Diabetes is a type of lifestyle-related disease that affects many people worldwide with approximately 90% of patients being diagnosed with diabetes type 2.
For those who are taking oral hypoglycaemic drugs, as well as those with type 1 diabetes (a condition where your body’s pancreas does not produce any insulin), one is strongly recommended to monitor their blood glucose levels frequently. Monitoring blood glucose levels can help you better understand how your daily activities, medication, food, insulin, mood swing and stress influence your blood sugar levels. Since most blood glucose monitors come with a memory to store the readings in which this data can be downloaded to a computer and hence helping a doctor to monitor and analyze so that a better treatment of diabetes can be recommended for the patient. To maintain the accuracy of the reading of a blood glucose meter, it should be recalibrated each time the reading is taken the device should be properly maintained. You should always ask your doctor’s advice regarding correct instructions in using a glucose meter. After getting the reading from your blood glucose meter, make sure you write it down in a record book everyday so that you can better keep track of your diabetes condition.
Another important point for you is that you should keep your blood glucose level as close as possible to its normal range so as to help reduce the risk of long-term complications arising from diabetes.
Note: If you are unable to perform this blood glucose testing, you can still perform urine test by using urine test strips to check the condition of your glucose levels.
Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Blood glucose monitoring – wikipedia, the free encyclopedia, Blood glucose monitoring is a way of testing the concentration of glucose in the blood . Insulin is required by almost all of the body's cells but its major targets are liver cells, fat cells and muscle cells. As such, insulin stores nutrients right after a meal by reducing the concentrations of glucose, fatty acids and amino acids in the bloodstream. Insulin and glucagon have opposite effects on liver and other tissues for controlling blood-glucose levelsSo, what happens when you do not eat? In contrast to insulin, glucagon mobilizes glucose from stores inside your body and increases the concentrations of glucose in the bloodstream -- otherwise, your blood glucose would fall to dangerously low levels.
Thus, one can say that insulin is the key that opens the door to let glucose into the cells. Ketoacidosis: A feature of uncontrolled diabetes mellitus characterized by a combination of ketosis and acidosis. Hypothalamic expression of the GCK gene plays an important role in the regulation of dietary glucose intake in particular, and overall feeding behavior in general.
The two activities of BPGM are 2,3-bisphosphoglycerate synthase, and 2,3-bisphosphoglycerate phosphatase. The other PK gene (identified as the PKM gene) is located on chromosome 15q23 and is composed of 16 exons that generate eight alternatively spliced mRNAs. As described in the previous section, altered metabolism of glucose is a hallmark of all types of cancer. The HIF-1 pathway, which is activated by conditions of hypoxia (low oxygen tension), is a major homeostatic mechanism for cellular responses to changes in the level of oxygen within cells.
Expression of PHD1 is highest in the testes with lower level expression seen in brain, liver, kidney, and heart.
The normal role of the HIF-1 pathway is to promote the delivery of oxygen and nutrients to the oxygen-deprived tissue via the stimulation of neovascularization (angiogenesis).
TCA cycle in the form of acetyl-CoA which is the product of the pyruvate dehydrogenase reaction. UDP-glucose is oxidized to UDP-glucuronate by the NAD+-requiring enzyme, UDP-glucose dehydrogenase.
Frequent checking and monitoring of your glucose blood level can help you stay healthy while reducing the risk of long-term complications arising from diabetes. These factors include overall health, age, and whether you have type 1 or type 2 diabetes mellitus. Similarly, people with type 2 diabetes (a condition when your body’s cells ignore the insulin or your pancreas does not produce enough insulin) are also advised to monitor their glucose level so that the given treatment can meet the desired goals. This info is much needed as it will aid in better management of your diabetes besides delaying or preventing diabetic complications which include kidney failure, blindness and diabetic indulged eye disease.
From the blood glucose monitor, you get a reading of your blood glucose level in a digital form.
Most manufacturers provide good service support but some do not, so you should look for the meter which offers the best service and technical support. It is always easier to prick on your fingertip as it is less painful to prick particularly on one side. Talk to your doctor if your blood glucose level is not within the normal range and ask him or her to suggest a good range for your blood glucose level and also what you should do to maintain a healthy blood glucose level. In times of fasting, or when there has been a long time after a meal and the blood levels of glucose drop significantly, your pancreas releases glucagon so that your body can produce glucose. For example, just after you eat a meal, your body is ready to receive the glucose, fatty acids and amino acids absorbed from the food. Given that erythrocytes lack mitochondria, they cannot completely oxidize glucose-derived pyruvate and instead reduce the pyruvate to lactate which enters the blood for delivery to the liver where it is used for glucose synthesis via gluconeogenesis.


The synthase activity of the enzyme is most active at alkaline pH, whereas, the phosphatase activity is more active acidic pH. The synthesis of PKL or PKR is the result of alternative splicing of the primary mRNA produced from the PKLR gene. The major protein products resulting from this complex alternative splicing of the PKM precursor mRNA are identified as PKM1 and PKM2. An alternate glycolytic pathway occurs in highly proliferative cells such as is observed in cancer cells. Recent work has demonstrated that small molecule PKM2-specific activators are functional in tumor growth models in mice.
The diversion of glucose carbons into biomass in cancer cells necessitates an increased delivery of glucose into these cells and an increase in the rate of anaerobic glycolysis to lactate.
Expression of the HIF1A gene is ubiquitous, whereas expression of the HIF2A gene is more restricted being primarily found active in interstitial cells, endothelial cells, and parenchymal cells. The ODD domain is hydroxylated by a member of the prolyl hydroxylase domain (PHD) family of proline hydroxylating enzymes. The microenvironment that surrounds most solid tumors is highly hypoxic and, therefore, the ability of the tumor cells to proliferate requires the ability to acquire oxygen and nutrients.
The conversion of pyruvate into lactate is enhanced in the context of activated HIF-1 since this transcription factor activates the expression of the LDHA gene. These enzymes are encoded for by four different genes in humans identified as LDHA, LDHB, LDHC, and LDHD. Monitoring diabetes or blood glucose level is important to help monitor how much glucose present in your blood.
Personal preferences and your understanding regarding your health condition can help you better target your blood glucose level. Many blood glucose monitors come with different features with some of them made specifically for those who have poor eyesight or other disabilities.
It is always advisable to ask your doctor which area (such as thigh, or forearm) should be used with your meter.
Certainly, in most cases, ‘acceptable’ blood glucose levels can be slightly varied from one individual to another. You may also need to advise your doctor about what you have eaten, how active you are during the day, and how medications affect your insulin when discussing your glucose level with them, so that they can help you manage your diabetes or blood glucose level.
Glucagon is another protein hormone that is made and secreted by the alpha cells of the pancreatic islets.
The presence of these substances in the intestine stimulates the pancreatic beta cells to release insulin into the blood and inhibit the pancreatic alpha cells from secreting glucagon. One of these transporters is the Na+-dependent glucose transporter 1 (SGLT1) while the other is the Na+-independent glucose transporter 2 (GLUT2). Expression of the hypothalamic GCK gene increases specifically within the ARC in response to fasting. This ADP-dependent glucokinase (ADP-GK) is encoded by the ADPGK gene which is located on chromosome 15q24.1 and is composed of 8 exons that encode a 496 amino acid precursor protein. The designation PKM reflects the fact that the enzyme was originally thought to be muscle specific in its expression. Cancer cells express the PKM2 isoform of pyruvate kinase which is much less active than other isoforms and is also negatively regulated by binding to tyrosine phosphorylated proteins. This is accomplished by an increase in the expression of genes encoding glucose transporters and glycolytic enzymes. Expression patterns of the HIF3A gene are less well defined and the gene generates multiple splice variant mRNAs, some of which lack the transcriptional transactivation domain.
The requirement of these enzymes for 2-oxoglutarate results in direct coupling of the activity this class of prolyl hydroxylases to metabolic processes that generate and utilize 2-oxoglutarate such as the TCA cycle. This is accomplished, in large part, through the activation of the HIF-1 pathway which is considered to be a modulator in the transactivation of genes implicated in the altered metabolism observed in cancer cells. The increased production of lactate, by cancer cells, contributes to the acidification of the tumor microenvironment which, in turn, promote further activation of the HIF-1 pathway. Therefore, it is particularly important for you to discuss with your doctor which one suits you best. The levels of insulin in the blood begin to rise and act on cells (particularly liver, fat and muscle) to absorb the incoming molecules of glucose, fatty acids and amino acids. Manipulation of GCK expression within the ARC of experimental animals alters glucose intake.
Expression of the ADPGK gene is seen in numerous tissues implying that it serves a housekeeping role with respect to glucose metabolism. The PKL mRNA contains an alternate 5' exon, relative to the PKR mRNA, and the resultant encoded protein is shorter at 543 amino acids.
The dashed arrow for the PKM2 reaction is to demonstrate that this reaction is inefficient compared to the transfer of phosphate from PEP directly to PGAM1.
These transcriptional changes can be observed in over 70% of human cancers and is driven in part through activation of the hypoxia induced factor 1 (HIF-1) pathway and by increased expression of various proto-oncogenes and decreased expression of various tumor suppressors.
The 2-oxoglutarate-dependent prolyl hydroxylase enzymes are identified as PHD1 (encoded by the EGLN2 gene), PHD2 (encoded by the EGLN1 gene) and PHD3 (encoded by the EGLN3 gene).


Several of the metabolic regulatory genes that are activated by HIF-1 include the pyruvate kinase M (PKM) gene, described in detail in the previous section, the fructose-1,6-bisphosphate aldolase (ALDOA) gene, the pyruvate dehydrogenase kinase 1 (PDK1) gene, the GLUT1 gene, and the lactate dehydrogenase A (LDHA) gene. This action of insulin prevents the blood-glucose concentration (as well as the concentrations of fatty acids and amino acids) from substantially increasing in the bloodstream.
Although GLUT2 does indeed transport glucose into intestinal enterocytes, this only occurs in response glucose-mediated translocation of intracellular vesicle-associated GLUT2, thus even in the absence of GLUT2 (such as is the case in individuals with Fanconi-Bickel disease), intestinal uptake of dietary glucose is unimpaired.
Increased GCK expression in the ARC results in increased glucose ingestion, whereas, decreased GCK expression results in reduced glucose ingestion. The ADP-GK enzyme is highly specific for glucose with a Km for this substrate of around 0.1 mM.
Deficiencies in expression of the PKLR gene in erythrocytes are the cause of the most common form of inherited non-spherocytic anemia.
PKM1 is found in numerous normal differentiated tissues, whereas, PKM2 is expressed in most proliferating cells. The designation of EGLN refers to the fact that these three genes are homologs of the Caenorhabditis elegans egg laying-9 (Egl-9) gene.
The hydroxylation reactions catalyzed by the PHD enzymes require molecular oxygen (O2) in addition to the Fe2+ and 2-oxoglutarate, therefore, reductions in oxygen content will result in loss of their activity. Pyruvate is a known inhibitor of the prolyl hydroxylases that hydroxylate the HIF1α subunit proteins.
It may require the administration of intravenous fluids, insulin, and glucose, and the institution of changes in the person's diet. See also diabetes mellitus and ketone bodies. These observations indicate that ARC expression of GCK underlies the phenomenon of carbohydrate craving.
All cancers that have been examined for PK expression pattern show expression of the PKM2 isoform. Hydroxylation of HIF α-subunits renders the proteins susceptible to proteosomal degradation under normoxic cellular conditions. As indicated below, different combinations of the M and H subunits generates LDH isoforms in different tissues.
The state of methylation of the PKM gene is a major mechanism for the control of expression of the PKM2 isoform.
In response to proline hydroxylation the ubiquitin ligase encoded by the von Hippel-Lindau (VHL) gene binds to the HIF α-subunit proteins and catalyzes their polyubiquitination. As indicated, expression of the HIF1A gene is ubiquitous and this pattern is maintained under normal oxygen availability (normoxic conditions). Thus, accumulation of lactate and pyruvate, which occurs as a result of both altered pyruvate kinase gene expression and activation of the HIF-1 pathway, further promotes activation of the HIF-1 pathway leading to a controlled and enhanced metabolic profile within cancer cells.
Elevated expression of the PKM2 isoform has been correlated, in numerous cancers, to a hypomethylated state in intron 1 of the PKM gene. The activity of the HIF1α protein is regulated by being hydroxylated on two prolines (P405 and P531) in the ODD. The enzyme encoded by the LDHD gene is a mitochondria-specific enzyme whose expression appears to rise in certain types of cancer (e.g. These monosaccharides are then transported into the circulation via the action of enterocyte GLUT2 present in the basolateral membrane.
The heightened expression of PKM2 allows for a unique pathway of enhanced glucose oxidation to lactate in cancer cells and constitute what is referred to as the Warburg effect (see below). His11 refers to the catalytic site histidine that is phosphorylated by phosphate donation from PEP. The presence of the trans-4-hydroxyproline residues increases the binding of the VHL encoded protein by over 1000 fold.
Following entry into the duodenal superior mesenteric vein the dietary sugars travel to the hepatic portal vein and then to liver parenchymal cells and other tissues of the body. Given that the PHD enzymes require O2 as a substrate for the hydroxylation reaction, when conditions of hypoxia exist the HIFα subunits escape hydroxylation and are, therefore, not ubiquitinated.
The LDHA gene is located on chromosome 11p15.4 and is composed of 9 exons that generate multiple alternatively spliced mRNAs. Within cells, the sugars are oxidized by the various catabolic pathways of cells or they can be used as precursors for biomass production or stored as glycogen. The activity of HIF1α is also regulated via the hydroxylation of a specific asparagine residue (N803) found in the C-terminal transactivation domain.
The LDHC gene is located on chromosome 11p15.1 and is composed of 8 exons that generate two alternatively spliced mRNAs that both encode the same 332 amino acid protein. The N803 hydroxylation is catalyzed by another 2-oxoglutarate-dependent dioxygenase originally identified as factor-inhibiting HIF-1 (FIH1; also identified as FIH). The LDHD gene is located on chromosome 16q23.1 and is composed of 11 exons that generate two alternatively spliced mRNAs encoding two isoforms of this enzyme. Mutations in the LDHA gene are associated with the glycogen storage disease type 11, GSD11.



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