Diabetes Testing

Question 1

What are the screening guideline levels for A1C, fasting plasma glucose, and casual plasma glucose?

Answer 1

A1C - >6.5% is DIABETIC 
Fasting Plasma Glucose:  >126mg/dL
          Impaired is 100-126
Casual Plasma Glucose:  >200mg/dL
w/ Polyuria, polydipsia, Unexplained weight loss

Question 2

How long should a typical fasting plasma glucose be at a MINIMUM?

Answer 2

8 hours

Question 3

What is a normal Fasting Glucose?

Answer 3

70-100mg/dL

126 or above is diagnostic for DM

Question 4

What is considered a normal lab value for a Random glucose?

Answer 4

<140mg/dL is normal

>200mg/dL is ABNORMAL

Question 5

Glucose tolerance tests though are not commonly used any more; may be useful in Dx what?

Answer 5

Gestational Diabetes

Question 6

How many times should you order a HgB A1C for your patients if they have Type 1 or Type 2 Diabetes and use insulin?

What if your PT is Type 2 and not using insulin?

Answer 6

4x a year

2x a year

Question 7

What conditions can impact the A1C diagnostic ability by providing FALSELY LOW LEVELS?

What could lead to FALSELY HIGH LEVELS?

Answer 7

Sickle Cell
Hemolysis / Heavy bleeding (menstruation)

Iron deficiency
(also elevated in alcoholics, lead tox, and hypertriglyceridemia)

Question 8

If you order a Creatinine for your PT and it comes back elevated; what are some potential causes?

Answer 8

Glomerulonephritis –> vessel swelling / damage to vessels of the kidney

Pyelonephritis –> infxn of the kidney

Acute tubular necrosis

Prostate Dz or Nephrolithiasis

Reduced blood flow to the kidneys –> COMPLICATIONS OF DIABETES, CHF, or dehydration

Question 9

What is most accurate microalbumin test to order?

What is a normal reference value of microalbumin / Creatinine ratio for a PT?

Answer 9

24-hour urine test

<30mcg of albumin/mg creatinine