The Chemcard? Glucose Test is an easy to use home screening test to identify high glucose or blood sugar levels. Diabetes can affect every organ system in the body, and is the leading cause of preventable blindness, lower extremity amputation, and end-stage renal disease. The American Diabetes Association recommends that all adults over the age of 45 receive a glucose test annually.
The Chemcard Glucose test - recommended for nondiabetics to measure the glucose level of your blood to make sure that you are not at risk.
The Hemoglobin A1c test - recommended for known diabetics to help make sure that your diabetes is under control. As recommended by the ADA, Chemcard? Glucose measures plasma glucose level after a minimum fasting period of 8 hours. Insulinoma is a deceptive endocrine tumour that can easily mislead even an astute clinician because of its bizarre and nonspecific symptom complex.
Keywords: Insulinoma, Neuroendocrine tumour, Hyperinsulinism, Hypoglycemia, Neuroglycopenia.
Insulinoma is a rare neuroendocrine tumour arising from beta cells of islets of Langerhans with an overall incidence of 4 cases per million per year. Under physiological circumstances, the pancreas secretes equimolar quantities of insulin and C-peptide from a common precursor (proinsulin).
To conclude, because of its elusive and deceptive nature, insulinoma can pose a diagnostic challenge even to an experienced clinician. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics.
ABCD sponsors treatment for those in need regardless of gender, race or creed, helping them to reach their full potential, to live life with dignity and to take their rightful place in their community.
ABCD works through local Palestinian partners, the Bethlehem Arab Society for Rehabilitation (BASR) based in Beit Jala, The Sheepfold in Beit Sahour and two UNWRA Refugee Camps in Jalazone and Nour Shams. Funding is constantly needed for new projects and to update and refurbish existing facilities. Context: Although there are several studies reported in the western literature regarding the association of C reactive protein (CRP) level with components of metabolic syndrome, data in the Indian population were lacking. How to cite this article:Chowta MN, Adhikari PM, Sinha R, Acharya SD, Gopalakrishna H N, Ramapuram JT. How to cite this URL:Chowta MN, Adhikari PM, Sinha R, Acharya SD, Gopalakrishna H N, Ramapuram JT.
10.Florez H, Castillo-Florez S, Mendez A, Casanova-Romero P, Larreal-Urdaneta C, Lee D, et al. A significant portion of the adult population in the US between the ages of 20 and 74 suffers from undiagnosed diabetes mellitus. Persons with diabetes are also at an increased risk for hypertension, stroke and heart disease. Among those most at risk are overweight people over 40 who do not exercise, African Americans, Hispanics, Native Americans, and those with a family history of diabetes.
This test can identify individuals with abnormal blood glucose levels which is often associated with diabetes or other carbohydrate metabolic disorders. A 45 year old woman presented with altered behaviour, seizures and spells of coma and was being treated as a case of hysterical neurosis. About 90% of insulinomas are solitary, benign, intrapancreatic and sporadic while 10% are multiple, malignant, extrapancreatic and familial. Contrarily, insulinoma predominantly secretes insulin (insulin-flooding) and causes hypoglycaemia, especially but not exclusively in the fasting state.
Accurate biochemical diagnosis and precise preoperative anatomic localization of insulinoma are highly desirable to avoid blind subtotal distal pancreatectomy.
Improved Contemporary Surgical Management of Insulinoma: A 25-year experience at the Massachusettes General Hospital.
As there will be a considerable difference in the profile of risk factors for cardiovascular diseases (CVDs), studies regarding the correlation of CRP level with cardiovascular risk factors and metabolic syndrome in the Indian population are required. Highly sensitive C reactive protein in patients with metabolic syndrome and cardiovascular disease.
Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Low grade inflammation and coronary heart disease: Prospective study and updated meta-analyses.
Population Distribution of High- Sensitivity C-reactive Protein among US Men: Findings from National Health and Nutrition Examination Survey 1999-2000. High-sensitivity C-reactive protein: Potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. C-reactive protein, the metabolic syndrome and risk of incident cardiovascular events: An 8 year follow-up of 14719 initially healthy American women. Association between subclinical inflammation and fasting insulin in urban young adult north Indian males. Inflammation, pravastatin and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Effect of rosiglitazone treatment on nontraditional markers of cardiovascular disease in patients with type 2 diabetes mellitus.


Chronic subclinical inflammation as part of the insulin resistance syndrome: The Insulin Resistance Atherosclerosis Study (IRAS). The metabolic syndrome and C-reactive protein, fibrinogen, and leukocyte count: Findings from the Third National Health and Nutrition Examination Survey. Reciprocal association of C-reactive protein with adiponectin in blood stream and adipose tissue.
Prospective study of C-reactive protein in relation to the development of diabetes and metabolic syndrome in the Mexico City Diabetes Study.
Markers of inflammation and cellular adhesion molecules in relation to insulin resistance in nondiabetic elderly: The Rotterdam study.
Effects of interleukin-6 on proliferation and follicle-stimulating hormone-induced estradiol production by bovine granulosa cells in vitro: Dependence on size of follicle. Proposed cardiovascular risk assessment algorithm using high-sensitivity C-reactive protein and lipid screening. A sterile disposable lancet is used to obtain a single drop of blood which is placed onto the "Test Area".
Biochemical and radiological investigations revealed fasting hypoglycaemia, endogenous hyperinsulinism, and a pancreatic parenchymal lesion.
Because of its deceptive, disguising and nonpathognomonic symptomatology, insulinoma can pose a diagnostic dilemma even to a shrewd clinician and remain undiagnosed for years. The patient was quickly revived by IV administration of 25% glucose followed by infusion of 10% dextrose-water.
Simple enucleation is the most favoured option for solitary insulinoma, especially if not abutting a main pancreatic duct or a major blood vessel while distal pancreatectomy with or without splenectomy is preferred for multiple insulinomas occurring in the body and tail of the pancreas. Objective: To correlate the highly sensitive CRP (hsCRP) level to individual components of metabolic syndrome and coronary vascular disease. Reaven's [1] first definition of the metabolic syndrome included these components: hyperglycemia, abdominal obesity, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol concentration, and hypertension. After three minutes, the top layer of the card is peeled off and the results obtained by matching the color of the test area with a sliding color chart.
Removal of the pancreatic lesion resulted in abrupt restoration of euglycaemia and complete disappearance of patients' symptoms. Actual history of the patient dated back to 5 years when she started to have dizziness, vertigo, blackouts, fatigability, poor work performance, sweating, tremors, palpitation and extremes of hunger. Pancreatoduodenectomy (Whipple's procedure) becomes indispensable for a non-enucleable insulinoma in the head and neck regions of the pancreas.6,9,10 After removal of one insulinoma, a comprehensive digital exploration of the remaining pancreas by a skilled surgeon is imperative to exclude the presence of additional insulinoma(s). Materials and Methods : Forty patients who were diagnosed clinically with metabolic syndrome were included in the study.
Patients with metabolic syndrome are at an increased risk for diabetes and cardiovascular events.
Upon matching colors, the test card is turned over and the result appears on the back side of the test card. This study reports a case of a similar patient of insulinoma who was misdiagnosed as "hysterical neurosis" and treated with antipsychotic drugs. With the passage of time, she developed altered behaviour, epileptiform fits and episodic loss of consciousness.
Detailed history with regard to diabetes mellitus, hypertension and other CVD was collected from each patient. The ATP-III (adult treatment panel III) guideline suggests a working definition of the metabolic syndrome, which includes the presence of at least three of the following characteristics: hyperglycemia, abdominal obesity, hypertriglyceridemia, reduced HDL cholesterol, hypertension and high fasting glucose. The aim of reporting this case is to create clinical awareness among the healthcare professionals in order to avoid occurrence of a serious mistake in the diagnosis and treatment of insulinoma. Her symptoms were characteristically precipitated by fasting, exertion and excitement and alleviated by intake of sugars, sweets, fruits and juices. After failure of spiritual, household and homeopathic remedies, she was mistakenly labeled as a case of hysterical neurosis and treated accordingly with antipsychotic drugs. The patient's condition worsened due to intolerable adverse effects of antipsychotic medications. CVD was assessed with the following: new-onset angina, fatal and non-fatal myocardial infarction or stroke, transient ischemic attack, heart failure or intermittent claudication.
Results: The mean hsCRP level was higher in patients with CVD compared with those without CVD.
This protein is very sensitive to inflammation, and its concentration can increase rapidly in response to a wide range of stimuli.
Originally described in 1930, CRP measurements served mostly in a diagnostic, although a non-specific one, and in a monitoring role in such fields as infectious diseases and rheumatology. In the past decade, as the role of inflammation in CVD became appreciated, interest turned to CRP as a possible risk marker for CVD.
But, statistical analysis has not shown any significant correlation between hypertension and hsCRP level. Thyroid function tests, serum calcium, cortisol and prolactin levels were within normal range. Similarly, although a higher hsCRP level was seen in diabeteics, statistical analysis failed to show a significant correlation between diabetes and the hsCRP level. CRP levels correlate with several components of the metabolic syndrome, including fasting insulin, microalbuminuria and impaired fibrinolysis, which are not easily evaluated in usual clinical practice.


Analyses of hsCRP correlation with body mass index, fasting glucose, cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein did not show a significant correlation with the hsCRP level. Conclusions: Increased hsCRP levels are associated with an increase in the incidence of CVDs. As there will be considerable difference in the profile of risk factors for CVDs, studies regarding the correlation of CRP level with cardiovascular risk factors and metabolic syndrome in the Indian population are required. Hence, this study was undertaken with the objective of measuring the highly sensitive CRP (hsCRP) level in patients with a diagnosis of metabolic syndrome and to correlate the hsCRP level to individual components of the metabolic syndrome. The study has been approved by the institutional ethics committee and written informed consent was taken from each patient who participated in the study. Forty patients who were diagnosed clinically with metabolic syndrome as per IDF 2005 criteria [5] were included in the study.
Histopathology of the resected specimen showed a well-encapsulated benign insulinoma (Figure-4).
The CRP level was correlated with the components of metabolic syndrome and the occurrence of cardiovascular disorders. Sample means between group with CVD and without CVD were compared using the Mann-Whitney U test. Spearmann's correlation coefficient was used to correlate hsCRP levels to BMI, fasting glucose, lipid profile, cholesterol and triglycerides. But, statistical analysis has not shown any significant correlation between hypertension and hsCRP level (Mann-Whitney U test, P = 0.603, [Table 2]). But, it was statistically not significant (P = 972).[Table 3] shows the analyses of hsCRP correlation with BMI, fasting glucose, cholesterol, triglycerides, HDL and LDL (Spearmann correlation coefficient). A clinical marker of inflammation is high-sensitivity CRP, [6] an acute-phase reactant that is produced by the liver in response to pro-inflammatory cytokines, such as interleukin-6, and reflects low-grade systemic inflammation. Inflammation releases cytokines, and the cytokine Interlukin-6 is thought to be largely responsible for triggering the production of CRP, which is thus generally viewed as a marker of inflammation, with very high values associated with acute inflammation. Chronic, low-level inflammation can result in near-normal, but nevertheless elevated, values. Elevated levels of hs-CRP have been shown to be predictive of increased risk of coronary artery disease in apparently healthy men and women. We investigated the association of metabolic syndrome components (hypertension, obesity, elevated triglyceride concentrations, decreased HDL-cholesterol concentrations and elevated fasting glucose) and CVD with hsCRP concentrations. There are a number of other studies reported in the western literature [4],[6] that showed a positive correlation between CRP levels and CVD.
Findings of these studies as well as our study point toward the significance of determining the CRP level in diagnosing and predicting various cardiovascular pathologies.However, the present study failed to show any correlation between hsCRP level and the components of metabolic syndrome. This is in contrast to several studies that have shown a significant association between CRP level and parameters of metabolic syndrome. Aspirin and statins are known to reduce vascular inflammation, which may result in reduced levels of CRP in those patients who were on these medications.
An important link between these conditions and obesity could be the pro-inflammatory cytokines produced by adipose tissue, such as tumor necrosis factor- and Interleukin-6. These cytokines can influence insulin resistance and glucose uptake, promote hepatic fatty acid synthesis and increase hepatic CRP production. A central role for obesity in the pathogenesis of insulin resistance could explain why some studies have shown that the relationship between inflammatory markers and the risk of developing diabetes is attenuated after correction for obesity. Individual features of the metabolic syndrome, such as hypertension and dyslipidemia, could directly cause endothelial dysfunction and subclinical atherosclerosis, leading to inflammation and raised CRP. Alternatively, insulin resistance could increase hepatic CRP production by blocking insulin-mediated inhibition of acute-phase protein gene expression. The Mexico City Diabetes Study has shown that CRP levels were more strongly related to insulin resistance and features of the metabolic syndrome in women.
Two more recent reports have shown that in a cross-sectional analysis, markers of inflammation, including CRP, were more strongly related to insulin resistance in women than in men.
Also, women might have greater quantities of total body adipose tissue compared with men, and this could be the source of the pro-inflammatory cytokines. Han and coworkers [17] have suggested that inflammation might have a greater effect on insulin resistance in women than in men. Laboratory studies have shown that the pro-inflammatory cytokine Interleukin-6 can influence estradiol production by granulosa cells and therefore that chronic inflammation could theoretically mitigate the protective effect of estrogen on insulin resistance and body fat distribution. The sample size was small and also there were difference in the criteria for inclusion of subjects in the study when compared with various other studies reported in the literature. All these factors would have affected the findings of our study.To conclude, increased hsCRP levels are associated with an increase in the incidence of CVDs.
Determining hsCRP levels in patients could add to the diagnostic and prognostic information for the patient in the context of cardiovascular disorders. Further research with a prospective longitudinal design in a larger sample may be needed to draw definite conclusions.



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