Diagnosis and Biochemical

Estimation for Diabetes

Presented By
Champalal Dhanotiya
M.Pharm (Pharmacognosy)
Assistant Professor

MODERN INSTITUTE OF PHARMACEUTICAL SCIENCES, INDORE
Contents
Introduction
Types of Diabetes Mellitus
Type I DM (IDDM)
Type II DM (NIDDM)
Gestational Diabetes
Symptoms
Causes
Prevention
Complications
Diagnosis





Introduction
Diabetes Mellitus

Diabetes comes from Greek, it means a "siphon".
Aretus the Cappadocian, a Greek physician during the second century A.D.,
named the condition diabainein. He described patients who were passing
too much water (polyuria) - like a siphon.
In 1675, Thomas Willis added mellitus. Mel in Latin means "honey"; the
urine and blood of people with diabetes has excess glucose, and glucose is
sweet like honey. Diabetes mellitus could literally mean "siphoning off
sweet water".


The blue circle symbol used to represent diabetes. This symbol has been
used to represent diabetes since March 2006.
Diabetes mellitus (DM) or simply diabetes, is a group of metabolic
diseases in which a person has high blood sugar. This high blood sugar
produces the symptoms of frequent urination, increased thirst,
and increased hunger. Untreated, diabetes can cause many complications.

It is also called high blood sugar or hyperglycemia.

It can be caused either due to the lack of insulin (type 1 diabetes) or
because the bodys cells fail to respond to the insulin produced (type 2
diabetes). Theres another form of diabetes that afflicts pregnant women
called gestational diabetes.

Types of Diabetes
Diabetes is due to either the pancreas not producing enough insulin, or
because cells of the body do not respond properly to the insulin that is
produced.

There are three main types of diabetes mellitus.

Type 1 DM (IDDM)
Type 2 DM (NIDDM)
Gestational Diabetes
Type 1 DM (IDDM)

Body's failure to produce insulin.
It is caused by the immune system destroying the cells in the pancreas
that make insulin.
The immune-mediated nature, in which a T-cell-
mediated autoimmune attack leads to the loss of beta cells and thus
insulin.
Type 1 diabetes can affect children or adults.

Type 2 DM (NIDDM)

Insulin resistance, a condition in which cells fail to use insulin properly.
Reduced insulin secretion.
A number of lifestyle factors are known to be important to the
development of type 2 diabetes, including obesity (defined by a body
mass index of greater than thirty), lack of physical activity, poor diet and
stress.
Dietary factors also influence the risk of developing type 2 diabetes.
Consumption of sugar-sweetened drinks in excess is associated with an
increased risk.
A lack of exercise is believed to cause 7% of cases.

Gestational Diabetes
Gestational diabetes, is the third main form and occurs when pregnant
women without a previous diagnosis of diabetes develop a high blood
glucose level.
It occurs in about 2-10% of all pregnancies and may improve or
disappear after delivery.

Symptoms
Increase in appetite
Frequent urination
Feeling too thirsty
Loss of weight
Feeling fatigued all day long
Frequent infection
Poor wound healing
High irritability/Depression
Blurred vision
Causes
Genes
Autoimmune destruction of beta cells
Lack of physical activity, obesity
Certain drugs (nicotinic acid, diuretics, can destroy the beta cells)
Pancreatic disease or injury (diseases like cancer, pancreatitis,).
Chemical toxins within food

Increasing age

Bad diet

Prevention
Healthy diet, physical exercise, not using tobacco, and being a normal body
weight, blood pressure control and proper foot care are also important for
people with the disease.

Dietary changes known to be effective in helping to prevent diabetes
include a diet rich in whole grains and fiber, and choosing good fats, such
as polyunsaturated fats found in nuts, vegetable oils, and fish. Limiting
sugary beverages and eating less red meat and other sources of saturated
fat can also help in the prevention of diabetes
Complications
The major long-term complications relate to damage to blood vessels.
Diabetes doubles the risk of cardiovascular disease

and about 75% of
deaths in diabetics are due to coronary artery disease.
Damage to the eyes, known as diabetic retinopathy, is caused by damage to
the blood vessels in the retina of the eye, and can result in gradual vision
loss and potentially blindness.
Damage to the kidneys, known as diabetic nephropathy, can lead to tissue
scarring, urine protein loss, and eventually chronic kidney disease,
sometimes requiring dialysis or kidney transplant. Damage to the nerves of
the body, known as diabetic neuropathy, is the most common complication
of diabetes

Foot complications - neuropathy, ulcers, and sometimes gangrene which
may require that the foot be amputated.
Skin complications - people with diabetes are more susceptible to skin
infections and skin disorders.
Mental health - uncontrolled diabetes raises the risk of suffering from
depression, anxiety and some other mental disorders.
Hearing loss - diabetes patients have a higher risk of developing hearing
problems.
Infections - people with badly controlled diabetes are much more
susceptible to infections.
Healing of wounds - cuts and lesions take much longer to heal.

Diagnosis

Diabetes is diagnosed using blood tests, and the three tests used for
diagnosing diabetes are:
Glycohaemoglobin Test
This test is used for diagnosing Type 2 diabetes. It measures a persons
average blood glucose levels over the past three months.
If a persons A1C level is below 5.7%, it means that he/she is normal.
If it is between 5.7 to 6.4%, it indicates prediabetes which may lead to
diabetes if appropriate measures are not taken.
A person is diagnosed with diabetes if he/she has an A1C level of 5.7% or
above.

Fasting Plasma Glucose (FPG) Test

The Fasting Plasma Glucose test is the most common test used for
diagnosing diabetes. It is performed by measuring a persons blood sugar
level, after he/she has fasted for at least 8 hours.
If a person has a fasting glucose level of 126 mg/dL or above, he or she has
diabetes. It is advised to repeat the test on another day for confirmation.

Oral Glucose Tolerance Test (OGTT)

In an oral glucose tolerance test, a person has to fast for at least 8 hours.
After that, he/she has to drink a glass of water mixed with 75g of glucose.
If a persons 2-hour blood glucose-level is between 140 to 199 mg/dL, the
person has prediabetes which could lead to diabetes if appropriate
measures are not taken.
If the blood glucose-level is above 200 mg/dL, then the person is
diagnosed with diabetes.
The fasting blood glucose level was determined using a glucose oxidase-
peroxidase reactive strips and a glucometer

0
50
100
150
200
control glibenclamide Dibecon
200mg/kg
Dibecon
400mg/kg
polyherbal
200mg/kg
polyherbal
400mg/kg
OGTT
0 min
30 min
60 min
120 min
Body Weight Changes
0
50
100
150
200
250
Normal Diabetic control Standard
glibenclamide
Diabecon
200mg/kg
polyherbal
200mg/kg
Diabecon
400mg/kg
Polyherbal
extract 400mg/kg
B
o
d
y

W
e
i
g
h
t

C
h
a
n
g
e
s

i
n

g
m
s

Body Weight Changes
0 Day
5th Day
10th Day
15th Day
20th Day
Biochemical Estimation
Estimation of Serum Insulin Level
0
2
4
6
8
10
12
14
16
18
20
Normal Diabetic
control
Standard Diabekon
200mg/kg
Poluherbal
200mg/kg
Diabekon
400mg/kg
Poluherbal
400mg/kg

U
/
m
l

Serum Insulin Level
Serum Insulin Level
Triglyceride Level

0
50
100
150
200
250
300
350
Normal Diabetic control Standard
glibenclamide
Diabecon
200mg/kg
polyherbal
200mg/kg
Diabecon
400mg/kg
Polyherbal
extract
400mg/kg
T
r
i
g
l
y
c
e
r
i
d
e

l
e
v
e

m
g
/
d
l

Triglyceride Level
Triglyceride Level
Total Cholesterol Level

0
20
40
60
80
100
120
140
160
180
Normal Diabetic control Standard
glibenclamide
Diabecon
200mg/kg
polyherbal
200mg/kg
Diabecon
400mg/kg
Polyherbal
extract
400mg/kg
T
o
t
a
l

C
h
o
l
e
s
t
e
r
o
l

L
e
v
e
l

m
g
/
d
l

Total Cholesterol Level
Total Cholesterol Level
HDL Cholesterol Level

0
10
20
30
40
50
60
70
Normal Diabetic control Standard
glibenclamide
Diabecon
200mg/kg
polyherbal
200mg/kg
Diabecon
400mg/kg
Polyherbal
extract 400mg/kg
H
D
L

L
e
v
e
l

m
g
/
d
l

HDL Cholesterol Level
HDL Level
LDL Cholesterol Level

0
20
40
60
80
100
120
140
Normal Diabetic control Standard
glibenclamide
Diabecon
200mg/kg
polyherbal
200mg/kg
Diabecon
400mg/kg
Polyherbal
extract
400mg/kg
L
D
L

C
h
o
l
e
s
t
e
r
o
l

L
e
v
e
l

m
g
/
d
l

LDL Cholesterol Level
LDL Cholesterol Level
VLDL Cholesterol Level

0
10
20
30
40
50
60
70
Normal Diabetic
control
Standard
glibenclamide
Diabecon
200mg/kg
polyherbal
200mg/kg
Diabecon
400mg/kg
Polyherbal
extract
400mg/kg
V
L
D
L

C
h
o
l
e
s
t
e
r
o
l

L
e
v
e
l

m
g
/
d
l

VLDL Cholesterol Level
VLDL Cholesterol Level
Estimation of DNA and RNA
Content
0
0.05
0.1
0.15
0.2
0.25
0.3
Normal Diabetic control Standard
glibenclamide
Diabecon
200mg/kg
polyherbal
200mg/kg
Diabecon
400mg/kg
Polyherbal
extract 400mg/kg
D
N
A

C
o
n
t
e
n
t

m
g
/
g
m

DNA Content
Liver
Testis
0
0.02
0.04
0.06
0.08
0.1
0.12
Normal Diabetic control Standard
glibenclamide
Diabecon
200mg/kg
polyherbal
200mg/kg
Diabecon
400mg/kg
Polyherbal extract
400mg/kg
R
N
A

C
o
n
t
e
n
t

m
g
/
g
m

RNA Content
Liver
Testis
Estimation of Total Proteins
0
50
100
150
200
250
300
350
Normal Diabetic control Standard
glibenclamide
Diabecon
200mg/kg
polyherbal
200mg/kg
Diabecon
400mg/kg
Polyherbal extract
400mg/kg
T
o
t
a
l

P
r
o
t
e
i
n

C
o
n
t
e
n
t

m
g
/
g
m

Total Protein Content
Liver
Testis
Histopathological Studies
Histopathological Studies
Normal Group Treated Group
Standard Group
Plant Treated Group
100mg.kg
Plant Treated Group
200mg.kg