Diabetes Testing

Question 1

Who should be screened for diabetes?

Answer 1

BMI ≥ 25 + 1 or more risk factors. Without risk factors start to screen > 45 yrs. If normal (A1C < 5.7, FPG ≤ 100) retest in 3 years

Question 2

What stressors may release hormones that increase blood sugar?

Answer 2

surgery, infection, stroke, MI, emotional stress/anxiety

Question 3

What conditions might affect blood glucose?

Answer 3

Cushing’s syndrome, acromegaly, pheochromocytoma, glucagonoma, liver disease, pancreatitis

Question 4

What are the differences between fingerstick and plasma glucose tests?

Answer 4

Venous glucose levels may be higher than capillary levels for fasting samples and random testing. Venous levels lower than capillary
2 h after oral glucose load

Question 5

What is a hemoglobin A1C and its parameters?

Answer 5

Glucose irreversibly binds to the RBC and gives a 2-3 month average blood sugar. ≥ 6.5% Diabetes. 5.7-6.4% Abnormal. < 5.7% Normal

Question 6

What factors might cause an increase in hgb A1C?

Answer 6

iron deficiency, alcohol toxicity, lead toxicity, late pregnancy due to iron deficiency

Question 7

What factors might cause a decrease in hgb A1C?

Answer 7

hemolytic anemia, chronic blood loss, pregnancy, chronic renal failure

Question 8

How frequently should a diabetic’s A1C be checked?

Answer 8

At least twice yearly if meeting DM treatment goals. Test quarterly if previous medication change or not meeting treatment goals

Question 9

What is a fructosamine test?

Answer 9

serum sample that measures ketoamines and tells 1-2 weeks of average blood glucose control. rarely used

Question 10

When should you test for ketones in the urine?

Answer 10

pregnancy, elevated blood sugars >300, when suspicious for DKA

Question 11

With what conditions are ketones expected in the urine?

Answer 11

poorly controlled DM, DKA, starvation, poisoning, anesthesia, alkalosis

Question 12

What can cause false positive tests of ketonuria?

Answer 12

levodopa, phenazopyrine, valproic acid, Vit C, dehydration

Question 13

At what blood glucose levels is it common to find glucosuria?

Answer 13

blood glucose >160-180. leads to osmotic diuresis

Question 14

What levels of proteinuria are needed to diagnose albuminuria?

Answer 14

protein needs to be ≥300 mg to show up on a regular urine dipstick. microalbuminuria occurs when albumin excretion is 30-300 mg/g

Question 15

What is needed to confirm a diagnosis of diabetic nephropathy?

Answer 15

2 out of 3 samples that are abnormal within a 6 month period. screening begins 5 yrs of diagnosis of Type I, at time of diagnosis for type II, and then annually for both