diabetestalk.net

Lab Tests For Diabetes Patients

Test Id: Hba1c Hemoglobin A1c, Blood

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 >>

Laboratory Diagnosis Of Diabetes Mellitus

Laboratory Diagnosis Of Diabetes Mellitus

FoldUnfold Table of Contents OBJECTIVES KEY TERMS BACKGROUND AND SIGNIFICANCE CLASSIFICATION OF DIABETES MELLITUS (NATIONAL DIABETES DATA GROUP, AMERICAN DIABETES ASSOCIATION) Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) Gestation Diabetes/IGT Previous Abnormality of Glucose Tolerance Maturity Onset Diabetes of the Young (MODY) Hyperglycemia Associated with Certain Conditions or Syndromes TESTS IN THE DIAGNOSIS, CLASSIFICATION AND MANAGEMENT OF DIABETES MELLITUS Determination of Blood Glucose: Where, How and When Determination of Ketone Bodies Determination of Insulin and C-peptide Glycosuria Glycylated-Hemoglobin Glycated Proteins Proteinuria Anti-Insulin Antibodies CASE STUDIES Case 1 Case 2 Case 3 Case 4 OBJECTIVES By the end of this session the reader should be able to: Describe the regulation of blood glucose Understand the analysis of blood glucose Identify appropriate laboratory tests for the diagnosis of diabetes Describe the major laboratory findings in diabetes mellitus type I Describe the major clinical findings in diabetes mellitus type I Describe the major laboratory findings in diabetes mellitus type II Describe the major clinical findings in diabetes mellitus type II Describe the differences between type 1 and type 2 diabetes mellitus Describe the laboratory and clinical findings in impaired glucose tolerance Discuss maturity onset diabetes of the young Discuss the hormonal regulation of blood glucose levels, noting what causes a decrease in concentrations and what causes an increase in concentrations Describe non-diabetic conditions in which hyperglycemia is noted Discuss appropriate sample collection for measurement of serum/plasma glucose Discuss the performance of the glucose tol Continue reading >>

Diabetes Mellitus: Diagnosis And Screening

Diabetes Mellitus: Diagnosis And Screening

Based on etiology, diabetes is classified as type 1 diabetes mellitus, type 2 diabetes mellitus, latent autoimmune diabetes, maturity-onset diabetes of youth, and miscellaneous causes. The diagnosis is based on measurement of A1C level, fasting or random blood glucose level, or oral glucose tolerance testing. Although there are conflicting guidelines, most agree that patients with hypertension or hyperlipidemia should be screened for diabetes. Diabetes risk calculators have a high negative predictive value and help define patients who are unlikely to have diabetes. Tests that may help establish the type of diabetes or the continued need for insulin include those reflective of beta cell function, such as C peptide levels, and markers of immune-mediated beta cell destruction (e.g., autoantibodies to islet cells, insulin, glutamic acid decarboxylase, tyrosine phosphatase [IA-2α and IA-2β]). Antibody testing is limited by availability, cost, and predictive value. Prevention, timely diagnosis, and treatment are important in patients with diabetes mellitus. Many of the complications associated with diabetes, such as nephropathy, retinopathy, neuropathy, cardiovascular disease, stroke, and death, can be delayed or prevented with appropriate treatment of elevated blood pressure, lipids, and blood glucose.1–4 In 1997, the American Diabetes Association (ADA) introduced an etiologically based classification system and diagnostic criteria for diabetes,5 which were updated in 2010.1 Type 2 diabetes accounts for approximately 90 to 95 percent of all persons with diabetes in the United States, and its prevalence is increasing in adults worldwide.6 With the rise in childhood obesity, type 2 diabetes is increasingly being diagnosed in children and adolescents.6 Clinical recommendati Continue reading >>

8 Important Diabetes Tests To Get Regularly

8 Important Diabetes Tests To Get Regularly

Type 2 diabetes can affect every part of your body, from your eyes to your feet. A critical part of managing diabetes is getting routine tests and checkups that can spot problems early to help prevent complications. “Too often, if someone isn’t seeing the same doctor routinely, these important tests can get overlooked,” says Diana Aby-Daniel, PA-C, a physician assistant at the Harold Schnitzer Diabetes Health Center at Oregon Health & Science University in Portland. “Many diabetes complications are preventable if they’re found early with one of these routine tests.” The following eight diabetes exams and tests will help you get the health care you need: 1. A1C test. This key blood test measures your average blood sugar levels over the previous two or three months, which lets your doctor know how well your blood sugar is being controlled. You should get this test twice a year, if not more often, according to the American Diabetes Association (ADA). “Try to get your A1C results below or as close to 7 percent as possible,” says George L. King, MD, director of research and head of the section on vascular cell biology at Joslin Diabetes Center and professor of medicine at Harvard Medical School in Boston. Talk to your doctor about the A1C goal that’s right for you. You can get this test through your primary care doctor. 2. Blood pressure checks. Diabetes makes you more likely to have high blood pressure, which can put you at increased risk for stroke and heart attack. Have your blood pressure checked every time you see your primary care doctor, Dr. King says. 3. Cholesterol test. Because having diabetes increases your risk of heart disease, it’s important to have a blood test to check your cholesterol as part of your annual exam or more frequently if your Continue reading >>

Guidelines And Recommendations For Laboratory Analysis In The Diagnosis And Management Of Diabetes Mellitus

Guidelines And Recommendations For Laboratory Analysis In The Diagnosis And Management Of Diabetes Mellitus

Diabetes mellitus is a group of metabolic disorders of carbohydrate metabolism in which glucose is underutilized and overproduced, causing hyperglycemia. The disease is classified into several categories. The revised classification, published in 1997 (1), is presented in Table 1. Type 1 diabetes mellitus, formerly known as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes mellitus, is usually caused by autoimmune destruction of the pancreatic islet β-cells, rendering the pancreas unable to synthesize and secrete insulin (2). Type 2 diabetes mellitus, formerly known as non-IDDM or adult-onset diabetes, is caused by a combination of insulin resistance and inadequate insulin secretion (3,4). Gestational diabetes mellitus (GDM), which resembles type 2 diabetes more than type 1, develops during approximately 7% (range, 5%–15%) of pregnancies, usually remits after delivery, and constitutes a major risk factor for the development of type 2 diabetes later in life. Other types of diabetes are rare. Type 2 is the most common form, accounting for 85%–95% of diabetes in developed countries. Some patients cannot be clearly classified as type 1 or type 2 diabetes (5). Diabetes is a common disease. The current worldwide prevalence is estimated to be approximately 250 x 106, and it is expected to reach 380 x 106 by 2025 (6). The prevalence of diabetes [based on fasting plasma glucose (FPG) results] in U.S. adults in 1999–2002 was 9.3%, of which 30% of the cases were undiagnosed (7). The most recent data, which were derived from the 2005–2006 National Health and Nutrition Examination Survey (NHANES) with both FPG and 2-h oral glucose tolerance test (OGTT) results, show a prevalence of diabetes in U.S. persons ≥20 years old of 12.9% (approximately 40 x 106) Continue reading >>

3 Diabetes Tests You Must Have

3 Diabetes Tests You Must Have

Mike Ellis was fly fishing when he first noticed a change in his vision. Ellis, an avid angler, had so much trouble focusing he struggled for 20 minutes before he was finally able to get a fly on his hook, something he'd done countless times over many years of fly fishing. Then, after casting his line, he was unable to see his lure on the water. "I thought I'd scorched my eyeballs from being out in the sun too much," says Ellis, 63, a retired mechanical engineer in Denver. An eye exam the following month revealed an equally unsettling reality: Ellis had type 2 diabetes, the most common type of the disease. Years of going undiagnosed had taken a toll on his eyesight. He had diabetic retinopathy. The blood vessels in the back of his eye were damaged, a problem that often comes with the condition. "Diabetes damages every blood vessel in your body, including the ones in your eyes," says Robert Rizza, MD, professor of medicine at the Mayo Clinic. "Similar damage can also occur in your heart, your head, and your kidneys. But if you take care of yourself -- if you control your blood sugar, blood cholesterol, and blood pressure -- the chances of bad things happening to you are very low." Certainly, that's the case with Ellis. With the help of three basic tests, he has his diabetes in check. These tests can help you, too. A simple blood test, the A1c (your doctor may call it "glycosylated hemoglobin") is done on a sample of blood taken from a finger-stick or from a small vial of it drawn from your arm. Not to be confused with the daily at-home monitoring that allows some people with diabetes to measure their blood sugars in the moment, the A1c test paints a picture of your average blood sugar level for the past 3 months. If you can keep your hemoglobin A1c in the range of about Continue reading >>

Type 1 Diabetes Mellitus Workup

Type 1 Diabetes Mellitus Workup

Laboratory Studies Plasma glucose Patients with type 1 diabetes mellitus (DM) typically present with symptoms of uncontrolled hyperglycemia (eg, polyuria, polydipsia, polyphagia). In such cases, the diagnosis of DM can be confirmed with a random (nonfasting) plasma glucose concentration of 200 mg/dL or a fasting plasma glucose concentration of 126 mg/dL (6.99 mmol/L) or higher. [2, 62] A fingerstick glucose test is appropriate in the emergency department (ED) for virtually all patients with diabetes. All fingerstick capillary glucose levels must be confirmed in serum or plasma to make the diagnosis. All other laboratory studies should be selected or omitted on the basis of the individual clinical situation. Intravenous (IV) glucose testing may be considered for possible early detection of subclinical diabetes. Individually measured glucose levels may differ considerably from estimated glucose averages calculated from measured hemoglobin A1c (HbA1c) levels. [64] Therefore, caution is urged when the decision is made to estimate rather than actually measure glucose concentration; the difference between the 2 has a potential impact on decision making. Hemoglobin A HbA1c is the stable product of nonenzymatic irreversible glycation of the beta chain of hemoglobin by plasma glucose and is formed at rates that increase with increasing plasma glucose levels. HbA1c levels provide an estimate of plasma glucose levels during the preceding 1-3 months. The reference range for nondiabetic people is 6% in most laboratories. Glycated hemoglobin levels also predict the progression of diabetic microvascular complications. American Diabetes Association (ADA) guidelines recommend measuring HbA1c at least every 6 months in patients with diabetes who are meeting treatment goals an Continue reading >>

4 Lab Tests For Diabetes

4 Lab Tests For Diabetes

Four blood tests are available to diagnose prediabetes and diabetes: • Fasting plasma glucose (FPG) • Oral glucose tolerance test (OGTT) • Hemoglobin A1c (A1c) test • Random plasma (blood) glucose To make a diagnosis, the results of each test must be confirmed by repeat testing on a different day, unless you have obvious symptoms of elevated blood glucose (hyperglycemia). If diabetes is diagnosed, you’ll need periodic A1c tests to monitor your blood glucose control. 1. Fasting plasma glucose (FPG) test The fasting plasma glucose test is the preferred method for diagnosing diabetes in children, men, and nonpregnant women. The test measures blood glucose levels after an overnight fast (no food intake for at least eight hours). A diagnosis of diabetes is made when the fasting blood glucose level is 126 mg/dL or higher on at least two tests. Values of 100 to 125 mg/dL indicate prediabetes. A normal fasting blood glucose level is less than 100 mg/dL. 2. Oral glucose tolerance test (OGTT) This test is done when diabetes is suspected, but you have normal results on a fasting plasma glucose test. For the test, you’ll have to fast overnight and then drink a very sweet solution containing 75 g of glucose. A sample of your blood will be drawn two hours later. Normal glucose levels are less than 140 mg/dL at two hours. The criterion for a diagnosis of diabetes with this test is a two-hour blood glucose level of 200 mg/dL or higher. Prediabetes is diagnosed if the blood glucose level at two hours is 140 to 199 mg/dL. 3. Hemoglobin A1c (A1c) test This blood test measures the amount of glucose attached to hemoglobin—the oxygen-carrying protein in red blood cells that gives blood its color. The A1c test was originally used to monitor glucose levels in people already diagn Continue reading >>

Blood Tests For Diabetes: Oral Glucose Tolerance Test

Blood Tests For Diabetes: Oral Glucose Tolerance Test

Also known as: OGTT; 2-hour glucose tolerance test. What is it? A test that measures blood glucose levels before and 2 hours after you drink an oral dose of glucose solution (75 to 100 grams of an extremely sweet drink), which should cause glucose levels to rise in the first hour, then fall back to normal within two hours as the body produces insulin to normalize glucose levels. Test results show how well your body is able to process glucose. Why is this test performed? To confirm a diagnosis of diabetes or gestational diabetes (and to diagnose other metabolic diseases). Because the OGTT is a more sensitive test than the fasting plasma glucose test, and involves multiple blood draws to monitor insulin production, it can often detect cases of diabetes that may be missed by the fasting test. How is the oral glucose tolerance test performed? The OGTT is typically performed in the morning, after you’ve fasted for at least eight hours. Your blood will be drawn to measure your fasting blood sugar level. You will then be given the sugary solution to drink, and your blood sugar levels will be tested periodically over the next two hours. How frequently should this test be performed? Once, in select individuals, for diagnosis of diabetes. A second retest may be appropriate in some patients, particularly pregnant women being tested for gestational diabetes. Additional laboratory tests may be required for an accurate diagnosis. What is the “normal” range for results? While laboratory test methods and measurements can vary for this test, normal OGTT results in those who are not pregnant are as follows: Fasting: 60 mg/dl to 99 mg/dl (3.3 mmol/l to 5.5 mmol/l) 1 hour: Less than 200 mg/dl (11.1 mmol/l) 2 hours: Less than 140 mg/dl (7.8 mmol/l) Factors such as age, weight, and rac Continue reading >>

Role Of Laboratory Tests In Diabetes Mellitus Featured

Role Of Laboratory Tests In Diabetes Mellitus Featured

Diagnosis of DM Screening of DM Assessment of glycemic control Assessment of associated long-term risks Management of acute metabolic complications. LABORATORY TESTS FOR DIAGNOSIS OF DIABETES MELLITUS Chemical methods: – Orthotoluidine method – Blood glucose reduction methods using neocuproine, ferricyanide, or copper. Enzymatic methods: These are specific for glucose. – Glucose oxidase-peroxidase – Hexokinase – Glucose dehydrogenase Fasting blood glucose: Sample for blood glucose is withdrawn after an overnight fast (no caloric intake for at least 8 hours). Post meal or postprandial blood glucose: Blood sample for glucose estimation is collected 2 hours after the subject has taken a normal meal. Random blood glucose: Blood sample is collected at any time of the day, without attention to the time of last food intake. Patient should be put on a carbohydrate-rich, unrestricted diet for 3 days. This is because carbohydrate-restricted diet reduces glucose tolerance. Patient should be ambulatory with normal physical activity. Absolute bed rest for a few days impairs glucose tolerance. Medications should be discontinued on the day of testing. Exercise, smoking, and tea or coffee are not allowed during the test period. Patient should remain seated. OGTT is carried out in the morning after patient has fasted overnight for 8-14 hours. A fasting venous blood sample is collected in the morning. Patient ingests 75 g of anhydrous glucose in 250-300 ml of water over 5 minutes. (For children, the dose is 1.75 g of glucose per kg of body weight up to maximum 75 g of glucose). Time of starting glucose drink is taken as 0 hour. A single venous blood sample is collected 2 hours after the glucose load. (Previously, blood samples were collected at ½, 1, 1½, and 2 hours, which is Continue reading >>

Diabetes Urine Tests

Diabetes Urine Tests

Urine tests may be done in people with diabetes to evaluate severe hyperglycemia (severe high blood sugar) by looking for ketones in the urine. Ketones are a metabolic product produced when fat is metabolized. Ketones increase when there is insufficient insulin to use glucose for energy. Urine tests are also done to look for the presence of protein in the urine, which is a sign of kidney damage. Urine glucose measurements are less reliable than blood glucose measurements and are not used to diagnose diabetes or evaluate treatment for diabetes. They may be used for screening purposes. Testing for ketones is most common in people with type 1 diabetes. Type 1 Diabetes: What Are The Symptoms? This test detects the presence of ketones, which are byproducts of metabolism that form in the presence of severe hyperglycemia (elevated blood sugar). Ketones are formed from fat that is burned by the body when there is insufficient insulin to allow glucose to be used for fuel. When ketones build up to high levels, ketoacidosis (a serious and life-threatening condition) may occur. Ketone testing can be performed both at home and in the clinical laboratory. Ketones can be detected by dipping a test strip into a sample of urine. A color change on the test strip signals the presence of ketones in the urine. Ketones occur most commonly in people with type 1 diabetes, but uncommonly, people with type 2 diabetes may test positive for ketones. The microalbumin test detects microalbumin, a type of protein, in the urine. Protein is present in the urine when there is damage to the kidneys. Since the damage to blood vessels that occurs as a complication of diabetes can lead to kidney problems, the microalbumin test is done to check for damage to the kidneys over time. Can urine tests be used to Continue reading >>

Laboratory Tests For Diagnosis And Management Of Diabetes

Laboratory Tests For Diagnosis And Management Of Diabetes

Tests that measure the levels of glucose in blood and urine are essential to the diagnosis and management of diabetes mellitus. Because blood glucose levels are affected by several factors, proper patient and sample preparation are important. Early diagnosis and control of diabetes can help reduce patient morbidity and mortality. Diabetes mellitus is a chronic metabolic disorder characterized by persistently high blood glucose levels (hyperglycemia). It may be congenital or acquired. In small animals, the acquired form is more common and usually occurs in middle-aged dogs and cats. Regardless of the etiology, patients with diabetes mellitus have excess glucose in their blood and low levels of glucose in most body cells. Patients receiving insulin for diabetes require periodic testing to monitor disease progression and to evaluate the effectiveness of therapy and client compliance. Diabetes mellitus is usually diagnosed based on the patient's history and clinical signs and the results of several blood and urine tests. Numerous conditions, including pancreatic trauma, neoplasia, and infection, may contribute to the onset of the disease (SEE BOX).1 Common clinical signs of diabetes mellitus include polydipsia, polyuria, and polyphagia. Weight loss, restlessness, ataxia, disorientation, and weakness may also occur. Patients that develop ketoacidosis may present with tachycardia, seizures, and Kussmaul's respiration (rapid, deep, labored breathing). Most tests used in the diagnosis of diabetes measure the level of glucose in the patient's blood. Normal blood glucose levels vary among species, but individual healthy animals tend to have relatively stable glucose levels because the body's normal homeostatic mechanisms, such as insulin release, maintain glucose within a very na Continue reading >>

Beyond Blood Sugar: Diabetes Monitoring In The Clinical Lab

Beyond Blood Sugar: Diabetes Monitoring In The Clinical Lab

Did you know that 1 in 11 Americans today has diabetes? Despite its prevalence, diabetes is an invisible disease. It affects men and women, people young and old, and people of all races, shapes and sizes. Often there are no outward signs from the 29 million Americans who fight this chronic illness every day. That’s why there is a critical need to foster awareness and education while breaking down stereotypes, myths and misunderstandings about this growing public health crisis that affects so many of us. The clinical laboratory’s critical role in Diabetes monitoring Blood sugar (glucose) monitoring is perhaps the most obvious way that lab testing matters to the diagnosis and ongoing care of diabetic patients. While “point-of-care” home glucose test strips do indeed help patients to better manage their disorder between medical appointments, physicians still rely on the clinical laboratory for a more detailed picture of a patient’s metabolic state. November is American Diabetes Month, established by the American Diabetes Association as a way to bring attention to the tens of millions of Americans living with diabetes. Nearly 10% of Americans have diabetes, and this number is growing as the population ages. Obesity is also a known risk factor for developing diabetes, which means that the disorder also affects a large number of overweight young adults and teens. Once diagnosed, diabetic patients must learn to maintain a healthy blood sugar through exercise, diet, and medication. Long-term high blood sugar (hyperglycemia) is associated with higher risk of complications of diabetes, so keeping track of a patient’s glycemic control is very important. Persistent hyperglycemia is correlated with kidney failure, peripheral vascular disease, retinopathy, and fatty liver Continue reading >>

Diabetes - Tests And Checkups

Diabetes - Tests And Checkups

See your diabetes doctor for an exam every 3 to 6 months. During this exam, your doctor should check your: Blood pressure Weight Feet See your dentist every 6 months, also. Your doctor should check the pulses in your feet and your reflexes at least once a year. Your doctor should also look for: If you have had foot ulcers before, see your doctor every 3 to 6 months. It is always a good idea to ask your doctor to check your feet. An A1c lab test shows how well you are controlling your blood sugar levels over a 3-month period. The normal level is less than 5.7%. Most people with diabetes should aim for an A1C of less than 7%. Some people have a higher target. Your doctor will help decide what your target should be. Higher A1C numbers mean that your blood sugar is higher and that you may be more likely to have complications from your diabetes. Continue reading >>

Diabetes

Diabetes

Note: This article addresses diabetes mellitus, not diabetes insipidus. Although the two share the same reference term "diabetes" (which means increased urine production), diabetes insipidus is much rarer and has a different underlying cause. Diabetes mellitus is a condition in which the level of glucose (sugar) in an individual's blood becomes too high because the body cannot use it properly. This results either from an... Continue reading >>

More in diabetes