Diabetes Mellitus

HbA1c

 

(insert pick of HbA1c curve)
Glycohemoglobin is a general term for the complexes where the whole blood glucose is non-enzymatically bound to α or β-chains of human hemoglobin. Within these complexes, HbA1c, which is the complex of glucose and the N-terminus of the β-chain, is the most prevalent. HbA1c is non-enzymatically synthesized in two steps. In first step labile HbA1c (L-A1c) is formed and in the second step, stable HbA1c (s-A1c) is formed. Due to the fact, L-A1c changes rapidly in response to changes in whole blood glucose concentrations, hence s-A1c is now used to evaluate the diabetes. S-A1c provides the best indication of average glucose levels over the most recent 1 to 3 month period because it does not fluctuate in response to physiological factors. A Tosoh Automated Glycohemoglobin Analyzer based on High Performance Liquid Chromatography (HPLC) physically designed for quick separatie of the L-A1c and s-A1c.Also this technology quantifies the HbF fraction and gives indication for the presence of hemoglobin variants

C-Peptide

 

C-Peptide can be used to help to evaluate the production of endogenous insulin (insulin made by the body) and to help to differentiate it from exogenous insulin (insulin that is not produced by the body and so does not generate C-peptide). In-vitro determination of insulin and C-Peptide levels help in the differential diagnosis of liver disease, acromegaly, Cushing’s syndrome, familial glucose intolerance, insulinoma, renal failure, ingestion of accidental oral hypoglycemic drugs or insulin induced factitious hypoglycemia.

Insulin (IRI)

Insulin is the antidiabetic hormone produced by the pancreatic B cell as a large proinsulin (containing of 109 amino acids). This peptide is rapidly converted by cleavage to proinsulin (containing of 86 amino acids). Equimolar quantities of insulin and C-peptide are produced through proteolytic cleavage and then secreted along with a small amount of proinsulin. In certain clinical types of diabetes, autologous insulin secretion is basically non-existent or defective and in these cases, the level of glucose is naturally elevated. The state of insulin secretion is ascertained by measuring the level of IRI with time as oral glucose tolerance test (OGTT). On the other hand, in the case of fasting hypoglycemia, insulin assay is important for identifying the cause and is used for the diagnosis of insulinoma (pancreatic islet tumor).

 

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