Diabetes Package Advanced

The Lipid Profile Test typically measures the levels of total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. Other results that may be reported include VLDL cholesterol, non-HDL cholesterol, and total cholesterol to HDL cholesterol ratio.

Lipids are fatty acids which store energy for the body and play essential roles in cellular structure and cell signaling. Cholesterols and triglycerides are essential lipids, carried in the blood by lipoprotein particles made up of cholesterol, triglycerides, proteins and phospholipid molecules. The lipoprotein particles are classified according to their densities into High Density Lipoproteins (HDL), Low Density Lipoproteins (LDL), and Very Low Density Lipoproteins (VLDL).

Cholesterol is a fat-like substance formed in the liver, as well as obtained from dietary sources. It is found in all the cells and is an essential part of the structural framework of the cells apart from performing various vital body processes. However, excess cholesterol is harmful. Increased cholesterol in blood can cause it to get deposited on the inner walls of the blood vessels forming plaque.

Triglycerides are the commonest type of fat in the body. Triglycerides are obtained from dietary sources and form the stored fat in adipose tissues. Increase in triglyceride concentration can also give rise to cardiovascular diseases.

High Density Lipoproteins or HDLs are high density particles which help to reduce the chances of cardiovascular diseases by picking up and carrying lipoprotein particles of lower density to the liver for disposal.

Low Density Lipoproteins or LDLs are lipoprotein particles of low density which carry cholesterol to the tissues. Cholesterol carried by LDLs easily comes out of blood and get deposited on the inner walls of the blood vessels, increasing the chances of cardiovascular diseases.

Very Low Density Lipoproteins or VLDLs are lipoprotein particles of very low density which carry triglycerides to the tissues. Excess triglycerides in blood causes increase in VLDL particles which in turn again increases the chance of developing cardiovascular diseases.

Plaque deposition makes the lumen of the blood vessels narrower thereby preventing proper flow of blood and may stop the flow completely. Excessive plaque deposition can also cause the arteries to harden, giving rise to a condition called Atherosclerosis. Improper flow of blood prevents the supply of nutrients and oxygen to the vital organs and may cause heart attack or stroke.

Urine Routine and Microscopy test involve the three-part evaluation of the urine sample.

1. Gross Examination - It involves the visual examination of the urine sample for color and appearance.

2. Chemical Examination - It is done by urine dip-stick method which involves the use of reagent test strips. These test strips are dipped into the urine sample and the colors that develop are matched with the control for analysis. It is done to examine the urine sample for glucose, protein, pH, specific gravity, blood, nitrites, ketones, leukocyte esterase, bilirubin, and urobilinogen.

3. Microscopic Examination - It involves the examination of the urine sample under the microscope for casts, crystals, cells, bacteria, and yeast. 

Glucose - Fasting Blood Test is done to measure the levels of glucose in blood during period of fasting.

Glucose is the main source of energy for body. Carbohydrates consumed in the diet are broken down in the body to glucose, which is absorbed by the intestines and transported by the blood to various organs. The cells of these organs utilize the glucose to produce energy when required, and the excess is stored either as glycogen in the liver for short-term storage or in fat tissues as triglycerides for long-term storage. The uptake, utilization, and storage of glucose after it is absorbed in the intestines is facilitated by the hormone- insulin which is secreted by the pancreas. Insulin influences the transport of glucose to the organs like heart, brain, working muscles, etc. It also directs storage of excess glucose. The action of insulin reduces sugar levels in the blood.

After a meal, sugar levels increase in blood and insulin is secreted in response to reduce sugar levels until it becomes normal. If glucose levels fall too low in blood, another pancreatic hormone called glucagon is released, which directs the liver to convert stored glycogen into glucose and releases it into the blood. The insulin and glucagon hormones create a feedback mechanism to keep blood glucose levels within the normal range. Imbalance in their activity causes an excess or shortage of blood sugar.

Glucose - Fasting blood Test helps to determine if the body is able to utilize or store glucose efficiently. High levels of sugar in blood indicates diabetes or resistance to insulin. Type 1 Diabetes is caused when insulin is not produced or produced in very little quantity. Type 2 Diabetes is caused when insulin produced is not utilized effectively by the body. In both these cases, blood sugar level rises, while cells are deprived of nutrition.

This is a test panel done to evaluate the kidney functions. It contains a group of tests integrated to collectively analyze any malfunction related to the kidney.

The kidneys are a pair of bean-shaped organs located on either side of the spinal column in the abdomen towards the back. The kidneys perform a number of important functions. The most important of these is that they filter the blood and separate the waste products generated out of regular metabolic activities of the body, primarily urea. Following the separation, the kidneys excrete the waste products out of the body through urine. They help in maintaining the normal pH level and water balance of the body. The kidneys also play essential roles in the synthesis of Vitamin D and Red Blood Cells (RBCs).

The Kidney Function Test includes the following tests to monitor kidney function:

·        Blood Urea Nitrogen (BUN)/ Urea:

Blood Urea Nitrogen is a test to measure the amount of urea nitrogen present in the blood. Urea is a nitrogenous by-product formed by the metabolism of protein, and its level in blood serves as an indication of the amount of nitrogen present in blood as urea. In simpler terms, BUN is the measure of the amount of nitrogen present in blood in the form of urea. High BUN levels in the blood can be caused as a result of kidney diseases, dehydration and obstruction in the urinary tract due to kidney stones, prostate gland enlargement, etc.

Urea test measures the level of urea in the blood. Urea is a final waste product formed from the breakdown of proteins. Urea is filtered out of the blood by the kidneys to excrete excess nitrogen present in the blood through urine. Excess of urea in blood is called uremia and can be caused by a number of conditions including kidney diseases.

·         Uric Acid:

This test measures the level of uric acid in the blood. Uric acid is a waste product formed from the breakdown of purines, which are essential building blocks of DNA. It is also produced by the metabolism of proteinaceous food, especially red meat. Uric acid is excreted from the body by the kidneys through urine and a small portion through stool. Although indirectly but uric acid test helps in estimating the proper functioning of the kidneys, .

The presence of excess amounts of uric acid in the blood is called hyperuricemia. This accumulation of uric acid crystals in the synovial fluid between joints lead to the formation of gouts. Hyperuricemia also causes the formation of hard lumps of uric acid crystals called tophi under the skin and at the top of the ears. Uric acid crystals can also accumulate in the kidneys and cause kidney stones.

·         Creatinine:

This test measures the level of Creatinine in blood. Creatinine is a waste product formed from the normal breakdown of muscles in the body. Creatinine is almost completely excreted by the kidneys, so their levels in the blood serve as an indication of improper kidney function.

The levels of creatinine in the blood can rise due to decreased elimination from the kidneys as well as due to increased creatinine production by muscular breakdown, eating cooked meat, protein supplements, etc.

·         BUN/Creatinine Ratio:

BUN/Creatinine Ratio compares the levels of nitrogen as urea in the blood to the levels of creatinine in the blood. This ratio serves as a more accurate representation of kidney function. An increase in the ratio can be seen in case of dehydration while creatinine levels remain the same. Low BUN to creatinine ratio can be caused due to a low protein diet, liver cirrhosis, rhabdomyolysis (muscle disease), syndrome of inappropriate antidiuretic hormone secretion (SIADH) as well as during pregnancy.

Electrolytes: The serum electrolyte test measures the following electrolytes:

• Sodium (Na+)

• Potassium (K+)

• Chloride (Cl-)

Electrolytes play an important role in a number of body functions like metabolism, neuromuscular functioning, maintaining hydration, and pH (acid-base balance). Electrolytes also help in the entry of nutrients into the cells and removal of waste products from the cells. Electrolytes carry an electrical charge which can be either negative or positive and exist as dissolved salts in blood and body tissues. The Serum Electrolyte test measures the following important electrolytes:

Sodium (Na+)

Sodium is an essential body electrolyte which, along with potassium, chloride, bicarbonate, etc.helps to maintain the normal fluid and pH balance of the body. It is also vital for cellular metabolism, and in the activity of nerves and muscles and transmission of impulses between them. Sodium is present in all the body fluids. The highest concentration of sodium is found in blood and extracellular fluid.

Sodium is supplied to the body principally through dietary salt (sodium chloride or NaCl), and a small portion of sodium is absorbed through other food items. The required portion is absorbed by the body and the remaining is excreted by the kidneys through urine. The body maintains a very narrow range of sodium concentration by three mechanisms:

·         Secretion of hormones natriuretic peptides and aldosterone to control sodium elimination through urine

·         Secretion of antidiuretic hormone (ADH), also called Vasopressin, to control the volume of water eliminated through urine

·         Induction of thirst

Any disruption in the above-mentioned mechanisms gives rise to an imbalance in the concentration of sodium in the blood to produce Hyponatremia (low blood sodium concentration), or Hypernatremia (high blood sodium concentration). Both these conditions produce a number of symptoms and may even lead to death.

Potassium (K+)

Potassium is one of the essential body electrolytes along with sodium, chloride, bicarbonate, etc. As an electrolyte, potassium helps to regulate the amount of fluids present in the body and to maintain a correct pH balance. It performs a vital role in cellular metabolism and transport of nutrients and waste products in and out of cells. It is also essential in the transmission of nerve impulses to muscles and muscle activity.

Sufficient amount of potassium required by the body is absorbed from dietary sources, and the remaining unabsorbed potassium is excreted by the kidneys. The hormone called aldosterone maintains the body potassium level within a small normal range. Aldosterone acts on the nephrons present in the kidneys and activates a sodium-potassium pump which helps the body to reabsorb sodium and excrete potassium. This helps to maintain the potassium concentration in the blood within its normal range. Deviation of potassium concentration from its normal range gives rise to Hyperkalemia (high potassium level in blood), or Hypokalemia (low potassium level in blood). Both these conditions may produce a number of symptoms, and may even be fatal if not controlled.

Chloride (Cl-)

Chloride is an essential mineral which acts as an electrolyte similar to potassium, sodium, bicarbonate, etc. It helps to maintain the normal fluid and electrolyte balance in the body. It also acts as a buffer to help maintain the pH balance of the body. It also plays an essential role in metabolism by producing hydrochloric acid (HCl) in the stomach for digestion. The highest concentration of chloride is found in blood and extracellular fluid (fluid present outside the cells).

Most of the chloride is supplied to the body through dietary salt (sodium chloride or NaCl), and a small portion is absorbed through other food items. The required portion is absorbed by the body and the remaining is excreted by the kidneys through urine. The concentration of chloride in blood is maintained within a very narrow range by the body. Its increase or decrease is directly correlated with the sodium levels.

Glycosylated Hemoglobin Test measures the percentage of glycosylated hemoglobin in blood which reflects the average blood glucose over a period of past two to three months (8 - 12 weeks).

Hemoglobin is the protein found in Red Blood Cells and is responsible for transporting oxygen. Of the different types of hemoglobin, Hemoglobin A is predominant. With the elevation of blood sugar levels, some glucose binds spontaneously to Hemoglobin A (this binding is called Glycosylation or Glycation) and remains bound for the complete lifetime of the RBC, which is 120 days normally. Higher the level of glucose in the blood, greater is the amount of it binding to Hemoglobin A. Hemoglobin A1c is the dominant form of Glycated Hemoglobin. As RBCs die and are replaced, Hemoglobin A1c is cleared and slowly replaced with non-glycosylated hemoglobin. Measurement of HbA1c level over a period of time gives an indication of the level of glucose in the blood over the specified period of time. This helps in the diagnosis of Diabetes and is useful for monitoring the effectiveness of measures taken to reduce blood sugar levels.

Usually, albumin and creatinine tests are done randomly (not timed) on a urine sample, and the results are used to calculate an albumin/creatinine ratio (ACR). This test gives a more accurate indication of how much albumin is being released into the urine.

The healthy kidneys keep healthy components such as albumin and filter waste from the blood. In case of kidney damage, albumin can leak through the kidneys and exit the body through urine. 

In case of any damage caused to the kidney, albumin is one of the first proteins to leak through the kidney. This test is recommended in those patients who are at increased risk of kidney disease or damage such as patients with type 1 diabetes, type 2 diabetes, or high blood pressure. 

Creatinine is a byproduct of muscle metabolism. Normally, it is released into the urine at a constant rate. The level of creatinine in the urine is an indication of the urine concentration. Thus, creatinine measurement can be used to indicate correct urine concentration when measuring albumin in a random urine sample.

The presence of a small amount of albumin in the urine can be an early indicator of kidney disease. The term ‘microalbuminuria’ is referred to a condition in which a small amount of albumin is present in the urine, while the term ‘albuminuria’ refers to a condition where there is presence of any amount of rise in albumin levels in the urine.