2.COMPLICATIONS
3.DURATION OF DIABETES
4.AGE
5.HBA1C
6.TYPE 1 OR TYPE 2
7.INSULIN DEFECIENCY OR INSULIN RESISTANCE
8.WHICH BLOOD SUGAR IS HIGH FASTING OR POST PRANDIAL
9.DIFFERENCE BETWEEN FASTING AND PP
10.DIABETES + OBESITY
11.DIABETES + HYPERTENSION
12.DIABETES + DYSLIPIDEMIA
13.PSYCO – SOCIO STATUS ,ECONOMIC STATUS
14.CO-OPERATION OF THE PERSON AND HIS FAMILY
SYMPTOMS
CLINICAL SYMPTOMS ARE THE MOST
IMPORTANT PARAMETER IN DECIDING THE
TREATMENT PATHWAY
Eg: POLYURIA,POLYPHYGIA,POLYDYPSIA,WT LOSS
INDICATES A DECOMPENSATED SYMPTOMATIC
DIABETES STATUS – NEEDS INSULIN THERAPY
SEVERE NEUROPATHY – THE CHOICE IS INSULIN
COMPLICATIONS
BASED ON THE MICRO OR MACRO VASCULAR
COMPLICATION THE TREATMENT DECESION
MAY DIFFER
ATDURATION
DIAGNOSIS 50 %OF
OF BETA
CELL IS LOST
DIABETES
LONGER THE DURATION MORE LIKELY REQUIRE
INSULIN THERAPY
AGE
YOUNG AGE ONSET
•
• MIDDLE AGE ONSET / CLASSICAL ONSET
• OLD AGE ONSET
YOUNG AGE ONSET
MAY REQUIRE A TIGHT CONTROL
HBA1C
INDICATES A CHRONIC HYPERGLYCEMIA
HBA1C > 10% MAY REQUIRE INSULIN THERAPY
INSULIN RESISTANCE OR INSULIN DEFECIENCY
WHICH IS PREDOMINANT ?
FASTING OR POST PRANDIAL
WHICH BLOOD SUGAR IS HIGH?
WHAT IS THE DIFFERENCE BETWEEN FASTING
AND POST PRANDIAL?
Eg: BASAL INSULIN TO CONTROL THE FASTING
BOLUS TO CONTROL THE POST PRANDIAL
CO – MORBID CONDITIONS
• HYPER TENSION
• OBESITY
• DYSLIPIDEMIA
PSYCO-SOCIAL, ECONOMICAL
STATUS