DIAGNOSIS TEST
DIABETES CAN BE DIAGNOSED
BY BLOOD TESTS OR URINE
TESTS
Blood glucose levels
 Oral glucose tolerance test(OGTT)
 Glycosylated hemoglobin (Hb A1c%)
 Glycosuria
 Benedict's test
 Ketonuria

Diagnosis of Diabetes
NORMAL
IGT or IFG
DIABETES
( Impaired Glucose
Tolerance or Impaired
Fasting Glucose)
FPG (Fasting
Plasma
Glucose)
2-h PG (2 hour
post load
Glucose Test)
>70mg/dl
<110 mg/dl
< 140 mg/dl
≥ 110 mg/dl &
< 126 mg/dl
(IFG)
≥ 126 mg/dl
≥ 140 mg/dl &
≥ 200 mg/dl &
< 200 mg/dl (IGT) Casual plasma glucose
conc.
≥ 200 mg/dl
IMPAIRED GLUCOSE HOMEOSTASIS

IFG (Impaired Fasting Glucose) has been
defined as a FPG level of greater than or equal
to 110 mg/dl but less than 126 mg/dl.

IGT (Impaired Glucose Tolerance) is defined as
an OGTT value of greater than or equal to 140
mg/dl but less than 200 mg/dl.

Both are risk factors for diabetes.
ORAL GLUCOSE TOLERANCE TEST (OGTT)
ORAL GLUCOSE TOLERANCE TEST (OGTT)

OGTT determines the body’s ability to utilize a
known amount of carbohydrate.
PROCEDURE:

The test is done in the morning after 3 days of diet
containing 150 g of carbohydrate daily with normal
activity.

Blood sample is taken to determine the FBG
(Fasting Blood Glucose).

75 g of glucose dissolved in 250 to 300 ml
of water is then given orally (for children
1.75 g glucose per kg of ideal weight up to
maximum of 75 g).

Blood samples are taken at every 30 min for
2 hours, and their glucose level is estimated.
RESULTS OF OGTT
mg of glu / 100 ml of blood
+
225
Renal threshold
180 --------------------------------135
225
Renal threshold
180 --------------------------------135
90
45
- Absence of glucose in the urine
- Presence of glucose in the urine
mg of glu / 100 ml of
blood
0
0
0
0
0
1 1½ 2
Hours
Normal Curve
½
90
45
+
+
+
+
+
1 1½ 2
Hours
Diabetes Mellitus Curve
½
GLYCOSYLATED HEMOGLOBIN (HBA1C)

During the life cycle of RBC’s about 120 days, glucose
molecules attach themselves to Hb to form
Glycohemoglobins.

Process of enzymatic attachment of sugar to Hb is
called Glycosylation.

Glycosylation indicates a high conc. of glucose over the
life of the cell (4 months). The test shows the average of
blood sugar for several months.

Advantage: it is not affected by the short term changes
in the blood sugar levels.
GLYCOSYLATED HEMOGLOBIN (HB A1C)
Hb A1c (%)
4 -7%
7–8% :
> 8% :
:
Ideal
Satisfactory
Unsatisfactory
NORMAL MAJOR TYPES OF HEMOGLOBINS
TYPES
COMPOSITION AND
SYMBOL
HbA1
Alpha 2
HbA2
Alpha2
delta2
<5%
HbF
Alpha2
gama2
< 2%
HbA1C
Alpha2
beta2 glucose
<5%
beta2
PERCENTAGE OF TOTAL
HEMOGLOBIN
90%
GLYCOSURIA
GLYCOSURIA :

The presence of abnormal amount of glucose in
urine.
PROCEDURE:
2 or 3 hours just before the meal urine is avoided.
 Breakfast or lunch is taken with usual helpings of
carbohydrate rich foods such as chapattis, rice,
fruits and sweets.

BENEDICT`S TEST
BENEDICT`S TEST

It is the traditional method for detecting reducing
substances in urine.
KETONURIA
KETONURIA
Presence of ketone bodies in the urine.
 It can be detected by nitroprusside reaction
which is conveniently carried out using Acetest
tabltes or ketostix paper sticks .
 If both glycosuria and ketonuria are found, the
diagnosis of diabetes is practically cretain.

SOURCES OF BLOOD GLUCOSE





Diet:- most digestible carbohydrates
ultimately form glucose and other
simple sugars that are transported
to the liver via the hepatic portal
vein.
Gluconeogenesis:- from
gluconeogenic compounds.
Net conversion to glucose without
significant recycling e.g. certain
amino acids and proprionate.
compounds which are the products
of the partial metabolism of glucose
in certain tissues and are conveyed
to the liver/kidney and resynthesized to glucose e.g. lactate
via Cori cycle.
Glucose is also formed from liver
glycogen by glycogenolysis.
BLOOD GLUCOSE LEVEL



The minute-by-minute adjustments that keep the
blood glucose level near 4.5 mm involve the
integrated actions of several hormones (insulin,
glucagon) on metabolic processes in many tissues,
primarily liver, muscle, and adipose tissue.
Insulin:- signals that blood glucose concentration
is higher than necessary - cells respond by taking
up glucose and converting to storage forms.
Glucagon:- signals that blood glucose is too low cells respond by producing glucose through
gluconeogenesis and glycogen breakdown.
Glycogen
If there is not
enough glucose
in the blood,
Glucagon
converts some
glycogen into
glucose.
Glucose in the blood
Glycogen
Glucose in the blood
If there is too
much glucose
in the blood,
Insulin
converts some
of it to
glycogen
Glycogen
Glucose
The
glucose
in the
Butconcentration
there
is no
blood
risesincreases.
toconvert
insulin
to
dangerous
it into
glycogen.
levels.
Glucose in the blood
HORMONES THAT AFFECT BLOOD GLUCOSE
Insulin:Insulin plays a central role in regulating blood
glucose concentration.
 It is produced by the  cells of the Islets of
Langerhans in the pancreas, as a direct response
to the degree of hyperglycemia.
 It is a heterodimeric polypeptide consisting of two
chains linked by disulfide bridges.
 It is synthesized as pre-proinsulin, stored in
secretory granules as proinsulin, and released as
mature insulin.

Glucose
Concentration
Glucose levels rise
after a meal.
Insulin is produced
and glucose levels
fall to normal
again.
Normal
Meal eaten
Time
GLYCEMIC
INDEX
GLYCEMIC INDEX (GI)
A GI value tells only how rapidly a particular
carbohydrate turns into sugar.
 The incremental area under the blood glucose
curve (AUC) after the ingestion of 50 gram of a test
food, expressed as a percentage of the AUC of an
equal amount of a reference food (generally
glucose or white bread)

Blood glucose response to 50 g test food
GI = --------------------------------------------------------------x 100
Blood glucose response to 50 g reference
food
• The calculated GI values are then categorized as low,
medium and high; the numerical value that is
representative of these categories depends on the
reference food used (i.e. white bread or glucose).
• Glycemic Index Categories:LOW GI = 55 or less
MEDIUM GI = 56 to 69
HIGH GI = 70 or more
FACTORS AFFECTING GLYCEMIC INDEX
TYPE OF STARCH:- contains two types of
molecules : amylopectin & amylase
 Amylase:- 20-30%
 Amylopectin:- 70-80%

Amylase absorbs less water, the molecules
form tight clumps which slows the rate of
ingestion.
 Kidney beans have higher levels of amylase
that is GI:-28.
 Amylopectin absorbs more water and they are
more open and lead to a higher rate of
digestion.
 Gluttonous rice have higher amylopectin that is
GI:- 98


PHYSICAL ENTRAPMENT:-It is the way food is
encased and the ability of the food to be
absorbed by the body & it is also effect the GI
ranking. Eg. bran has a physical barrier which
slows down the enzymatic activity of the
internal starch layer during digestion. Bran has
low GI:-38.
VISCOSITY OF FIBER:- viscosity is the
measurement of the thickness of the liquid.
 A high viscosity item has a sticky consistency
somewhere between liquid & a solid.
 This can have large influence of foods GI
ranking as viscous soluble fiber can
transform the contents of the intestine into a
gel like matter.
 A slower rate of digestion reduces the rate of
rise in blood glucose levels.


SUGAR CONTENT:- sugar content of food item
also affects its ranking. Food with higher sugar
content are more likely to be ranked higher as
sugar is a food item very similar to glucose.
FAT AND PROTEIN CONTENT:- slow the gastric
emptying( the process by which food exists the
stomach & enters the duodenum) The
duodenum aids digestion by secreting enzymes
into the material passing down from the
stomach.
 By slowing down gastric emptying the food
matter is absorbed more slowly by the body
which reduces blood glucose levels.


COOKING:- the cooking process swells the
starch molecules in food and softens it. This
speeds up the rate of digestion giving rise to
higher levels of blood glucose.
GLYCEMIC LOAD
GLYCEMIC LOAD
 GL is a ranking system for CHO content in food
portions based on their GI & the portion size.
 Actually GL is the total amount of CHO
contained in each food, food preparation or
meal.
 The usefulness of GL is based on the idea that
a high glycemic index food consumed in small
quantities would give the same effect as larger
quantities of a low GI food on blood sugar.
 GL= GI valueX CHOper serving/100
EXAMPLES OF GI & GL OF SOME FOODS (FOSTER-POWELL ET
AL., 2002)
PRODUCT
Glucose
GI(GLUCOSE=100)
CARBOHYDRATE
(g/100g)
GL(g/100g)
100
100
100
Corn flakes
81
86
70
White bread
70
47
33
Porridge
58
9
5
Coca cola
58
10
6
Rice, long grain
56
27
15
Mango
51
14
7
Whole grain bread
51
43
22
peach
42
10
4
Apple juice
40
10
4
Apple
38
13
5
yogurt
36
6
2
RELATION OF GLYCEMIC INDEX AND DIABETES

GI is food ranking system that gives lower
number to foods that result in lower and more
gradual blood glucose increases, & a higher
number to foods that raise blood levels more
drastically and more quickly. A particular food
has ranking within the GI the total GL depend
on the serving size together with the amount
of CHO that serving.
ARTIFICIAL SWEETNERS
ARTIFICIAL SWEETNERS
An ideal sweetener is as or sweeter than
sucrose, has a pleasant taste with no after
taste, is colorless, readily soluble, stable,
functional and economically feasible.
 It is nontoxic does not promote dental cavities
and is either metabolized normally or excreted
from the body unchanged without contributing
to any metabolic abnormalities.
 When multiple sweetener are used together
they have a synergistic effect.

LOW CALORIE SWEETENER
POLYOLS: Polyols occur in nature, they are synthesized on
industrial scale from easily accessible CHO such as
starch, sucrose, glucose, invert sugar, xylose, and lactose.
Sugar alcohols(xylitol, sorbitol, mannitol, maltitol lactitol,
isomalt) Known as polyols are white crystalline, slightly
hygroscopic, water soluble powders.
They are less sweet and 50% of energy of polyols is
available to human body.
Average caloric value is 2.4kcal/g. Polyols are suitable
for diabetics because rapid glycemic response is
avoided.
For the same reason sorbitol & xylitol are often included
in parenteral nutrition to provide more controllable CHO
energy source to glucose or fructose.
Due to induced digestibility of polyols, their intake
should be restricted to 40-50g/day for adults & 30g
/day for children in order to avoid gastrointestinal
discomfort.
NON CALORIE SWEETENER

CYCLAMATE. It is 30 times sweeter than
sucrose.It taste much like sugar & is heat
stable.It was banned following a report that
some rats receiving very large doses had
developed tumors of the urinary bladder.

Acelsulfame –k. It is a synthetic derivative of aceto-acetic acid.
It is not metabolized in the body & is excreated unchanged.
It has little undesirable after taste.At very high concentrations
it exhibits lingering bitter & metallic flavor attributes.
Acelsulfame-k, the potassium salt of acelsulfame is up to
200 times sweeter than a 3% sucrose solution.
In mixtures of acelsulfame-k & aspartame there is a strong
synergistic enhancement of sweetness.
Blends are 300 times sweeter than sucrose solutions while
individually they are only 100 times sweeter.

ALITAME. It is a dipeptide based amide & has a
sweet taste similar to sugar. It is more than
2000times sweeter than sucrose.

Aspartame. It is made by combining two amino acids:-aspartic acid &
phenylalanine- & adding methyl alcohol to form a methyl ester.

Aspartame is a white, odourless, crystalline powder that has a sugar
like taste and instability to sweetness potency 180-200 times that of
sucrose without any bitter aftertaste.

Since it can not be utilized by the body the caloric value is
insignificant.

It is not stable to heat & changes chemically & loses sweetness.

Its heating can be corrected by encapsulating a core of granulated
aspartame with a water resistant coating of polymer or a layer of fat.

After the outer layer melts, the core layer slowly hydrates ,releasing
the aspartame in the final stage of baking.
SACCHARIN:- it is sodium ortho benzene
sulphonamide or the calcium salt.
 It is stable in a wide variety of products under
extreme processing condition.
 It can be synthesized with relatively few
impurities and is inexpensive.
 It gives bitter after taste at higher
concentration.
 When used in combination with aspartame
or cyclamate , sweetness is enhanced
&bitterness is decreased.

SUCROLOSE:- white crystalline solid
produced by the selective addition of
chlorine atoms to sucrose.
 It is 600 times sweeter than sugar & no
bitter after taste. It is very soluble in water &
stable at high temperatures and therefore
can be used in baked goods.
 Sucrolose does not interact with any other
food components.
