Diabetes Mellitus

APPLICATION OF BIOCHEMISTRY IN
DIAGNOSIS AND MANAGEMENT OF

DISEASES
DIABETES
OVERVIEW
• Diabetes is a major health problem with an estimated 425 million

people affected worldwide
• The rise in numbers is associated with an increase in obesity in the
population and treating the complications is a major healthcare cost
CLASSIFICATION
• Type 1 Diabetes-
• When the body loses the ability to make insulin or can only make a very small amount of insulin.
• Type 1 diabetes is usually caused by an autoimmune process, where your body’s immune system
mistakenly destroys the insulin-producing cells.
• Type 2 Diabetes-
• Caused by a dual defect of resistance to the action of insulin combined with an inability to make enough
insulin to overcome the resistance.
• Type 2 diabetes is the most common.
• Gestational diabetes
• diabetes diagnosed during pregnancy.
INTRODUCTION TO DIABETES
MELLITUS
• Diabetes mellitus is a condition in which the body is unable to control blood glucose
levels adequately, resulting in high blood glucose levels (hyperglycaemia)
• Type 1 diabetes is an autoimmune disease in which there's destruction of insulin
secreting β-cells in the pancreas, leading to a deficiency of insulin production.
• There are typically antibodies against key pancreatic proteins involved in insulin
storage and secretion.
• It is a relatively rare form of the disease affecting 5–10% of diabetics, which is usually
diagnosed in childhood and is not associated with excess body weight.
DIAGNOSIS
• In a patient with typical symptoms of hyperglycaemia, diabetes mellitus

can be diagnosed on any one of the following criteria:
i. Casual plasma glucose ≥ 11·1 mmol/L
ii. Fasting plasma glucose (FPG) ≥ 7·0 mmol/L
iii. 2-hour plasma glucose following an oral glucose tolerance test
(OGTT) ≥ 11·1 mmol/L
SYMPTOMS
• Symptoms include frequent

urination due to the osmotic effect
of excess glucose in the urine,
thirst due to loss of fluids and
weight loss.
DISEASE
COMPLICATIONS
AND KETO
ACIDOSIS
• Long-term complications of
diabetes, if blood glucose has
been poorly controlled include
cardiovascular disease, damage
to nerves, the kidney and eyes.
• Ketone bodies are released into
the blood and are detectable in
the breath as a smell similar to
that of acetone.
• Release of ketones into the
blood causes a drop in pH
(acidosis) and the body tries to
compensate by hyperventilating.
• If untreated, these events can
lead to coma and death.
DISCOVERY OF
INSULIN
• On July 27, 1921, Canadian

surgeon Frederick Banting and
University of Toronto medical
student Charles Best
successfully isolated the
hormone insulin for the first
time.
• It marked one of the most
important breakthroughs in
the history of diabetic
treatment. Within a year,
people suffering from diabetes
were being treated with
insulin for a disease that had
been considered fatal.
INSULIN HORMONE
• Insulin is secreted in response to increased blood

glucose levels, and its overall effect is to store
chemical energy by enhancing the uptake and
storage of glucose, amino acids and fats;
consequently reducing blood glucose levels, via
actions on liver, muscle and adipose tissue
• Insulin consists of two polypeptide chains, an
alpha chain containing 21 amino acids and a beta
chain containing 30 amino acids, covalently linked
by two inter-chain disulphide bridges.
• Normal range- In healthy individuals, blood
glucose levels range between 3.5 and 5.5 mmol/l
before meals.
INTEGRATED MANAGEMENT OF
DIABETES
• Diabetes care should be structured and organised around purpose-built

Diabetes Centres, where an interdisciplinary team approach to the
management of diabetes can be effectively organised with minimal
inconvenience to the patient.
• The management team should include the primary care doctor, diabetes
educators with direct access to diabetes specialists and other support
professionals, and health-care providers such as cardiologist,
ophthalmologists, neurologists, nephrologists, podiatrists, pharmacists
and social workers.
TREATMENT
• For treatment of Type 1 diabetes, insulin is essential. Human insulin is

now produced by recombinant DNA technology, rather than via
extraction from the pancreases of animals. Diet and exercise are key to
treatment of Type 2 diabetes and this can be combined with drug
treatment
• Insulin is central to the treatment of diabetes, as all types of diabetes
occur due to the body’s inability to regulate blood sugar efficiently as a
result of insufficient, ineffective, or non-existent insulin supplies
HBA1C
• One of the diagnostic tests for diabetes involves measuring levels of

glycated haemoglobin (HbA1c) from red blood cells.
• This is a valuable test because it gives an assessment of the average
plasma glucose concentration over months, because of the 120 days
lifespan of a red blood cell, and it also gives an indication of how
effective treatment has been.
MANAGEMENT OF CONCOMITANT
CONDITIONS
• Diabetic Dyslipidaemia- The primary target of therapy is the

identification of low-density lipoprotein cholesterol (LDL-C), for which
the goal for persons with diabetes is < 2·6 mmol/L (100 mg/dL),
irrespective of whether or not there is documented CHD13
• Microalbuminuria- is an important risk factor for the development of
progressive diabetic nephropathy. Microalbuminuria is defined as either
an albumin concentration of 20-200 mg/I or an albumin: creatinine
ratio of > 3·5 (women) and > 2-5 g/mmol (men) on first void morning
urine.
SCREENING OF ASYMPTOMATIC
INDIVIDUALS
• The local recommended guidelines for the screening of asymptomatic
individuals for diabetes mellitus are:
• All individuals aged 40 and above, at 3 yearly intervals.
• At a younger age if the following are present:
• Obesity (BMI >27 kg/m2)
• Hypertension (BP >140/90 mmHg)
• 1st Degree relative with diabetes
• Previous gestational diabetes
• Documented coronary artery disease
• All individuals with impaired glucose tolerance or impaired fasting
glucose should be screened annually.
SUMMARY
• Diabetes is a chronic illness with numerous serious complications

resulting in significant morbidity and mortality.
• Addressing issues of medical effectiveness of treatment and continuous
improvement of the quality of care of patients with diabetes have been
shown to have significant positive impact on the patient, the community
and health service provider.
REFERENCES
• Article on “The Clinical Biochemistry of Diabetes Mellitus in Singapore” by SK Sethi

and MS Wong from the journal of international Federation of clinical chemistry and
laboratory medicine.
• Article on “The biochemical basis of disease” by Alastair J. Barr from Essays in
Biochemistry, Portland Press Ltd.
THANK YOU

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APPLICATION OF BIOCHEMISTRY IN

DIAGNOSIS AND MANAGEMENT OF

• Diabetes is a major health problem with an estimated 425 million

• In a patient with typical symptoms of hyperglycaemia, diabetes mellitus

• Symptoms include frequent

• On July 27, 1921, Canadian

• Insulin is secreted in response to increased blood

• Diabetes care should be structured and organised around purpose-built

• For treatment of Type 1 diabetes, insulin is essential. Human insulin is

• One of the diagnostic tests for diabetes involves measuring levels of

• Diabetic Dyslipidaemia- The primary target of therapy is the

• Diabetes is a chronic illness with numerous serious complications

• Article on “The Clinical Biochemistry of Diabetes Mellitus in Singapore” by SK Sethi

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