CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Diabetes is a disease and also a disorder of glucose metabolism. Diabetes as defined by
oxford dictionary is a disease of the pancreas in which sugar and starchy foods cannot be
properly absorbed.
Nelson and Cox (2000) stated that, diabetes mellitus caused by a deficiency in the
secretion or action of insulin is defective. Under normal circumstances, some of the food people
eat is converted into glucose during metabolism. Glucose is carried in the blood stream, and
move into the cells where it is available as energy, through the action of a hormone called
‘INSULIN’. Insulin is the most important hormone that regulates the amount of glucose in the
blood; it is the rate at which glucose is taken up by the tissues, and the conversion of glucose to
glycogen.
In relation to the estimation of glucose level in different diabetic patients, People with
diabetes do not produce enough insulin to move glucose into cells, or the body resistance to the
insulin that is produced. In either case, the glucose builds up in the blood stream above 180g in
the blood and is excreted in the urine.
Glucose is transported from the body cell via the blood stream and is made available for cell
absorption via the hormones insulin (a peptide hormone produce beta cell of pancreases, and it
central to regulate carbohydrate and fat metabolism in the body produced in body primarily in
the pancreas. The mean normal blood glucose level in human is about 5.5mol/l or 100mg/dl.
However, this level fluctuate throughout the day.
Glucose level are usually lowest in the morning before the first meal of the day (term
fasting level) and rise after meal for an hour or two by few gram. The normal blood glucose
level (tested while fasting for non-diabetes should be between 70 and 100mg/dl and blood sugar
level for those without diabetes and who are not fasting should be below 129mg/dl. According
to American diabetes association the blood glucose target range for diabetes should be 100-
130(mg/dl) before meal and less than 150mg/dl after meals (as measured by a blood glucose
monitor). Blood glucose sugar level outside the normal range may be an indicator or a medical
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condition. A persistently high level glucose is referred to as hyperglycemia, low level is referred
to as hypoglycemic.
1.1 Types of diabetes
The different types of diabetes are classified by the underlying insulin problem, they
include:
i. Type 1 diabetes: These are also called insulin dependent diabetes (IDDM). This is
when a patient’s body produces little or no insulin, in this form; the body’s own
immune system attacks itself destroying the cells that are responsible for creating
insulin. This type one diabetes have been speculated that it may be caused by a
combination of genetic and environment factors.
ii. Type 11 diabetes: These are also known as non-insulin department diabetes
dependent diabetes (NIDDM). This is when the body is resistance to the insulin that
is produced. This form of diabetes, account for about 80 percent of all diabetes
cases. It is closely linked to ‘OBESITY’ and occurs more frequently in African,
native America, and pacific islanders.
iii) Gestational diabetes: This is another type of diabetes which occurs in pregnant women,
when their body cannot produce enough insulin for both mother and the developing
fetus. Although, it usually disappears after pregnancy, women who have experienced
gestational diabetes have about 2 to 50 percent chances of later developing type 11
diabetes.
1.2 Definition of terms and terms used to describe the collection of blood glucose
specimens are:
a) Fasting Specimen
This refers to blood collected after period of no food intake. The normal values for this
are 70-100mgldl.
b) Random Specimen
This refers to a blood sample collected at any time of food intake. The normal value is
100-130mgldl.
c) Blood Sugar: Blood sugar concentration or blood glucose level is the amount of glucose
(sugar) present in the blood of humans.
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d) Insulin: Is a hormone produced and secreted by the beta-cells in the islet of longerhans
in the pancreas.
e) Diabetes mellitus: Is a condition characterized by hyperglycemia resulting from the
bodies, inability to use blood glucose for energy.
f) Two hours post prandial specimen: Blood is usually collected two hours after a meal
has been eaten.
1.3 Interpretation of Blood Glucose Result
a) Raised blood glucose is called hyperglycemia. This is when the level of sugar in the
blood is high, when it is definite it is diagnostic of diabetes mellitus, hyperglycemias can
lead to eye disease, stroke, heart disease, high blood pressure, kidney disease, impaired
blood flow to lower legs, and nerve damage (peripheral neuropathy).
b) A low blood glucose level is called hypoglycemia. This is when the level of sugar in the
blood is low. Persistent occurrence of hypoglycemia with glucose level less than
2.2mdle is accompanied by symptoms such as fainting, fits, sweating, hunger, pallor,
confusion or violent causes of hypoglycemia include severe liver disease, alcoholic
excess, insulin secreting tumors, Addison’s disease and certain drugs.
1.4 Statement of Problem
Diabetes is a dangerous metabolic disease, which is responsible for most of adult
mortality rate in Africa, Asia and America. Diabetes is caused by absolute or relative
insulin deficiency.
When carbohydrate is taken, the body system coverts starch in the carbohydrate
to glucose, which is carried into the blood stream and move in the cell where it is
available for energy. People with diabetes, either do not produce enough insulin or the
body is resistance to the insulin produced in the body. Diabetes can lead to other disease
like ulcer, high blood pressure and hypertension.
1.5 Aim of the study
To estimate the level of blood glucose in difference diabetic patients
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1.6 Objectives of the study
i. To know the possible cause of diabetes.
ii. To know the relationship of high blood glucose with ages.
iii. To bring out possible solution for high blood sugar.
1.6 Significance of Study
Diabetes result from the inability of the insulin to transport glucose from the blood
stream to the various cell in the body thereby, increasing the blood sugar if the exact level of
glucose in the blood is known using the appropriate method, it will enable the physicians to give
the diabetic patient the right therapy that can reduce the glucose level in the blood.
Also, it will help the doctor to give specialized and expert advise to the patient in terms
of the type of diet to be taken, the type of exercises to be done etc. Also, a general knowledge of
the disease, its cause and management that will be critically analyzed in this project work will
serve as a prophylactic treatment for those that are not diabetic.
Above all, this project work is important because it will provide a more suitable and
accurate method of determining the glucose level in the body.
1.7 Hypothesis
HO – Diabetes affects glucose level
H1 – Diabetes does not affect glucose level.
1.8 Scope and Limitation of the Study
In the study, the researcher focused attention on the study of estimation of glucose level
in different diabetic patients in Specialist Hospital Gombe, Gombe State.
Most of the methods used in the medical laboratory for determination of glucose level in
diabetic patients are not accurate due to contamination in the laboratory expired kits and
apparatus. The cost of the kits and laboratory medicine is also a problem in determination of
glucose level in diabetic patients.
Most of the kits are very costly and so it affects those coming for the test, as the price is
very high.
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CHAPTER TWO
LITERATURE REVIEW
2.1 Background of the study
Most carbohydrates in the diet are digested to form glucose or fructose and are taken by
the portal vein to the liver, where fructose is converted to glucose. Glucose fuels the body’s
trillion cells to enter the cells, however, the utilization of glucose by the body cells is intimately
related to the ‘KEY’ insulin – the hormone secreted from the islets of Langerhans in the
pancreases, synthesized by the beta cells (Conover 1990).
When B-cells fail to produce insulin, glucose builds up in the blood, causing
hyperglycemia. The liver plays a key role in maintaining blood (glucose) in that the liver helps
to manage blood sugar levels by storing excess glucose in a form called glycogen (Robert et al
1993).
Glucose is defined as dextrose or grape monosaccharide, the form in which
carbohydrates are absorbed through the intestinal tract and circulates in the body (Walker et al
1999).
Glucose, which is a monosaccharide, is a reducing sugar and cannot be hydrolyzed;
glucose is a primary energy source for human body. It is derived from the breakdown of
carbohydrate in the diet and in the body stares as glycogen. When energy intake exceeds
expenditure, the excess carbohydrate is converted to glycogen for storage in the adipose tissue
and liver, or muscle respectively (Martin et al 1981).
Glucose can be gotten from cereal grains, e.g. corn, wheat, rice, tubers like yam and
cassava, fruits like grape and sugar cane. Glucose plays a vital role both biochemical and
physiologically in the body, these seems to have a very observable relationship between glucose
level increase after intake of food and decrease on exercise (Philip 1994).
The structure of glucose can be in a straight chain structural formula (adohexose) cyclic
structure seen as simple ring then, the x-ray diffusion analysis. This shows that the 6-membered
ring containing one oxygen atom is actually in the form of a chain.
Several researchers have been made to show that there are changes in random blood
glucose among various population including the non-psychotic (Die bold 1976, Videbch 2008).
A research work done over a decade ago showed that people with low blood glucose could
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suffer from imaginary sickness, irreplaceable brain damage, mental damage and cerebral
atherosclerosis (Feal, 1994).
In one study, it demonstrated the insulin resistance is implicated on the development of
normal obesity. The investigation also concluded that inappropriate activation of hypothalamic
pituitary adrenal axis by stress is responsible for the link between psychological and economic
problem and acute myocardial infection (Bjorntorp, 2001). Hence, insulin resistance and
hyperinsuline is characteristic feature of obesity (Robinowitzet et al, 1962). Moreover, in 1961,
it was observed that patience with arterial hypertension had significant of high plasma insulin
concentration before and after an oral glucose challenge (Reavenmetal 1999).
Straight chain structural formula of glucose
CH2OH
Diabetes mellitus in a man is due to a deficiency of insulin, which is characterized by
hyperglycemic and glycosuria (glucose in the urine) while insulinoma (hypoglycemia) is caused
by a functioning B-cell tumor of the islet langerhans producing too much insulin (Backer and
Silverton 1976).
People with diabetic do not produce enough insulin to move glucose into cells, or the
body resistance to the insulin that is produced. In either case, the glucose builds up in the blood
stream above 180g in the blood and is excreted in the urine (Monica 1987).
John (1972), defined diabetes as a complex disorder involving many aspect of body
function. One of the most striking and important features of diabetes is an impaired ability of
the body to use glucose as a source of energy.
Diabetes is wide spreading throughout the world. It is known to affect more than 30
million people with a sharp rise in prevalence, having been reported from those developing
countries in which the diseased have been studied (Monica 1987).
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Mindwoski (1983), followed Ehedon and Laguesse has established by means of
transplantation, that this form of diabetes where due to the deficiency of an internal secretion on
the pancreas known as insulin.
Klebs and Munk (1896), operated on the pancreas for the express purpose of trying to
elucidate the relationship of pancreatic lesions diabetes. A young diabetic, whose natural
production of the essential hormone insulin has failed, suffers from accumulation of toxic acid
(ketones) substances in the body (Laurence 19789).
Insulin increases the permeability of cells to glucose accretes carbohydrates, oxidation
and at the same time glycogenesis (formation of glucose or glycogen from non-carbohydrates
source) is depressed and the conversion of glucose to fat is increased (Baker et al 1976).
The early symptoms of diabetes are mainly digestive nausea, lack of appetite, vomiting,
colic and abdominal pain. The consequences of diabetes are stroke, heart attack, liver disease,
blindness, gangrene, ulcer, high blood pressure and hypertension. It can also lead to diabetic
coma and death.
A provisional diagnosis of diabetes mellitus must always be confirmed by glucose
measurement on blood specimens. The criteria for the diagnosis of diabetes mellitus have been
laid down by the world health organization (WHO) separate criteria are described, depending on
whether venous or capillary plasma specimens, are used. According to these criteria, a random
venous plasma (glucose) or 110mg/100ml or more establishes the diagnosis (Walker et al 1999).
A single result is sufficient in the presence of typical symptoms, but in the absence, or
more should be detected on two separate occasions. Where there is any doubt, an oral glucose
tolerance test should be performed, but this is not often necessary (Walker et al 1999).
There are two principle types of diabetes mellitus, occurring in young people (Juvenile
on set) and that occurring in older people (maturity on set) the first is due to lack of natural
insulin production in the pancreas and is treated by replacement therapy i.e. administration of
insulin by injection, secondly, the patients tissue have become resistant to his own insulin and it
is commonly treated with synthetic drugs taken by mouth (Laurence et al 1978).
Nelson et al (2000), stated three types of diabetes, which includes:
2.2 Type 1 Diabetes
This is when the patient’s body produces little or no insulin, they are recommended to
take insulin for the rest of their lives or slip into a diabetic coma.
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2.3 Type 2 diabetes
This is when the body is resistant to the insulin that is produced; this type may
sometimes require insulin therapy. However, physicians also recommend weight loss and
dietary changes to help regulate blood glucose levels.
Treatment for diabetes aims to keep the level of blood glucose within normal range through
blood monitoring, diet and exercise, and insulin therapy. To avoid serious consequences of low
blood sugar levels, diabetics are encouraged to carry high-sugar foods or glucose – rich drinks
such as orange juice with them at all times.
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CHAPTER THREE
MATERIALS AND METHOD
3.1 Study Area
The project work was carried out in the Chemical Pathology unit of State Specialist
Hospital Gombe. The Hospital is located in jekadafari ward at the center of the city. The
Hospital was commissioned on the 7th of July, 1956 with professionals, Examples: Doctors,
Medical Laboratory Scientists, Nurses, Pharmacist, Medical Laboratory Technicians,
Community Health Extension Workers, Health Record Officers, Attendance and Cleaners.
The Hospital is composed of structures like: Accidents and Emergency (A&E) unit,
National Programme on Immunization (NPI), Antenatal Care Unit (ANC), Administrative
block, Theater unit, Laboratory unit, Dental clinic and Eye clinic, Male and Female Medical
Wards Gynae ward, Pediatrics Ward and Maternity ward etc. The hospital shared boundary with
GSSS Gombe, Abacha road, Gombe, Bauchi road to the West, North, East and South
respectively.
3.2 Materials
Materials used for the collection of data are
i. Hospital Record Book
ii. Pen
iii. Data Collection Paper
3.3 Study Design
The research work is targeted at estimation of glucose level in different diabetic
patients attending State Specialist Hospital, Gombe.
3.4 Sampling Technique
The information was collected from the Hospital Laboratory record book. General
Hospital Gombe, State. From 1-1-2017 to 31-12-2017.
3.5 Data Analysis
The data obtained were analyzed using simple percentage method.
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CHAPTER FOUR
RESULTS
4.1 Presentation and Analysis
In this chapter, we present the analysis of result of 120 patients diagnosed in specialist
Hospital Gombe. It was diagnosed according to the age bracket (18-25 years, 26-50years, and
50 years and above) and the results are tabulated as follows:
4.2 Age Distribution
Age Frequency Percentage (%)
18-25 18 15
26-50 32 26.6
51 and above 70 58.3
Total 120 100
This table shows that 70 of the patients falls from 51 and above years while 36 falls between 26-
50, the lowest population of the patients are from the age 18-25 years (Table 1)
.
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4.3 Sex Distribution
Sex Frequency Percentage (%)
Male 50 41.6
Female 70 58.3
Total 120 100
The above table shows that the highest population 50 (41.6) were Male and 70 (58.3) were female
(Table 2)
.
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CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
5.1 Discussion
In these research findings,it is found that most of the patients suffering from high blood
suger which is “Hypoglycemia” aer female between the age of 15 and above,it occur when
blood sugar is too high.it happe when there is no enough insulin in the body to work
properly.once the body start to notice some sign like hungry (polyphazia),excessive thirst
(polydipsia),frequent urination (polyuria),Dry Mouth,deep and rapid breathing and dry skin etc.
Therefor diabetic are estimated in various ways like physical, chemical and enzymatic
method.
According to study carried out by Rhoda(2017) show that (26-30) are mostly maintain normal
range of glucose level with (26%),which come in line with these study which show that 70 of
the patient's fall from 51(58.3%) and above years while 36 falls between 26-50,(26.6%), the
lowest population of the patient are from age of 18-25 years 18 with the parentage of
(15%)respectively.
This project was to determine the estimation of glucose level in different diabetic
patients, attending state Specialist Hospital Gombe, the study focused on the different
classification of diabetic, genetics disorders associated with diabetes mellitus, among different
diabetics patient as well as age and gender.
History and different mode of diagnosis of diabetes mellitus, diabetic can be defined as
an endocrine disorder in which there is deficiency or lack of insulin production leading to
metabolic disorder of carbohydrate, fat and protein and characterized by hyperglycemia,
degenerative vascular changes and neuropathy (WHO, 2000).
Diabetic complications are largely a result of elevated blood sugar and are responsible
for most death due to diabetes mellitus. Strict blood sugar control, achieved through adherence
to treatment and life style modifications such as physical activities and eating a healthy diet is
critical in the reduction of the incidence of these complications.
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5.3 Conclusion
Based on the research, it was discovered that diabetes is associated with the rate of
diabetes in children and teenager is very low, while the rate of diabetes in adult from forty years
and above is very high due to insufficient production of insulin. And that diabetes is a metabolic
disorder, which occurs as a research of the inability of the insulin to transport glucose in the
blood to the cell to be utilized.
Also, people with diabetes tend to be dehydrated as a result of the creation of excess
water and glucose in the urine and that diabetic patient tend to lose weight and show muscular
weakness since the cells in the body cannot absorb glucose.
Fasting blood sugar may be normal while random blood sugar may be abnormal and
verse vise, such a person is still diabetic.
Diabetes is a metabolic disorder due to deficiency in the insulin production, when
insulin is produced in low quantity or the absence of insulin causes the body cells not to absorb
glucose, and excess glucose cannot be converted to glycogen. As a result, the blood glucose
level becomes raised leading to the excretion of excess glucose in urine.
Also, suitable method was used in this research work to determine fasting blood sugar
and random blood sugar.
5.2 Recommendation
Since diabetes is a metabolic disorder an appropriate method such as this should be used
to determine the glucose level in the body and as such, it can be treated metabolically. A
diabetic patient should control his or her intake of carbohydrate diet. This condition is treated by
controlling the diet.
Also, since diabetes result from deficiency in the insulin production. However, taking
regular dozes of insulin orally or by injection will help in the treatment of diabetes. borin insulin
has been found to be a good replacement for human insulin.
Light exercises should be recommended for diabetic patients.
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