Download what is diabetes?

Mystery Molecule
This mystery molecule has to do with biological variation. It is a commonly measured hormone notorious for having
significant diurnal variation. Can you guess what it is?
VOL. 17, NO. 4 • December 2010
Regional Response. Personal Results.
What Is Diabetes?
Answer: Cortisol
Cortisol has many metabolic effects but, overall, its production appears to represent an adaptation to stress. Mammals have developed an internal rhythm for cortisol production. Levels
rise upon awakening, preparing the body for the stress of the new day. Levels fall as the day wanes, preparing the body for sleep. This rhythm is influenced by sunlight, which activates
production of pro-opiomelanocortin, the precursor of adrenocorticotropin in the anterior pituitary, which regulates production and secretion of cortisol by the adrenal gland. Although
it was once common to draw cortisol levels at 8 a.m. (assuming that the patient had a conventional diurnal rhythm), most experts recommend a 24-hour urine collection to determine
whether or not cortisol is elevated. Also, salivary cortisol, obtained by the patient at bedtime, is an excellent marker of the loss of the normal pattern of cortisol secretion seen in
Cushing’s syndrome.
Diabetes mellitus, or diabetes, is a metabolic
disorder characterized by high blood-sugar
levels that result from defects in insulin
secretion. Diabetes was first identified in the
ancient world as a disease associated with
“sweet urine” and excessive muscle loss. The
elevated level of blood glucose leads to spillage
of glucose into the urine hence “sweet urine.”
Mystery Molecule reprinted with permission from www.AACC.org
Avera Laboratory Network Lab Links is published quarterly to provide information of interest from labs of the
Avera Laboratory Network. Questions may be directed to your Avera Laboratory Network representative.
Diabetes is a disease that deals with the
pancreas, insulin and glucose. The pancreas is
a deep-seated organ in the abdomen, located
behind the stomach. Inside the pancreas
are the Islets of Langerhans which contain
specialized cells (beta cells) that produce a
hormone called insulin. Insulin helps glucose
enter the cells and regulates the level of
glucose in the blood. After food is eaten, the
blood-glucose level rises. In response to the
increase in glucose, the pancreas normally
releases more insulin into the bloodstream
to help glucose enter the cells and lower the
blood-glucose levels after digestion. When
the blood-glucose levels are lowered, the
amount of insulin released from the pancreas
decreases. It is important to note that even
when food is not being consumed, there is a
low steady release of insulin that fluctuates a
bit to help maintain steady blood-sugar levels.
Without insulin the cells are unable to absorb
the glucose. The abundant, unutilized glucose
is wastefully excreted in the urine.
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Sioux Falls, SD 57108
Insufficient production of insulin or the
inability of cells to use insulin properly and
efficiently leads to diabetes. There are two
main forms of diabetes, type 1 and type 2.
Avera St. Luke’s Hospital, Aberdeen
Avera Queen of Peace Health Services, Mitchell
Avera McKennan Regional Lab, Sioux Falls
Avera Sacred Heart Hospital, Yankton
Type 1 diabetes also is called insulindependent diabetes, or juvenile-onset diabetes.
This type of diabetes is often diagnosed in
children and teens. Type 1 diabetes is actually
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an autoimmune disease where the immune
system mistakenly manufactures antibodies
and inflammatory cells that are directed
against the beta cells in the pancreas, causing
damage and rendering it incapable of making
insulin. Antibodies are proteins in the blood
that are part of the body’s immune system.
Abnormal antibodies have been found in the
majority of patients with type 1 diabetes.
Patients with type 1 diabetes must rely on
insulin medication for survival.
Type 2 diabetes also is referred to as noninsulin-dependent diabetes, or adult-onset
diabetes. In type 2 diabetes, people can still
produce insulin, but inadequately for their
body’s needs, particularly because of insulin
resistance. A major part of type 2 diabetes is
a lack of sensitivity to insulin by the cells of
the body or insulin resistance (particularly fat
and muscle cells). In addition to that problem,
the release of insulin by the pancreas also may
be defective. In fact, there is a known steady
decline in beta-cell production of insulin in
those with type 2 diabetes that contributes
to worsening glucose control as does the
production of glucose in the liver.
Although type 2 diabetes usually occurs
mostly in individuals older than age 30 and
risk increases with age, there are alarming
numbers of patients with type 2 diabetes
who are barely in their teen years. In fact,
for the first time in history, type 2 diabetes
is now more common than type 1 diabetes
in childhood. Most of these cases are a direct
result of poor eating habits, higher body
weight and physical inactivity. It is estimated
that the chance of developing type 2 diabetes
doubles for every 20-percent increase over
desirable body weight.
Continued on page 3
Regional Service Center Spotlight
Each quarter, one of our regional service centers is featured in “Regional Spotlight.”
In this issue, we share information on the Avera Queen of Peace Laboratory.
Through a unique vision, the Avera Queen of Peace Cancer Center and
Occupational Health, in collaboration with the Laboratory, Business Office and
Social Services staff members, developed a promotional campaign called ASK
ME. The campaign promotes screenings made available by the South Dakota
Department of Health and Avera Queen of Peace. The screening provides men
with free screenings similar to those provided to women by All Women Count.
The men’s screenings are paid for by the Avera Queen of Peace Foundation.
By combining both the All Women Count services and the newly available free
screenings for men under the ASK ME umbrella, Avera Queen of Peace is able
to provide free screenings for breast and cervical cancer, colon cancer, heart
disease, diabetes and prostate cancer to adults ages 30-64 who are uninsured
or underinsured and meet income guidelines.
Avera
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IMPORTANT ALERT: CMS to Require Physician Signature on
Laboratory Paper Requisitions
The Centers for Medicare and Medicaid Services (CMS) is
finalizing its controversial laboratory rule. Starting
Jan. 1, 2011, the signature of a physician or non-physician
practitioner (NPP) is required on the paper test requisition
for clinical diagnostic laboratory tests paid under the
Medicare Part B laboratory fee schedule. This reverses
the long-standing Medicare policy, established by the
congressionally mandated lab-negotiated rulemaking,
that laboratory paper test requisitions do not require a
signature. Until this new rule, all that was needed was order
documentation and a signature in a retrievable format such
as in the beneficiary’s medical record within the originating
facility.
This new CMS final rule will require changes to current
processes within all Avera Laboratory Network Service
Centers related to utilizing paper test requisition to order
testing from each service center. These changes will not
affect testing requests billed to individual facilities (account
bill) or if the test requests utilize one of the approved
electronic order systems (Meditech direct order entry,
Atlas/elaborders, Emdeon or other electronically interfaced
ordering systems).
Look for additional communications and instructions that
will be coming very soon!
SAVE THE DATES!
ASCLS-SD Spring Symposium - April 15, 2011, Sioux Falls, S.D.
Avera McKennan Hospital & University Health Center
ASCLS Region V Fall Symposium - Oct. 13-14, 2011, Fargo, N.D.
ASCLS-SD & CLMA Fall Collaborative Conference - Nov. 3-4, 2011, Mitchell, S.D.
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What Is Diabetes?
Continued from page 1
Diabetes can occur temporarily during pregnancy due to
significant hormonal changes that can lead to blood-sugar
elevation in genetically predisposed individuals. Elevated
blood glucose during pregnancy is called gestational
diabetes. Gestational diabetes usually resolves once the
baby is born. However, 25-to-50 percent of women with
gestational diabetes will eventually develop type 2 diabetes
later in life. Women with gestational diabetes are usually
asked to undergo an oral glucose tolerance test about six
weeks after giving birth to determine if their diabetes has
persisted beyond the pregnancy and if there is future risk
for developing diabetes.
Secondary diabetes refers to elevated blood-sugar levels
caused by another medical condition. Secondary diabetes
may develop when the pancreatic tissue responsible for
the production of insulin is destroyed by disease, such as
chronic pancreatitis, trauma or surgical removal of the
pancreas.
Diabetes can also result from other hormonal disturbances,
such as excessive growth hormone production and
Cushing’s syndrome. In addition, certain medications may
worsen diabetes control or “unmask” latent diabetes. This
is seen most commonly when steroid medications (such as
prednisone) are taken and also with medication used in the
treatment of HIV infection (AIDS).
Symptoms of Diabetes
Symptoms of diabetes include:
• Increased urine output
• Increased thirst and water consumption
• Weight loss despite an increase in appetite
• Fatigue, nausea and vomiting
• Infections of the bladder, skin and vaginal areas
• Blurred vision
• Ultimately a coma
Diabetes Diagnosis
To determine if patients have diabetes a fasting blood
glucose test is done. Patients fast overnight (at least eight
hours) then have blood drawn and sent to the laboratory
for analysis. Patients also may check their blood-glucose
levels at home using a glucose meter.
Normal fasting blood-glucose levels are less than 100
milligrams per deciliter (mg/dl). Fasting blood-glucose
levels of more than 126 mg/dl on two or more tests on
different days indicate diabetes. A random blood-glucose
test also can be used to diagnose diabetes. A random
blood-glucose level of 200 mg/dl or higher indicates
diabetes.
When fasting blood-glucose stays above 100mg/dl, but in the
range of 100-126 mg/dl, this is known as impaired fasting
glucose. People with impaired fasting glucose are then given
oral glucose-tolerance tests. The following are possible
results of an oral glucose-tolerance test:
• Normal response: A person is said to have a normal
response when the two-hour oral-glucose level is less
than 140 mg/dl, and all glucose values between zero and
two hours are less than 200 mg/dl.
• Impaired glucose tolerance: A person is said to have
impaired glucose tolerance when the fasting bloodglucose is less than 126 mg/dl and the two-hour oralglucose level is between 140 and 199 mg/dl.
While patients with impaired fasting glucose do not have
the diagnosis of diabetes, this condition carries its own
risks and concerns. Each year, 1-to-5 percent of people with
impaired glucose tolerance eventually develop diabetes.
Weight loss and exercise may help return glucose levels to
normal. Some medications can be taken to help prevent or
delay the onset of overt diabetes.
Treatment of Diabetes
Diabetes treatment depends on the type and severity of the
diabetes. Type 1 diabetes is treated with insulin, exercise
and a recommended diet. Type 2 diabetes is treated with
weight reduction, a recommended diet and exercise. If
these measures are unable to control the elevated blood
sugars, oral medications are used. If oral medications are
still insufficient, insulin medications are considered.
For more information about diabetes, visit Avera’s Health
Information page at www.Avera.org.
Diabetes at a Glance
• Diabetes is a chronic condition associated with
abnormally high levels of sugar (glucose) in the blood.
• Insulin produced by the pancreas lowers blood glucose.
• Absence or insufficient production of insulin causes
diabetes.
• The two forms of diabetes are referred to as type 1
(insulin-dependent) and type 2 (non-insulin-dependent).
• Symptoms of diabetes include increased urine output,
thirst, hunger and fatigue.
• Diabetes is diagnosed by blood-glucose testing.
• The major complications of diabetes are both acute and
chronic:
• Acutely: Dangerously elevated blood sugar or
abnormally low blood sugar due to diabetes
medications may occur.
• Chronically: Disease of the blood vessels (both small
and large) that can damage the eyes, kidneys, nerves
and heart may occur.
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