Diabetic profile 1

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DIAB

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Diabetes mellitus is a condition in which the level of glucose (sugar) in blood becomes too high because the body cannot use it properly. This results either from an inability to produce insulin or because the body has become resistant to the insulin produced. About 2.8 million people in the United Kingdom (4.45% of the population) are known to have diabetes and a further ¾ million may have the condition and not know it.


Insulin is a hormone, produced by the pancreas, which controls the movement of glucose into most of the body’s cells and maintains blood glucose levels within a narrow concentration range. Most tissues in the body rely on glucose for energy production, and all but a few are entirely reliant on insulin to deliver this essential fuel. Diabetes disrupts the normal balance between insulin and glucose.


This profile measures levels of Glucose and Glycated Haemoglobin in a blood sample.

About

Diabetes is a group of metabolic disorders defined by an inability to produce or respond to the hormone insulin, resulting in elevated blood glucose levels. While the bodily processes that lead to different types of diabetes are distinct, most of the tests used to diagnose diabetes do not specify which type is present and can be used interchangeably. The main tests used to diagnose diabetes are the fasting plasma glucose test, the oral glucose tolerance test, and the HbA1c test.


A fasting plasma glucose test is simply a blood glucose test that is conducted when the person has not had any caloric intake for at least eight hours. Using this test, diabetes is defined as a blood glucose level of 126 mg/dl (milligrams per deciliter) or higher. A level between 100 and 125 mg/dl indicates prediabetes, while a level between 70 and 99 mg/dl is considered “normal.” Since conditions other than diabetes (including stress) may elevate blood glucose levels temporarily, a doctor may order a repeat test or a different type of test if the results of a person’s fasting plasma glucose test are borderline or are high in the absence of diabetes symptoms.


The oral glucose tolerance test is more complicated and is used less frequently for diagnosis than the fasting plasma glucose test. For this test, the person drinks a solution containing 75 grams of glucose. Two hours later, a blood glucose level of 200 mg/dl or higher indicates diabetes.


While the HbA1c (haemoglobin A1c, or glycated haemoglobin) test has long been used to evaluate long-term blood glucose control in people with known diabetes, only in 2010 was it approved as a diagnostic test by the American Diabetes Association. An HbA1c level of 6.5% or higher indicates diabetes when the test is used for diagnosis. If a blood glucose reading is like a snapshot, indicating the glucose level at the time of the test, an HbA1c result is like a long-exposure photograph, giving an estimate of the average blood glucose level over the past two to three months.

Preparation

Fasting is recommended.

Indications

  • Evaluating the long-term control of blood glucose concentrations in diabetic patients
  • Diagnosing diabetes
  • Identifying patients at increased risk for diabetes (prediabetes)

Interpretation

With no symptoms diagnosis should not be based on a single glucose determination but requires confirmatory plasma venous determination. At least one additional glucose test result on another day with a value in the diabetic range is essential, either fasting, from a random sample or from the two hour post glucose load. If the fasting random values are not diagnostic the two hour value should be used.


An HbA1c of 48mmol/mol (6.5%) is recommended as the cut off point for diagnosing diabetes. A value of less than 48mmol/mol (6.5%) does not exclude diabetes diagnosed using glucose tests.


Finger-prick HbA1c should not be used unless the methodology and the healthcare staff and facility using it can demonstrate within the national quality assurance scheme that they match the quality assurance results found in laboratories. Finger prick tests must be confirmed by laboratory venous HbA1c in all patients.


In patients without symptoms of diabetes the laboratory venous HbA1c should be repeated. If the second sample is <48mmol/mol (6.5%) the person should be treated as at high risk of diabetes and the test should be repeated in 6 months or sooner if symptoms develop.


The criteria for diagnosing gestational diabetes is different. Gestational diabetes should be diagnosed if the woman has either:
  • a fasting plasma glucose level of 5.6mmol/l or above or
  • a 2-hour plasma glucose level of 7.8mmol/l or above.

Disclaimer

The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario. Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

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