The pancreas has both
endocrine and exocrine
functions. The endocrine
tissue is grouped together in
the islets of Langerhans and
consists of four different
cell types each with its own
- Alpha cells produce
- Beta cells produce
proinsulin. Proinsulin is the
inactive form of insulin that is
converted to insulin in the
- Delta cells produce
- F or PP cells produce
pancreatic polypeptide.
Glucagon metabolism
Insulin metabolism
Exploration of endocrine pancreas is connected with the diagnosis and treatment of
diabetes mellitus. This is a complex disease characterized primarily by relative or
absolute insufficiency of insulin secretion and concomitant insensitivity or resistance to
the metabolic action of insulin on target tissues.
Pathophysiology of Diabetes Mellitus
Laboratory tests
Laboratory tests used in order to explore the pancreas endocrine
function are :
Fasting blood glucose
Oral Glucose Tolerance Test (OGTT)
HBA1c level (also called glycosylated haemoglobin level)
Urine glucose concentrations
Urinary ketone bodies
Insulin blood level – measured by RIA ( n. value :10-20 uU/ml ;
21U = 40ug insulin)
Glucagon secretion – measured by RIA (n. value: 50-85pg/ml - fasting level)
Islet Cell Antibody tests
Fructosamine level
Fasting blood glucose
Normal value : 70 -110 mg/dl ( venous blood )
Variations : >110 mg/dl – hyperglycaemia
50-60 mg/dl - hypoglycaemia
Oral Glucose Tolerance Test (OGTT)
During the oral glucose tolerance test
your blood glucose is tested two hours
after drinking 75 grams of glucose
(1 g glucose/kg body weight ) solved in
200-300 ml water
Normal values : fasting value < 110 mg/dl
2 hours < 140 mg/dl
Diabetes mellitus
fasting glucose
-2 hours
> 110 mg/dl
> 200 mg/dl
Impaired glucose
tolerance (IGT)
fasting glucose
-2 hours
> 110 mg/dl
140 - 200 mg/dl
Impaired fasting
glycaemia ( IFG)
fasting glucose
-2 hours
> 110 mg/dl
< 140 mg/dl
Glycosylated hemoglobin or hemoglobin A1c
This test is a measurement of how high blood sugar levels have been over about
the last 120 days (the average life-span of the red blood cells on which the test is
Excess blood glucose hooks on to the hemoglobin in red blood cells and stays
there for the life of the red blood cell.
The percentage of hemoglobin that has had excess blood sugar attached to it can
be measured in the blood. The test involves having a small amount of blood drawn.
Blood glucose level
( mg/dl)
Normal value
Good control
Medium control
Poor control
Urine glucose concentrations
- Normal value : undetectable amounts of glucose in the urine. ( Benedict
- Variations : Diabetic patients lose glucose in small to large amounts (
glycosuria), in proportion to the severity of disease and the intake of
carbohydrates. The renal threshold for glucose ( the arterial blood level at
which glycosuria appears) is reached when the glucose concentration in
plasma is above 180 mg/dl).
Urinary ketone bodies
- Normal value : normal individuals do not lose ketone bodies in the urine
(Legal - Imbert method)
- Variations : the identification ( violet ring ) and the quantity of urinary
ketone bodies is important in the diagnosis of the severity of the diabetes.
Diabetes mellitus is characterized by recurrent or persistent
hyperglycemia, and is diagnosed by demonstrating any one of the
Fasting plasma glucose level at or above 7.0 mmol /L (126 mg/dL).
Plasma glucose at or above 11.1 mmol /L (200 mg/dL) two hours after a
75 g oral glucose load as in a glucose tolerance test.
Symptoms of hyperglycemia and casual plasma glucose at or above
11.1 mmol/L (200 mg/dL).
Glycated hemoglobin (hemoglobin A1C) at or above 6.5. (This criterion was
recommended by the American Diabetes Association in 2010).
Pregnancy tests
All pregnancy tests work by detecting a certain hormone in the urine or
blood that is only there when a woman is pregnant. This hormone is called
human chorionic gonadotropin or hCG. It is also called the pregnancy
HCG is being produced by the placenta and enters the blood stream as
soon as implantation happens, about one week after fertilization and
ovulation, when the embryo implants and the placenta attaches to the
uterine lining.
Quantitative tests ( blood tests) :
- hCG < 5 mIU/ml : Negative. Not pregnant
- hCG : 5-25 mIU/ml : "Equivocal". Maybe pregnant maybe not. Repeat
test in a couple of days
- hCG > 25 mIU/ml : You are pregnant!
hCG Information
hCG is measured in milli-international units per milliliter (mIU/ml)
There is a wide range of normal hCG levels and values and the values are
different in blood serum or urine.
Urine hCG levels are usually lower than serum (blood) hCG levels.
Blood hCG testing is much more sensitive than a urine HPT. This means
that the blood test can detect pregnancy several days earlier than the urine
test, as early as 2-3 days after implantation or 8-9 days after fertilization.
Urine tests measure the urine HCG qualitatively, which means that the HPT
results are either "positive" or "negative." Around the time of the first missed
period (14+ days after ovulation), over 95% of HPTs are usually positive.
About 85% of normal pregnancies will have the hCG level double every 48 72 hours. As you get further along into pregnancy and the hCG level gets
higher, the time it takes to double can increase to about every 96 hours
hCG Information
1. Greater than normal levels of human chorionic gonadotropin (hCG)
may indicate:
a tumor of the placenta with death of the fetus
multiple pregnancy, such as twins or triplets
ovarian cancer and other types of cancer in some cases
a normal pregnancy
blood or protein in the urine, which can interfere with the result
use of medications to prevent seizures, drugs to treat Parkinson’s
syndrome, or phenothiazine drugs, such as chlorpromazine, by the mother
2. Lower-than-normal human chorionic gonadotropin (hCG) levels may
ectopic pregnancy
a miscarriage, or abortion.
Home Pregnancy Tests ( HPT) - qualitative tests
Home Pregnancy Tests ( HPT)
For optimal detection of early pregnancy, a "first morning" urine specimen is
preferred, since it contains the highest concentration of ß hCG. However,
randomly collected urine specimens may be used.
Collect the urine specimen in a clean container.
If testing is not immediate, the specimen should be refrigerated (4 degrees
C )or kept cool (below 25 degrees C )for up to twenty-four hours. In any
case, bring the specimen to room temperature prior to testing.
atc anti-hCG + hCG
Positive test :
= coloured reaction ( coloured line)
(on the stick)
1. Negative:
One (1) colored band appears in the
control region (C).
No apparent band is detectable in the
test region (B).
2. Positive:
In addition to the control band, a clearly
distinguishable band also appears in the
test region (B), indicating the presence
of ß hCG in the sample.
3. Inconclusive:
The test is inconclusive in the absence
of distinct color bands in both the control
(C) and test window (B). In this case, it
is recommended that the test be
repeated, or a fresh specimen be
obtained and tested forty-eight hours
( somatic measurements)
Body weight ( kg):
IBW - Estimated ideal body weight in (kg)
Males: IBW = 50 kg + 2.3 kg for each inch
over 5 feet.
Females: IBW = 45.5 kg + 2.3 kg for each
inch over 5 feet.
ABW - Estimated adjusted body weight (kg)
If the actual body weight is greater than 30%
of the calculated IBW, calculate the adjusted
body weight (ABW)
ABW = IBW + 0.4(actual weight - IBW)
Body Mass Index (BMI)
The body mass index (BMI) is a statistical measure which compares a
person's weight and height. Though it does not actually measure the
percentage of body fat, it is used to estimate a healthy body weight based on a
person's height. Due to its ease of measurement and calculation, it is the most
widely used diagnostic tool to identify weight problems within a population,
usually whether individuals are underweight, overweight or obese .
BMI Categories:
Underweight = <18.5
Normal weight = 18.5-24.9
Overweight = 25-29.9
Obesity = BMI of 30 or greater
Body Mass Index (BMI)
Body Mass Index (BMI)