What is Diabetes?

Diabetes prevents the body from properly using energy from food. The condition occurs when the pancreas produces little or no insulin, a hormone required to sustain life, or when the pancreas makes insulin, but the body resists it.

• Insulin, a hormone required to sustain life
  Insulin is a hormone produced by the Pancreas to aid accessing to the energy stored in the food. Largely this results from the ability of the body, under the influence of Insulin, to release sugar from the food intake, to store it and to use it, when needed, to drive our normal functions.

• The normal stability of blood sugar levels
  The normal metabolic process of releasing glucose from the food intake ensures that the amount of sugar in our blood remains within the region of 3.5 to 4.5 mmol/l(60-80 mg/100ml). Insulin levels rise when we have a meal in order to capture the sugar from the food intake. Insulin levels reduce after the processing of the food intake over a period of approximately 2 hours. During the rest of the day, an associated mechanism prevents blood sugar levels from falling below the normal levels by releasing glucose from the body storage areas in fat and tissues.

• The Diabetes disease
  Diabetes is a description of the condition where there is a mismatch between the food intake and the levels of production or utilisation of Insulin.
  • In Type 1 diabetes, the pancreas no longer produces insulin, an important hormone that helps metabolise glucose and supply energy to cells. A person with this condition must administer insulin using injections or an insulin pump.
  • Type 2 diabetes is a metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. Type 2 diabetes is often controlled by diet and exercise, oral medications and, in some cases, insulin. Research indicates that obesity and weight gain are associated with an increased risk of Type 2 diabetes. Insulin pumps have been successfully used to treat Type 2 patients requiring insulin and with poor glycaemic control.

Without an adequate availability of insulin, a person is unable to get energy from food or to keep glucose levels in balance. Poor glucose control can lead to acute complications from hypoglycaemia (low blood glucose) orhyperglycaemia (a condition associated with higher-than-normal blood glucose), which can lead to ketoacidosis, causing coma or death, if left untreated. Diabetes is the leading cause of blindness, kidney failure and amputation, and is a major factor in cardiovascular disease and nerve damage.

Why good control is important?

Better blood glucose control has been the focus of a lot of attention since the release of the results of the landmark Diabetes Control and Complications Trials (DCCT) in 1993. The DCCT was the largest long-term research study on the effects of glucose control ever conducted. There were two groups of subjects in the study. One group managed their diabetes using "conventional" methods (1 - 2 injections per day and 1 - 2 daily blood glucose tests), while the other half used "intensive" methods, with frequent blood glucose monitoring and daily adjustments of food and insulin to keep blood glucose as near normal as possible. Nearly half in the intensively treated group used insulin pumps to help them achieve that level of control. The chart shows the differences in control that the different styles of treatment produced.

An insulin pump is a good way to achieve the degree of control now known to be the best defense against long-term health problems.

What is HbA1C?

Glycated hemoglobin (glycosylated hemoglobin, hemoglobin A1c, HbA_1c, A1C, or Hb_1c; sometimes also HbA1c) is a form of hemoglobin used primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose. Normal levels of glucose produce a normal amount of glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of glycated hemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous months prior to the measurement.

The 2010 American Diabetes Association Standards of Medical Care in Diabetes added the A1c ≥ 6.5% as another criterion for the diagnosis of diabetes,^[1] but this is controversial and has not been universally adopted.^[2]

Underlying Principle of HbA1c

In the normal 120-day lifespan of the red blood cell, glucose molecules react with hemoglobin, forming glycated hemoglobin. In individuals with poorly controlled diabetes, the quantities of these glycated hemoglobins are much higher than in healthy people.

Once a hemoglobin molecule is glycated, it remains that way. A buildup of glycated hemoglobin within the red cell, therefore, reflects the average level of glucose to which the cell has been exposed during its life-cycle. Measuring glycated hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation. The HbA_1c level is proportional to average blood glucose concentration over the previous four weeks to three months. Some researchers state that the major proportion of its value is related to a rather shorter period of two to four weeks.