What Is Diabetes?
By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L, SCLV Definitions of Diabetes Diabetes Mellitus has several definitions: A metabolic disorder A chronic, progressive disease A growing public health concern. Diabetes is characterized by a high level of glucose in the bloodstream, also known as hyperglycemia. Glucose is the principal circulating sugar in the blood and provides energy to all cells in the body. These cells cannot use glucose, however, without the help of insulin. Insulin is a hormone produced by the pancreas that converts sugar and starch from food into the energy needed to fuel everyday activities. Diabetes occurs when the pancreas does not make or release enough insulin, the body's cells are resistant to insulin, or both conditions are present. A Metabolic Disorder Metabolism is a term that describes the processes through which food is converted into energy for your body to use immediately or store for later use. In normal food metabolism: The food you eat is broken down into glucose and other simple sugars and enters your bloodstream; Your body senses the rise in blood glucose and signals your pancreas to release insulin into your bloodstream; The released insulin acts as a "key" that unlocks your cells and allows glucose to enter; Your cells absorb glucose to provide energy for physical activity. The foods you eat that break down into glucose are called carbohydrates, which: Are one of the three main nutrients in food, in addition to proteins and fats; Include sugars and starches contained in fruit; breads and cereals; milk and dairy; starchy vegetables such as corn, potatoes, and peas; cake and ice cream; Cause blood glucose levels to rise about one to two hours after a meal; Determine how high or low blood your glucose levels will go, according to Continue reading >>
- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
- Diabetes doctors: Which specialists treat diabetes?
Diabetes Type 2
There are two sorts of blood glucose tests for people with diabetes. The HbA1c test which is done by a health professional and the 'finger-prick test' which you can do for yourself. The HbA1c or glycated haemoglobin test is usually done once a year by the GP or specialist nurse as part of the annual check-up for people with type 2 diabetes (see 'Care and treatment for type 2 diabetes'). The test measures the amount of glucose that the body's red blood cells are carrying and indicates how blood glucose levels have been over the previous 2 or 3 months. If the result is high the test can be repeated in a few months after changes in diet or treatment. The finger-prick test gives an instant reading or snapshot of the glucose level in the blood at that moment which indicates whether your diabetes is under control. Regular testing had made many people we talked to more aware of foods they needed to limit or avoid altogether, and that exercise could help to reduce blood glucose levels. Many people with diabetes feel that they are bound to have better control of their blood sugar if they can monitor it themselves on a regular basis. But several large studies have failed to confirm this, and found that regular monitoring by people who are not taking insulin often increases anxiety about normal ups and downs in blood glucose levels without improving long-term control. A large part of the NHS annual spend on diabetes is taken up by the inappropriate use of blood testing strips, so in many parts of the UK there are local guidelines aimed at restricting their availability to appropriate levels for each stage of diabetes. Blood glucose targets Everyone with diabetes is advised to try to keep their blood glucose levels steady and within the recommended range. For most people with diabe Continue reading >>
Ultimate Guide To The A1c Test: Everything You Need To Know
The A1C is a blood test that gives us an estimated average of what your blood sugar has been over the past 2-3 months. The A1c goes by several different names, such aswa Hemoglobin A1C, HbA1C, Hb1C, A1C, glycated hemoglobin, glycohemoglobin and estimated glucose average. What is Hemoglobin? Hemoglobin is a protein in your blood cells that carries oxygen. When sugar is in the blood, and it hangs around for a while, it starts to attach to the red blood cells. The A1C test is a measurement of how many red blood cells have sugar attached. So, if your A1C result is 7%, that means that 7% of your red blood cells have sugar attached to them. What are the Symptoms of a High A1C Test Level? Sometimes there are NO symptoms! That is probably one of the scariest things about diabetes, your sugar can be high for a while and you may not even know it. When your blood sugar goes high and stays high for longer periods of time you may notice the following: tired, low energy, particularly after meals feel very thirsty you may be peeing more than normal, waking a lot in the middle of the night to go dry, itchy skin unexplained weight loss crave sugar, hungrier than normal blurred vision, may feel like you need new glasses tingling in feet or hands cuts or sores take a long time to heal or don’t heal well at all frequent infections (urinary tract, yeast infections, etc.) When your blood sugar is high, this means the energy that you are giving your body isn’t getting into the cells. Think about a car that has a gas leak. You put gas in, but if the gas can’t get to the engine, the car will not go. When you eat, some of the food is broken down into sugar and goes into your bloodstream. If your body can’t get the sugar to the cells, then your body can’t “go.” Some of the sugar tha Continue reading >>
Diabetes Mellitus: Screening And Diagnosis
Diabetes mellitus is one of the most common diagnoses made by family physicians. Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure, and vascular and heart disease. Screening patients before signs and symptoms develop leads to earlier diagnosis and treatment, but may not reduce rates of end-organ damage. Randomized trials show that screening for type 2 diabetes does not reduce mortality after 10 years, although some data suggest mortality benefits after 23 to 30 years. Lifestyle and pharmacologic interventions decrease progression to diabetes in patients with impaired fasting glucose or impaired glucose tolerance. Screening for type 1 diabetes is not recommended. The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and type 2 diabetes in adults 40 to 70 years of age who are overweight or obese, and repeating testing every three years if results are normal. Individuals at higher risk should be considered for earlier and more frequent screening. The American Diabetes Association recommends screening for type 2 diabetes annually in patients 45 years and older, or in patients younger than 45 years with major risk factors. The diagnosis can be made with a fasting plasma glucose level of 126 mg per dL or greater; an A1C level of 6.5% or greater; a random plasma glucose level of 200 mg per dL or greater; or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg per dL or greater. Results should be confirmed with repeat testing on a subsequent day; however, a single random plasma glucose level of 200 mg per dL or greater with typical signs and symptoms of hyperglycemia likely indicates diabetes. Additional testing to determine the etiology of diabetes is not routinely recommended. Clinical r Continue reading >>
- Diagnosis and treatment of diabetes mellitus in chronic pancreatitis
- Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
Hba1c Of 6.5% To Diagnose Diabetes Mellitus — Does It Work For Us? — The Bellville South Africa Study
Abstract HbA1c has been the gold standard for glycaemic control follow-up for decades. In 2009, a level of 6.5% (48 mmol/mol) was proposed as diagnostic for diabetes. We test this cut-off in our community. Participants (946) from a community-based study were screened for diabetes using either a fasting blood glucose or oral glucose tolerance test (OFTT). The HbA1c cut-off of 6.5% was tested for each group. A receiver operator characteristic (ROC) curve for both groups was generated to establish an optimal cut-off. Our study included 224 (23.7%) males and 722 (76.3%) females. Using fasting blood glucose alone, 117 (14%) were diagnosed with diabetes −50% had an HbA1c value of ≥6.5% (48 mmol/mol). Using an OGTT, 147 (18%) were diagnosed with diabetes −46% had an HbA1c value of ≥6.5% (48 mmol/mol). ROC curves found a level of 6.1% (43 mmol/mol) to be optimal in both groups (AUC 0.85 and 0.82 respectively). The sensitivities were 80% and 75% and the specificities 77% and 78% respectively. A cut off of 6.5% (48 mmol/mol) is a good diagnostic tool with its high specificity; however the low sensitivity limits its use. We found a level of 6.1% (43 mmol/mol) to be optimal. This emphasizes the need for evidenced based values to be established in various population groups. Citation: Zemlin AE, Matsha TE, Hassan MS, Erasmus RT (2011) HbA1c of 6.5% to Diagnose Diabetes Mellitus — Does It Work for Us? — The Bellville South Africa Study. PLoS ONE 6(8): e22558. Editor: Jose A. L. Calbet, University of Las Palmas de Gran Canaria, Spain Received: April 4, 2011; Accepted: June 27, 2011; Published: August 12, 2011 Copyright: © 2011 Zemlin et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use Continue reading >>
Diagnosing Diabetes
How much do you know? Self assessment quizzes are available for topics covered in this website. Find out how much you have learned about Diabetes. Random or casual plasma glucose test A plasma glucose test is a measure of how much sugar/glucose you have circulating in your blood. “Random” or “Casual” simply means that you have blood drawn at a laboratory at any time. Whether you have fasted or recently eaten will not affect the test. A plasma glucose test measurement equal to or greater than 200 milligrams per deciliter (mg/dl) indicates that you may have diabetes. To be sure, you will need to have the test results confirmed on another day through another random test, or by taking a fasting plasma glucose test or an oral glucose tolerance test. Fasting plasma glucose test This simple blood test is taken after you have abstained from food and drink (except water) for at least 8 hours. A normal plasma glucose level after fasting is between 60 and 99 mg/dl. Diabetes is not confirmed until 2 separate fasting plasma glucose tests each measure 126 or greater. Oral glucose tolerance test It’s possible for people with diabetes – even those with symptoms – to have a normal fasting plasma glucose test. If you fall into this category, you will again be asked to abstain from food and drink (except water) for 8 hours and then drink a liquid containing a known amount of glucose, usually 75 grams.Your blood is drawn before drinking the glucose mixture and 2 hours later. You will be asked to refrain from eating until the test is completed. This test is called an Oral Glucose Tolerance Test (OGTT). Your fasting plasma glucose normally is less than 100 mg/dl. Values from 100mg/dl to 126 mg/dl are diagnostic of pre-diabetes. Fasting plasma glucose levels equal or above 126 m Continue reading >>
Your A1c Levels – What Goal To Shoot For?
Measuring Your A1C An A1C test gives you and your provider insight into all of your blood glucose ups and downs over the past two or three months. It’s like the 24/7 video of your blood sugar levels. Observing your A1C results and your blood glucose (also known as blood sugar) results together over time are two of the key tools you and your health care provider can use to monitor your progress and revise your therapy as needed over the years. Recent research is changing the way health professionals look at A1C levels. Instead of setting tight controls across the board, a healthy A1C level is now a moving target that depends on the patient. In the past, an A1C of 7 percent was considered a healthy goal for everyone. Yehuda Handelsman, M.D., medical director of the Metabolic Institute of America in Tarzana, California, says experts now recommend taking a patient-centered approach to managing A1C levels, which means evaluating goals based on individual diabetes management needs and personal and lifestyle preferences. Current ADA Goals The 2015 American Diabetes Association (ADA) Standards of Medical Care in Diabetes advise the following A1C levels: • 6.5 percent or less: This is a more stringent goal. Health care providers might suggest this for people who can achieve this goal without experiencing a lot of hypoglycemia episodes or other negative effects of having lower blood glucose levels. This may be people who have not had diabetes for many years (short duration); people with type 2 diabetes using lifestyle changes and/or a glucose-lowering medication that doesn’t cause hypoglycemia; younger adults with many years to live healthfully; and people with no significant heart and blood vessel disease. • 7 percent: This is a reasonable A1C goal for many adults with d Continue reading >>
What Level Of Blood Sugar Level Is Diabetic, 6.5 Or 7.0?
Physicians focus so much ondisease that we sometimes lose sight of whats healthy and normal. For instance, the American Diabetes Association defines tight control of diabetes to include sugar levels as high as 179 mg/dl (9.94 mmol/l) when measured two hours after a meal. In contrast, young adults without diabetes two hours after a meal are usually in the range of 90 to 110 mg/dl (5.006.11 mmol/l). Another way to consider normal and abnormal blood sugar levels is to look at a blood test called hemoglobin A1c, which is an indicator of average blood sugar readings over the prior three months. The average healthy non-diabetic adult hemoglobin A1c is 5% and translates into an average blood sugar of 100 mg/dl (5.56 mmol/l). This will vary a bit from lab to lab. Most healthy non-diabetics would be under 5.7%. A hemoglobin A1c of 7% is equivalent to average blood sugar levels of 160 mg/dl (8.89 mmol/l). Hemogobin A1c of 6% equals, roughly, average blood sugar levels of 130 mg/dl (7.22 mmol/l). But remember, healthy non-diabetics spend most of their day under 100 mg/dl (5.56 mmol/l) and have hemoglobin A1cs around 5%. Diabetic experts actively debate how tightly we should control blood sugar levels. For instance, Dr. Richard K. Bernsteina type 1 diabetic himselfrecommends keeping blood sugar levels under 90 mg/dl (5.00 mmol/l) almost all the time. If it exceeds 95 mg/dl (5.28 mmol/l) after a meal, then a change in medication or meal is in order, he says. My fasting sugar has never been below 100, and is rarely below 120. My blood sugar is always highest first thing in the morning and then goes down throughout the day. Im usually lower after meals than before meals. Mine is like that too. Its usually 100 to 110 in the morning. But lower during the day, usually less than 120 2 hou Continue reading >>
Prevalence Of Hemoglobin A1c Greater Than 6.5% And 7.0% Among Hospitalized Patients Without Known Diagnosis Of Diabetes At An Urban Inner City Hospital
Context: Bronx, New York, an urban county with a large low-income, immigrant and minority population, has a prevalence of diabetes that is among the highest in the United States. Objective: The aim of the study was to evaluate the utility of hemoglobin A1c (HbA1c) in identifying patients at risk for diabetes on an in-patient medical service of a hospital serving a high prevalence community. Design and Setting: We conducted a prospective cohort study at an urban public hospital. Patients: The study included 971 patients (1132 admissions) admitted to the general medicine service over 4 months. Main Outcome Measures: HbA1c was measured on all patients. Records were checked for prior diagnosis of diabetes and other clinical data. Follow-up data were obtained for those with repeat HbA1c testing or glucose within 1 yr after admission. Results: We found that 35.2% of the patients (n = 342) had an established diagnosis of diabetes. The remaining 629 patients defined the study cohort of patients without known diabetes. Mean HbA1c was 6.05 ± 0.87%. A total of 152 patients (24%) had admission HbA1c of at least 6.5% and 62 (9.9%) had HbA1c of at least 7.0%. Fifty-five patients with HbA1c of at least 6.5% had follow-up HbA1c within 1 yr. Of those, 44 (80.0%) met the criteria for diabetes as proposed by The International Expert Committee using repeated HbA1c testing. Conclusion: In communities with high prevalence of diabetes, a large percentage of patients without a diagnosis of diabetes who are admitted as in-patients have HbA1c of at least 6.5% and 7.0%. Hospital-based HbA1c testing might identify patients for whom further testing is indicated to make the diagnosis of diabetes. Context: Widespread thyroid hormone actions offer the possibility of developing selective thyromimetic Continue reading >>
Test Id: Hba1c Hemoglobin A1c, Blood
Evaluating the long-term control of blood glucose concentrations in diabetic patients Diagnosing diabetes Identifying patients at increased risk for diabetes (prediabetes) Diabetes mellitus is a chronic disorder associated with disturbances in carbohydrate, fat, and protein metabolism characterized by hyperglycemia. It is one of the most prevalent diseases, affecting approximately 24 million individuals in the United States. Long-term treatment of the disease emphasizes control of blood glucose levels to prevent the acute complications of ketosis and hyperglycemia. In addition, long-term complications such as retinopathy, neuropathy, nephropathy, and cardiovascular disease can be minimized if blood glucose levels are effectively controlled. Hemoglobin A1c (HbA1c) is a result of the nonenzymatic attachment of a hexose molecule to the N-terminal amino acid of the hemoglobin molecule. The attachment of the hexose molecule occurs continually over the entire life span of the erythrocyte and is dependent on blood glucose concentration and the duration of exposure of the erythrocyte to blood glucose. Therefore, the HbA1c level reflects the mean glucose concentration over the previous period (approximately 8-12 weeks, depending on the individual) and provides a much better indication of long-term glycemic control than blood and urinary glucose determinations. Diabetic patients with very high blood concentrations of glucose have from 2 to 3 times more HbA1c than normal individuals. Diagnosis of diabetes includes 1 of the following: -Fasting plasma glucose > or =126 mg/dL -Symptoms of hyperglycemia and random plasma glucose >or =200 mg/dL -Two-hour glucose > or =200 mg/dL during oral glucose tolerance test unless there is unequivocal hyperglycemia, confirmatory testing should be Continue reading >>
Clinical Use
Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. From the Executive Summary of the 2014 American Diabetes Association Clinical Practice Recommendations (Diabetes Care 2014;37,suppl.1:S5-13) Consider A1C targets as close to non-diabetic levels (< 6.5 percent) as possible without significant hypoglycemia in people with short duration of diabetes, little comorbidity, and long life expectancy. Consider less stringent A1C targets (e.g., 8 percent) for people with a history of severe hypoglycemia, limited life expectancy, extensive comorbid conditions, advanced complications, major impairments to self-management (e.g., visual, cognitive, social), or long-standing diabetes where the A1C goal is difficult to attain despite optimal efforts. Reassess A1C targets and change (lower or higher) as appropriate. From: National Diabetes Education Program website on Guiding Principles, When interpreting laboratory results health care providers should: be informed about the A1C assay methods used by their laboratory send blood samples for diagnosis to a laboratory that uses an NGSP-certified method for A1C analysis to ensure the results are standardized consider the possibility of interference in the A1C test when a result is above 15% or is at odds with other diabetes test results consider each patient’s profile, including risk factors and history, and individualize diagnosis and treatment decisions in discussion with the patient From: National Diabetes Information Clearinghouse (NDIC), Links to clinical guidelines from other organizations are listed below; the NGSP does not endorse specific guideli Continue reading >>
Criteria For Diagnosing Diabetes
Topic Overview To be diagnosed with diabetes, you must meet one of the following criteria:2 Have symptoms of diabetes (increased thirst, increased urination, and unexplained weight loss) and a blood sugar level equal to or greater than 11.1 millimoles per litre (mmol/L). The blood sugar test is done at any time, without regard for when you last ate (random plasma glucose test or random blood sugar test). Have a fasting blood sugar level that is equal to or greater than 7.0 mmol/L. A fasting blood sugar test (fasting plasma glucose) is done after not eating or drinking anything but water for 8 hours. Have a 2-hour oral glucose tolerance test (OGTT) result that is equal to or greater than 11.1 mmol/L. An OGTT is most commonly done to check for diabetes that occurs with pregnancy (gestational diabetes). Have a hemoglobin A1c that is 6.5% or higher. (This test is most reliable for adults. Some experts recommend using one of the other tests to diagnose diabetes in children.)1 Your doctor may repeat the test to confirm the diagnosis of diabetes. If the results of your fasting blood sugar test are between 6.1 to 6.9 mmol/L, your OGTT result is between 7.8 to 11.0 mmol/L (2 hours after the beginning of the test), or your hemoglobin A1c is 6.0% to 6.4%, you have prediabetes. This means that your blood sugar is above normal but not high enough to be diabetes. Discuss with your doctor how often you need to be tested.2 Continue reading >>
Is Type 2 Diabetes Reversible Or Curable?
One of the most frequently asked questions we receive is whether type 2 diabetes is reversible or curable. The answer is not a black and white “yes / no”, but more of a: “it depends”. Depends on what? To answer this question, it helps to look at the background of how type 2 diabetes develops in order to understand if it is reversible. The people at most risk of developing type 2 diabetes currently have ‘pre-diabetes’. If they don’t change, 70% of them will develop type 2 diabetes in their lifetime. What is staggering is that 1 in 3 people in the UK have pre-diabetes and do not know about it. So how is pre-diabetes defined? Pre-diabetes can be defined as “blood glucose concentrations higher than normal, but lower than that of type 2 diabetes itself”. In clinical terms, pre-diabetes is defined as having a glycated blood Haemoglobin A1c (HbA1c) level between 5.7-6.4%. HbA1c basically represents a 3 month average of your blood glucose levels. Higher HbA1c = higher average blood glucose levels. Once your HbA1c level is consistently above 6.5% you are officially considered to have type 2 diabetes by the World Health Organisation (note: type 2 diabetes can still be diagnosed with HbA1c levels below 6.5%). So, broadly speaking: HbA1c Levels Implication Reversible? 6.5% or higher Type 2 diabetes Depends 5.7-6.4% Pre-diabetes Reversible 5.6% or lower Healthy level N/A A question I was recently asked was: “Say you have an HbA1c level of 6.4% and are considered to have ‘reversible pre-diabetes’, but then it goes up by 0.1% to 6.5%, you are now are considered to have type 2 diabetes. Surely if you just lower it by 0.1% again you’re back to being OK and have reversed type 2 diabetes?” I think this question hits the nail on the head. Blood glucose is a cont Continue reading >>
A Practical Guide To A Healthy Body For People Living With Hiv
Normally, when we eat, our body converts food into glucose (sugar) and that glucose is then carried to cells throughout the body, providing our muscles, tissues and brain with the energy they need. If a person has too much blood glucose or blood sugar (a condition called hyperglycemia), it can eventually cause serious health problems. This is why it is so important to do as much as possible to avoid developing a blood sugar problem in the first place or, if you already have one, to take steps to manage it. Fortunately, diabetes can be controlled through eating well, exercise and medicine. Insulin is a hormone that your body needs to maintain the right level of glucose in your blood. When you don’t have enough insulin, or your body cannot use insulin properly, the amount of glucose in the blood becomes too high. This is called insulin resistance. When insulin resistance first develops, your body tries to compensate by producing more and more insulin. But eventually, these efforts are unsuccessful and sugar levels build up in the blood instead of being used by your cells for energy. This ongoing high blood sugar is the hallmark of type 2 diabetes. When a person has diabetes and their cells don’t get enough glucose, the cells cannot function properly. High blood glucose levels can also result in damage to the blood vessels in different parts of the body. Over time, this can lead to serious, and some potentially deadly, health problems—such as cardiovascular problems, kidney failure, blindness, nerve damage and digestive issues. These problems need advanced medical care. There are three types of diabetes: Gestational diabetes – diabetes that can develop during pregnancy. Type 1 diabetes – an autoimmune disease that typically develops during childhood. It occurs wh Continue reading >>
Your Good Health: Blood-sugar Tests Show It’s Time For Changes To Diet
Dear Dr. Roach: My A1c test on blood sugar is always higher (prediabetes) than my fasting glucose test (normal) on the same visit to the doctor. Which result should I believe? My latest test at a doctor’s office showed that my A1c is 6.2 per cent, and fasting glucose is 88 mg/dL. The A1c pretty much remained at 6.2 per cent level, while the fasting glucose varied between 81 and 88 in the past two years. The test is drawing a blood sample after a 12-hour overnight fast. I am not taking any diabetes medication. Previously, my A1c results were 5.9 per cent in August 2016 and 5.5 per cent in December 2016. K.H. Both the A1c test and the glucose tests are blood tests for diabetes. The blood glucose test is a snapshot of an instant in time, while the A1c is a measure of the average value over the past two or three months or so. The A1c looks at the amount of sugar molecules on the large hemoglobin protein of the blood. In general, the A1c is a better screening test for diabetes than a fasting glucose test, because fasting blood sugar is normal for a long time (potentially years) before one shows overt diabetes. In early Type 2 diabetes, the only time the blood sugar gets above normal is after eating (the blood sugar is supposed to go up a bit after eating, but in the early stages of diabetes, it goes higher than it should). The most sensitive test for Type 2 diabetes is a glucose tolerance test, where a fixed amount of sugar is given, and the blood is tested after two hours. An elevated level at two hours is prediabetes or diabetes. However, the A1c, which is affected by both fasting blood glucose levels and those after eating, is nearly as sensitive, and is much easier to do. Both the glucose tolerance test and the A1c usually will diagnose prediabetes and diabetes before Continue reading >>
