Diagnostic TestDIAGNOSTIC TEST

7/28/2019 Diagnostic TestDIAGNOSTIC TEST

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DIAGNOSTIC TEST


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Blood Test

is the main diagnostic test for diabeticpatient. It measures the glucose in theblood.


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Types of Tests to Diagnose Diabetes

(FBG) Fasting Blood Glucose Test

(HBA1C) / Glycosylated hemoglobin

(RBGT) Random Blood Glucose Test

(OGTT) Oral Glucose Tolerance Test


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Types of Tests to Diagnose

Diabetes (FBG) Fasting Blood Glucose Test

(HBA1C) / Glycosylated hemoglobin (RBGT) Random Blood Glucose Test

(OGTT) Oral Glucose Tolerance Test


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(FBG) Fasting Blood Glucose

Test blood glucose levels are checked afterfasting for between 12 and 14 hours. Youcan drink water during this time, but shouldstrictly avoid any other beverage. Patientswith diabetes may be asked to delay theirdiabetes medication or insulin dose until the

test is completed.


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The fasting blood glucose test will confirm thatthe person has diabetes if it shows that thelevel of glucose in their blood is higher thannormal when they are fasting.

Sometimes the test result of the fasting bloodglucose test is borderline. If this is the case,

an oral glucose tolerance test may beperformed.


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Normal values: 70-110 mg/dl some books 80-120 mg/dl

More than 126ml/dl = DM mgt.

111-125 mg/dl = borderline close monitoring 60-69 mg/dl = borderline

Less than 60 mg/dl = hypoglycemia


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(HBA1C) / Glycosylated

hemoglobin

To check how well an individual controls ormanage the glucose levels for at least 3-4months/ (120 days)

Values:

7.5% & below = good management 9% & above = poor management


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(RBGT) Random Blood Glucose

Test

blood glucose levels are checked at varioustimes during the day, and it doesnt matterwhen you last ate. Blood glucose levels tendto stay constant in a person who doesnt havediabetes.


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(OGTT) Oral Glucose Tolerance

Test

a high-glucose drink is given. Blood samplesare checked at regular intervals for twohours.

This test will confirm diabetes if the personsblood sugar levels stay high for a long timeafter the tests. For a person doesnt have

diabetes, the result will show that their bloodsugar levels fall within the normal range.


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The WHO recommendation is for a 75g oraldose in all adults: the dose is adjusted forweight only in children.The dose should bedrunk within 5 minutes.

Blood sample checked at intervals for twohours.


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Accuracy of Test ResultsDepending on the test used, the level of blood

glucose can be affected by many factorsincluding:

Eating or drinking

Medications

Physical illness or surgery that maytemporarily alter blood sugar levels.


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MANAGEMENT


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Management concentrates on keeping bothshort-term and long-term blood glucose levelswithin acceptable bounds ("euglycemia"). Thiscan usually be accomplished with:

Diet & Exercise Medications

Insulin

Surgery


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Diet & Exercise Modifying eating habits and increasing physical

activity are typically the first steps towardreducing blood sugar levels. Achieving nutrition-

related goals requires a coordinated team effortthat includes the person with diabetes.

However, it is essential that all team membersare knowledgeable about nutrition therapy and

are supportive of the person with diabetes whoneeds to make lifestyle changes.

Avoid: high sugar, high CHO, high FATS


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Medications Pharmacological treatment is indicated if

there is an inadequate response to lifestylemodifications and improved glucose control.The first priority of pharmacological therapyis to lower LDL cholesterol to a target goal of


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Oral Diabetes Medication The medications work in several different

ways. These include improve theeffectiveness of the body's natural insulin,reduce blood sugar production, increaseinsulin production and inhibit blood sugarabsorption. Oral diabetes medications are

sometimes taken in combination with insulin.


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Statin - it is the drug of choice in lowering LDL. Itraises HDL modestly, but a greater increase is

usually achieved with fibrates.

Fibrates are used for a range

of metabolic disorders,mainly hypercholesterolemia (high cholesterol) andare therefore hypolipidemic agents.

Metformin - is generally recommended as a first

line treatment for type 2 diabetes, as there is good

evidence that it decreases mortality. .


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Surgery Pancreas Transplants - have been tried with

limited success in type 1 DM

Gastric Bypass - has been successful in manywith morbid obesity and type 2 DM.


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Insulin Rapid-acting insulin

Begins to work about 5 minutes after

injection, peaks in about 1 hour, andcontinues to work for 2 to 4 hours.

Ex:

Insulin lispro (Eli Lilly),

Insulin aspart (Novo Nordisk)

Insulin glulisine (sanofi-aventis)


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Regular or Short-acting insulin

Usually reaches the bloodstream within 30

minutes after injection, peaks anywhere from2 to 3 hours after injection, and is effective forapproximately 3 to 6 hours.


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Intermediate-acting insulin

Generally reaches the bloodstream about 2 to

4 hours after injection, peaks 4 to 12 hourslater, and is effective for about 12 to 18 hours.


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Long-acting insulin (ultralente)

Reaches the bloodstream 6 to 10 hours after

injection and is usually effective for 20 to 24hours.


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Premixed insulin can be helpful for peoplewho have trouble drawing up insulin out oftwo bottles and reading the correct directionsand dosages. It is also useful for those whohave poor eyesight or dexterity and isconvenient for people whose diabetes has

been stabilized on this combination.


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Characteristics of Insulin Onset is the length of time before insulin

reaches the bloodstream and begins loweringblood glucose.

Peaktime is the time during which insulin is atmaximum strength in terms of lowering bloodglucose.

Duration is how long insulin continues to lowerblood glucose.


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Notes

Regular- clear NPH- cloudy

Steps: air NR withdraw RN

Route: subcutaneous = 45 degrees

Sites: arms, thigh, mostly abdomen Systematic rotation, use 1-1/2 inches

spacing

Can inject again after 2-3 weeks

No to massage, and shakes


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Diagnostic TestDIAGNOSTIC TEST

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