People with diabetes should see their main doctor, whether it be an internist, primary care physician or endocrinologist to obtain their 3-month blood work. Most ordered blood work is routine information for the physician, but it may be meaningless to you. Managing your diabetes also requires visiting various doctors throughout the year and taking other important lab tests. Always request a copy of your lab tests during your next exam to read over and discuss the results with your doctor. Maintain a file to keep and compare each lab report in the future. Learning how to read a lab report may help you take control of your health and diabetes.

Keeping Track of Your Health

Laboratory tests are done to keep track of your health and refine your diabetes self-management plan. These tests are used to determine your blood sugar control, cardiovascular well-being, and kidney function. No matter what type of lab test you are reading, all the reports have some standard features. These include basic information such as your name, identification number, the name and address of the lab and the authorized people who ordered the tests. The lab test will indicate the specimen type, such as blood or urine, along with all the tests done on that specimen. The results may be expressed as positive, negative or in numbers. Out-of-range or abnormal results appear in bold print or are highlighted. Critical results will show a date of notification to your doctor which will likely result in a follow-up phone call to you. Reference ranges are provided to show how your results compare with the normal results of those who are tested. You will also see a unit of measurement for each test result. Use your lab report results to ask your doctor about any questions or concerns you may have.

Diagnosing Diabetes

People with diabetes are either unable to produce or respond to insulin properly. This leads to elevated blood sugar levels. Three specific lab tests are used to diagnose diabetes. They include the fasting plasma glucose test, the oral glucose tolerance test and the HBA1c or A1C. The A1C is also used to monitor your 3-month average after your diabetes diagnosis. Keep track of your A1C levels to follow your diabetes control.

Types and Values of Lab Report Tests for Diagnosis and Monitoring

People taking the fasting plasma blood glucose test, fast, except for water, for at least eight hours prior to taking the test. Diabetes is defined as a blood sugar level of 126 mg/dl or more at least two times in a row. After an initial evaluation the fasting blood test is repeated. A level from 100 to 125 mg/dl is referred to as pre-diabetes and normal blood sugar is defined as 60 to 99 mg/dl. For the oral glucose tolerance test, the person is given a high glucose drink and is tested to determine the response. The blood sugar is drawn prior to drinking the sweet solution. Then the blood is redrawn in two hours after drinking. If the blood sugar is under 140mg/dl after two hours, then it is considered normal. If the blood sugar is 141-199mg/dl then it is considered pre-diabetes. If the level is 200 mg/dl or more after two hours, it is considered diabetes. The A1C test is used to diagnose diabetes without fasting. If the A1C is 6.5 %, then you are considered to have diabetes. It also determines long-term blood sugar control in people diagnosed with diabetes. It does not require fasting since it shows an estimate of the blood glucose levels of the patient over a period of two to three months. These results can help doctors and patients develop a more effective diabetes management plan. A diabetes-related auto-antibody test might be ordered by your doctor to verify if you have type 1 or type 2 diabetes. Diabetes type 1 is diagnosed in 5-10 % of the population and almost 90% are considered type 2.

These are some of the common lab tests ordered for people with diabetes. Other tests may be recommended to detect diabetes-related conditions such as cardiovascular disease. It includes the total cholesterol which should be under 200mg/dl, the LDL (unhealthy cholesterol) which should be under 70mg/dl for those with diabetes and the HDL (healthy cholesterol) which should be at least 45-50 mg/dl for those with diabetes. The triglyceride value should be under 150mg/dl. The doctor may recommend a CRP blood test or a homocysteine level which indicates systemic inflammation. Talk to your physician to see which blood tests are right for you.

Testing at Home

Lab tests are done periodically but diabetes is a condition that needs to be monitored according to your physician’s recommendations when at home. Home glucose testing should be done by the patient to monitor diabetes values regularly. Abnormalities should be reported to the doctor as needed. If blood sugar numbers are under 70 mg/dl or over 200mg/dl for 2 consecutive days, report values to your doctor. The doctor may suggest changes to lifestyle habits or add/subtract medications because of these fluctuations.

Testing Your Own Blood Glucose Levels

Home blood glucose monitors are used to determine daily blood glucose levels which may result in certain patterns. The devices take a small blood sample, usually from a fingertip, which is applied to a test strip, which has already been placed into a blood glucose meter. Results are reported in 5-10 seconds. A portable blood glucose meter should be within 20 percent accuracy, 99% of the time, as compared to lab results. This means your blood meter reading might be up to 20 points higher or lower than your lab test results. Bring your meter to each visit to get a comparison. Talk to your doctor about where your blood glucose levels should be. Testing before meals will result in different readings as compared to testing 2 hours after a meal, after exercising, when you are ill or before bedtime.

Testing for Ketones

When your blood sugar is extremely high, due to lack of insulin, your body stops using glucose for energy and starts to breakdown fats. This produces ketones. In high concentrations, ketones can disrupt the acid balance in your body. This can lead to a medical emergency called Diabetic Ketoacidosis (DKA). Symptoms include nausea, disorientation, frequent urination, thirst, dehydration, rapid breathing and breath with a fruity scent. Certain home blood monitors can be used to test for ketones. Urine ketone testing kits can also be used at home. Testing for blood ketones is more accurate than testing for urine ketones since ketones present more quickly in blood. DKA is much more common in type 1 diabetes so be aware of the symptoms. If you suspect symptoms of DKA, contact your doctor or go to hospital immediately. DKA can be life-threatening.

The A1C Test

People can now use an A1C test kit in the comfort of their home to monitor the long-term effects of diabetes for a period of two to three months. A normal A1C level is 4.5-5.6%. A pre-diabetes A1C is considered 5.7 -6.4%. Diabetes is diagnosed with an A1C of 6.5% or higher. The higher the results the higher your blood sugar levels have been over that 3-month period. The test does not require fasting, so blood can be taken any time of the day. You will still need to be followed by your physician, but this can offer you some solid information between visits. It may help you institute immediate changes to lower your A1C before your next visit.

Ways to lower Lab Test Results

It helps to minimize your intake of fatty, salty, sugary and processed foods and exercise for about a half hour each day to help get your numbers to safer values. Consider taking a diabetes self- management course. Take your medications as prescribed. Because diabetes is the leading cause of kidney failure in the US, a yearly test for albumin in the urine is done. Albumin leaks into the urine when the kidneys are losing function. Blood creatinine might also be measured to detect kidney failure. As this number increases, it indicates a problem with kidney function. Another blood test measures the glomerular filtration rate (GFR). The normal range is above 60 ml/min/1.73 m2. As the numbers get lower, the risk of kidney failure increases. Working with your physician and dietitian may help preserve kidney function as well as keeping blood sugars in good control.

Many laboratory tests can be done today to monitor diabetes and related health conditions. Taking these tests helps your doctor determine the best treatments to keep you healthier. Learning how to read your own lab test results gives you greater control over your well-being and the quality of your life in the years to come.

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Roberta Kleinman

Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.

She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
Roberta Kleinman

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