Diabetes

Fasting Insulin and Its Significance for Diabetic Patients

By Dr. Vikram Chauhan 2 weeks ago

Abstract

Diabetes is derived from a greek word “Diabainein” meaning excessive urination and “mellitus” meaning like honey. This reflects the sweet taste or smell of the patient’s urine. Diabetes is termed to be the commonest lifestyle disease which empties the patient inside out in long runs. Diabetes mellitus is a disease in which the blood glucose commonly termed as blood sugar levels increases in the blood due to the deficiency of a hormone called “insulin”. Insulin is a hormone which converts the glucose into glycogen. This hormone moves sugar from the blood into your cells to be stored or used for energy. With diabetes, your body either doesn’t make enough insulin or can’t effectively use the insulin it does make. Many a times it even goes unnoticed that the patient is suffering from diabetes at all, hence it becomes very important to keep up with the appropriate investigatory tests to be assured against diabetes. In a diabetic patient the Fasting insulin plays a very important role in its diagnosis and management and this article explains its varied significance.

Incidence

A source from wikipedia has shown that India has an estimated 77 million people with Diabetes, which makes it the second most affected in the world, after China. One in six people (17%) in the world with diabetes is from India.(India’s population as calculated in October 2018 was about 17.5% of the global total. The number is projected to grow by 2045 to become 134 million as per the International Diabetes Federation.For this disease National Diabetes Control Program was initiated in 1987  in the for the detection, prevention and management of this disease.

Introduction

Untreated high blood sugar due to some pathology involved with the hormone called “Insulin” brings a pathological metabolic state called Diabetes. Even diabetes is of various different kinds depending upon its causative factor, the symptoms it brings along and its duration.

Various Kinds of Diabetes are

  1. Type 1 diabetes is considered to be an Autoimmune disease. In this disease the immune system attacks and destroys cells in the Pancreas( an endocrine gland), where insulin is made. It’s not clear what actually causes this attack. Around 10 % of people with diabetes have this type.
  2. Type 1.5 diabetes is Latent Autoimmune Diabetes in Adults.This kind is a slow processing form of autoimmune diabetes.
  3. Type 2 diabetes results in  when the body becomes resistant to the insulin, and sugar builds up in the blood.
  4. Prediabetes is a condition that  occurs when the blood sugar is higher than normal, but it’s not high enough for a diagnosis of type 2 diabetes.
  5. Gestational diabetes is a kind in which there is high blood sugar during pregnancy. Insulin-blocking hormones produced by the placenta results in this type of diabetes.

Sign and Symptoms

Diabetes is a metabolic disorder that is associated with so many sign and symptoms such as

  1. Increased hunger
  2. Increased thirst
  3. Weight loss
  4. Frequent urination
  5. Blurry vision
  6. Extreme fatigue
  7. Non healing sores

The disease is accompanied with the complications such as ” Retinopathy”, “Neuropathy” ,” Nephropathy”, ” Diabetic foot”, ” Hearing loss”, ” Dementia”, “Depression” etc…

Diagnosis

There are several tests meant to diagnose diabetes

  1. HbA1C: This test measures what body’s blood glucose level has averaged for the last 2 or 3 months. This does not require the person to fast or drink anything.
  2. Fasting plasma glucose (FPG): The person will need to fast for at least 8 hours before this test.
  3. Oral glucose tolerance (OGTT): This test requires 2 to 3 hours. The blood glucose levels are tested in the beginning and then repeated at intervals for 2 hours after consuming a specific sweet drink.
  4. Random plasma glucose test: A person can  get this test done at  any time and does not need to be fasting.
  5.  Glucose challenge test: The blood sugar is checked an hour after the person drinks sugary liquid.
  6. C- peptide test: This test rules out autoimmune antibodies.

To make a diagnosis of Gestational diabetes, the blood sugar levels are to be tested between the 24th and 28th weeks of the pregnancy.

Fasting Plasma Glucose

Fasting, the name itself indicates, refraining from eating or drinking of any liquids other than water for at least eight hours. This phenomenon of fasting is used as an effective test for diabetes. It is a kind of carbohydrate metabolism test which is conducted after fasting to measure blood glucose levels. During the interval of fasting the hormone glucagon (which converts glycogen into glucose) is stimulated and thus increases the level of plasma glucose in the body.

If a patient happens to be non- diabetic, then their body will produce insulin in order to rebalance the increased glucose levels. However patients with diabetes either don’t produce enough insulin to rebalance their blood sugar (typically in type 1 diabetes) or it is that their body is unable to use the insulin effectively enough (typical of type 2 diabetes).As a result, when the blood glucose levels are tested, people with diabetes will have blood sugar levels significantly higher than people who do not.

The FPG test is regarded as accurate and more sensitive than the A1C, It is also better than Oral glucose tolerance test (OGTT) in a way that it can be used to monitor the effectiveness and the results of a diabetes management program already going through on being diagnosed.

There still are several reasons for having a high FPG that have causes other than diabetes. These include

  1. Preeclampsia
  2. Cushing syndrome
  3. Pancreatitis
  4. Sepsis
  5. Myocardial infarction( heart attack)

On the basis of several signs and symptoms, these pathologies are investigated under some other tests done.

Reference Range for Fasting Plasma Glucose Test is

  1. Normal(70 to 90 mg/dl)
  2. Prediabetes(100 to 125mg/dl)
  3. Diabetes(126 mg/dl)
  4. Dangerously Hypoglycemia( below 55mg/dl)-Could be a result of Reactive hypoglycemia(Postprandial),Liver or kidney insufficiency,Malabsorption syndrome,Hypopituitarism etc.

Impaired Fasting Glucose

This is a type of Prediabetes, in which a person’s blood sugar levels of fasting are consistently above the normal value, but below the diagnostic cut-off for a formal Diagnosis of  Diabetes. Along with Impaired glucose tolerance test, it is a sign of “ resistance developed towards insulin”. In this manner, it is also one of the conditions associated with this metabolic syndrome.

Ayurveda has considered the intake of Guru( heavy), Snigdha( unctuous),amla( sour), lavana ( salty)navanna (new grain),aasya sukha ( living in leisure), atinidra( excessive sleep), avyayam( no exercise),achinta( not worrying) to be the causes of Madhumeh( Diabetes). The accumulation of the toxins over the pancreatic cells is considered to be the causative factor behind diabetes.Ayurvedic methods of interpreting the diabetes ( Madhumeh) to be curable or incurable is mentioned on the basis of an age old method known by the  name “Taila Bindu pariksha” in which the mid-stream of the morning voided urine is collected and a drop of sesame oil is dropped in it.

The drop of an oil is detected for its “spreading time”, “shape” and “ direction”. If the drop maintains the circular shape then the disease is in its curable stage and if the oil droplet gets non circular then the disease is in its incurable stage.If the inserted oil spreads quickly that it is a sadhya( curable) disease.If it doesn’t spread then it may be an incurable disease and if the dropped oil directly goes inside and touches the bottom of the vessel, then it is regarded as Asadhya ( incurable). As for management of this disease Ayurveda has mentioned “ Nidana parvarjana”(avoiding the causative factors),Samshodhana (detoxification therapies),Shamna(by the formulations made of herbs such as

  • Haridra
  • Jambu
  • Amalki
  • Gudmar
  • Methi
  • Vijaysaar,
  • Saptachakra,
  • Bimbi,
  • Karavalli etc).

Conclusion

Diabetes is a lifestyle disorder, If untreated can lead to a life threatening condition called Diabetic ketoacidosis in which the fats are broken down for energy and ketones are produced in the blood.The reason behind this disease could be genetic, sedentary lifestyle, obesity, bearing an overweight fetus, etc but a prior control can benefit its management. One must get himself checked for Fasting Plasma Glucose once every 3 years. Early detection can help fight the disease symptoms from getting aggravated. Fasting blood sugar not only helps to detect diabetes but also helps in monitoring anti-diabetic medications. A better lifestyle along with a dietary regimen can help combat this. Practices like Yoga, meditation, exercise can improve the condition to a larger extent.

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