Many Ways Evaluating Fitness Concerns
Diagnosis And Assessment of Diabetes
There are three primary blood tests used to diagnose diabetes. These tests require a laboratory measurement of plasma glucose concentration on a venous sample with enzymatic assay techniques. All test results are reported as milligrams per deciliter (mg/dl).
Fasting Plasma Glucose (FPG)
This test checks the amount of glucose in the blood stream, and requires at least an eight hour fast. A normal value is less than 110 mg/dl. A value of 126 mg/dl or more is considered diabetes, and requires a retest on another day. If the value is less than 126, but the medical provider suspects diabetes, an oral glucose tolerance test is performed.
75-g Oral Glucose Tolerance Test (OGTT)
This test measures how well the body deals with a dose of sugar. Normal blood sugar rises after eating, and comes back down to a normal level in an hour or two. With diabetics, the blood sugar stays elevated after two hours. This test is performed after overnight fasting, after at least three days of an unrestricted diet, and after unlimited physical activity. First, a fasting glucose level is taken. Then, the patient drinks a glucose load containing the equivalent of a 75-g anhydrous glucose dissolved in water. During the next two to three hours, blood tests are taken every 30 minutes to one hour. Plasma glucose at two hours after drinking the glucose load of less than 140 mg/dl is considered normal. A value of 200 mg/dl or more is considered diabetes, and indicates the need for a retest on a different day.
Casual Plasma Glucose (CPG)
This test is also known as “random plasma glucose”, and does not require fasting. The test checks the amount of glucose in the patient’s bloodstream, but without regard to when the person last ate or drank. Normal value is less than 140 mg/dl. A value of 200 mg/dl or more with diabetic symptoms indicates a diabetes diagnosis, and also requires retesting on another day.
Any of these three methods can be used in a retest to confirm a diabetes diagnosis. However, the fasting plasma glucose (FPG) is preferred, as it is faster to perform, less expensive, and generally more acceptable to patients.
A FPG value of 110 mg/dl or more but less than 126 mg/dl is all not high enough for a diagnoses of diabetes, but is too high to be considered healthy. This condition is called “impaired fasting glucose” or “impaired glucose tolerance”, and affects 21 million Americans, of which 40% may eventually get Type 2 diabetes.
Self Monitoring of Blood Glucose
In the past, urine tests were the only way to check diabetes control at home and were not very accurate. Urine tests cannot tell the exact blood sugar level, and they cannot tell low blood sugar levels. They can only tell whether there has been excessive sugar in the blood at some time since last emptying the bladder.
Self monitoring of blood glucose is considered by many to be the greatest innovation in diabetes. It allows patients to take control of the disease, since everything they do and everything that happens to them affects their blood sugar. The two methods of self-monitoring are meter testing and visual testing.
There are many different types of testing meters available. A strip with a drop of blood, usually from the fingertip, is inserted into the meter to obtain the blood glucose level. This method of testing provides an exact reading of the blood sugar level.
Visual testing is done with a strip having a soft chemically treated pad. When a drop of blood is placed on the pad, chemicals cause the pad to change color when it comes in contact with sugar. The strip is then compared to a color chart to identify the amount of blood sugar.
Variation in blood glucose readings is normal for someone with diabetes. Some meters and strips measure plasma glucose, while others measure blood glucose. It is obviously important for the diabetic to know which type of glucose is being measured.
Patients are encouraged to keep a record of their blood glucose levels and other information, like their diet and exercise, which may cause changes in their blood glucose levels. This information helps the doctor assess the effectiveness of the therapy and make any needed adjustments to treatment.
Recommendations for self-monitoring include the following:
— all insulin patients should test.
— Type 1 diabetics should test at least three times a day.
— all patients not achieving blood glucose goals should test.
— both Type 1 and 2 patients should test more often than usual when modifying therapy.
Unfortunately, data indicates that only a minority of patients perform self-monitoring of their blood glucose levels. Barriers to self testing are thought to include the cost of the testing, physical discomforts associated with the testing, inadequate understanding about the health benefits, and the general inconvenience of doing such testing (the time involved and complexity of technique).
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