Blood Sugar Tests

Blood Sugar Tests 

Definition

Blood sugar tests include several different tests that measure the amount of sugar (glucose) in a person's blood. These tests are performed either on an empty stomach, or after consuming a meal or pre-measured glucose drink. Blood sugar tests are done primarily to diagnose and evaluate a person with diabetes mellitus.

Purpose

The body uses sugar, also called glucose, to supply the energy it needs to function. People get sugar from their diet and from their body tissues. Insulin is made by the pancreas and affects the outer membrane of cells, making it easy for glucose to move from the blood into the cells. When insulin is active, blood glucose levels fall. Sugar from body tissues is stored in the form of glycogen. When glycogen is active, blood glucose levels rise.

After a meal, blood glucose levels rise sharply. The pancreas responds by releasing enough insulin to take care of all the newly added sugar found in the body. The insulin moves the sugar out of the blood and into the cells. Only then does the blood sugar start to level off and begin to fall. A person with diabetes mellitus either does not make enough insulin, or makes insulin that does not work properly. The result is blood sugar that remains high, a condition called hyperglycemia.

Diabetes must be diagnosed as early as possible. If left untreated, it can damage or cause failure of the eyes, kidneys, nerves, heart, blood vessels, and other body organs. Hypoglycemia, or low blood sugar, also may be discovered through blood sugar testing. Hypoglycemia is caused by various hormone disorders and liver disease, as well as by too much insulin.

Description

There are a variety of ways to measure a person's blood sugar.

Whole blood glucose test

Whole blood glucose testing can be performed by a person in his or her home, and kits are available for this purpose. The person pricks his or her finger (a finger stick) with a sterile sharp blade from the kit. A single drop of blood is placed on a strip in a portable instrument called a glucometer. The glucometer quickly determines the blood sugar and shows the results on a small screen in usually a few seconds.

New technologies for monitoring glucose levels will help diabetics better control their glucose levels. These tests are particularly important for children and adolescents. In mid-2002, the U.S. Food and Drug Administration (FDA) approved a new home test for use by children and adolescents (it had already been approved for adults) called the Cygnus GlucoWatch biographer that helped better detect hypoglycemia. Studies show that more frequent checks are better; new monitors such as this allow for simpler frequent testing. Continuous monitoring was in development in early 2004, as a company called TheraSense, Inc. received preapproval from the FDA for clinical trials on its home continuous glucose monitor. The monitor was designed to provide users with real-time glucose data, alarms for hypoglycemia and hyperglycemia and to show trends in their blood sugar levels.

Fasting plasma glucose test

The fasting plasma glucose test is done on an empty stomach. For the eight hours before the test, the person must fast (nothing to eat or drink, except water). The person's blood is drawn from a vein by a health care worker. The blood sample is collected into a tube containing an anticoagulant. Anticoagulants stop the blood from clotting. In the laboratory, the tube of blood spins at high speed within a machine called a centrifuge. The blood cells sink to the bottom and the liquid stays on the top. This straw-colored liquid on the top is the plasma. To measure the glucose, a person's plasma is combined with other substances. From the resulting reaction, the amount of glucose in the plasma is determined.

Oral glucose tolerance test

The oral glucose tolerance test is conducted to see how well the body handles a standard amount of glucose. This test measures the amount of glucose in a person's plasma before and two hours after drinking a large premeasured beverage containing glucose. The person must eat a consistent diet, containing at least 5.25 oz (150g) of carbohydrates each day, for three days before this test. For eight hours before the test, the person must fast. A health care provider draws the first sample of blood at the end of the fast to determine the glucose level at the start of the test. The health care provider then gives the person a beverage containing 2.6oz (75g) of glucose. Two hours later, the person's blood is drawn again. These blood samples are centrifuged and processed in the laboratory. A doctor can then compare the before and after glucose levels to see how well the patient's body processed the sugar.

Two-hour postprandial blood glucose test

The two-hour postprandial blood glucose test measures the amount of glucose in plasma after a person eats a specific meal containing a certain amount of sugar. Although the meal follows a predetermined menu, it is difficult to control many factors associated with this testing method.

Blood sugar tests can be used in a variety of situations including:

• Testing people suspected for diabetes. The American Diabetic Association (ADA) recommends that either a fasting plasma glucose test or an oral glucose tolerance test be used to diagnose diabetes. If the person already has symptoms of diabetes, a blood glucose test without fasting (called a casual plasma glucose test) may be done. If the test result is abnormal, it must be confirmed with another test performed on another day. The two tests can be different or they can be the same, but they must be done on different days. If the second test also is abnormal, the person has diabetes. A two-hour postprandial test is not recommended by the ADA as a test to use for the diagnosis of diabetes. A doctor may order this test, and follow it with the oral glucose tolerance test or the fasting plasma glucose test if the results are abnormal.
• Testing pregnant women. Diabetes that occurs during pregnancy (gestational diabetes) is dangerous for both the mother and the baby. Women who may be at risk are screened when they are 24-28 weeks pregnant. A woman is considered at risk if she is older than 25 years, is not at her normal body weight, has a parent or sibling with diabetes, or if she is in an ethnic group that has a high rate of diabetes (Hispanics, Native Americans, Asians, African Americans). The blood sugar test to screen for gestational diabetes is a variation of the oral glucose tolerance test. Fasting is not required. If the result is abnormal, a more complete test is done on another day.
• Testing healthy people. Healthy people without symptoms of diabetes should be screened for diabetes when they are 45 years old and again every three years. Either the fasting plasma glucose or oral glucose tolerance test is used for screening. People in high risk groups should be tested before the age of 45 and tested more frequently.
• Testing of people already diagnosed with diabetes. The ADA recommends that a person with diabetes keep the amount of glucose in the blood at a normal level as much as possible. This can be done by the diabetic person testing his or her own blood at home one or more times a day.

Preparation

Each blood sugar test that uses plasma requires a 5 mL blood sample. A healthcare worker ties a tight band (tourniquet) on the person's upper arm, locates a vein in the inner elbow region, and inserts a needle into the vein. Vacuum action draws the blood through the needle into an attached tube. Collection of the sample takes only a few minutes.

When fasting is required, the person should have nothing to eat or drink (except water) for eight hours before the test and until the test or series of tests is completed. The person should not smoke before or during the testing period because this can temporarily increase the amount of glucose in the blood. Other factors that can cause inaccurate results are a change in diet before the test, illness or surgery two weeks before the test, certain drugs, and extended bed rest. The doctor may tell a person on insulin or taking pills for diabetes to stop the medication until after the test.

Aftercare

After the test or series of tests is completed (and with the approval of his or her doctor), the person should eat, drink, and take any medications that were stopped for the test.

The patient may feel discomfort when blood is drawn from a vein. Bruising may occur at the puncture site or the person may feel dizzy or faint. Pressure to the puncture site until the bleeding stops will reduce bruising. Warm packs to the puncture site will relieve discomfort.

Risks

If the person experiences weakness, fainting, sweating, or any other unusual reaction while fasting or during the test, he or she should immediately tell the person giving the test.

Normal results

Normal results are:

• fasting plasma glucose test less than 120 mg/dL
• oral glucose tolerance test, 2 hours less than 140 mg/dL

For the diabetic person, the ADA recommends an ongoing blood sugar goal of less than or equal to 120 mg/dL.

Abnormal results

These abnormal results indicate diabetes and must be confirmed with repeat testing:

• fasting plasma glucose test less than or equal to 126 mg/dL
• oral glucose tolerance test, 2 hours less than or equal to 200 mg/dL
• casual plasma glucose test (nonfasting, with symptoms) less than or equal to 200 mg/dL
• gestational oral glucose tolerance test, 1 hour less than or equal to 140 mg/dL

Brain damage can occur from glucose levels below 40 mg/dL and coma from levels above 470 mg/dL.

A condition known as prediabetes or impaired glucose tolerance, which may lead to Type 2 diabetes, usually is indicated with a reading of 100 mg/dL. Other hormone disorders can cause both hyperglycemia and hypoglycemia. Abnormal results must be interpreted by a doctor who is aware of the person's medical condition and medical history.

Resources

Periodicals

"New Guidelines Set Lower Threshold for Precursor to Diabetes." RN (January 2004): 17.

Plotnick, Leslie P. "The Next Step in Blood Glucose Monitoring?" Pediatrics (April 2003): 885.

"Premarket Approval Application Filed for Continuous Glucose Monitor." Medical Letter on the CDC & FDA (January 4, 2004): 26.

Organizations

American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342-2383. http://www.diabetes.org.

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

National Diabetes Information Clearinghouse. 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747. http://www.niddk.nih.gov/health/diabetes/ndic.htm.