Testing for Diabetes

I originally published this blog post on October 16th 2007. However, since then this blog has come along way and so has my writing (or at least I hope it has). After re-reading some of my initial posts I identified this one as a post that I could improve a lot. So without further ado, please read the new, improved version of ‘Testing for Diabetes’.

Diabetes is a disease which develops when the cells in your body are no longer getting enough insulin (a hormone which helps your cells convert glucose into energy). There are a number of causes which vary depending upon the type of diabetes. There are also a number of symptoms which can indicate that you are suffering from diabetes. However, the problem with these symptoms is that in a lot of cases they are quite hard to spot. The only way to be certain that you have diabetes is to get yourself tested by a qualified medical practitioner. There are a number of tests available and whilst there is no universal standard by which diabetes is measured, certain tests have become more popular than others. In this article I will discuss 6 tests that can be used to look for diabetes.

1) FASTING PLASMA GLUCOSE (FPG) TEST:- This test measures glucose (the body’s main source of energy) levels in a person’s blood following a period of fasting (not eating). It is one of the most popular diabetes tests but is only given to non-pregnant adults. Therefore, it can be used to test for pre-diabetes, type 1 diabetes and type 2 diabetes BUT it cannot be used to test for gestational diabetes.

You will usually have to fast for eight hours prior to the FPG test. Following your fast a blood sample will then be taken (usually from a vein in your arm). This blood sample will then be used to measure your blood glucose levels and the results will indicate whether or not you have diabetes:

- A blood sugar reading of 99 milligrams per decilitre (mg/dL) or below is considered normal.
- A blood sugar reading of between 100 mg/dL and 125 mg/dL indicates that you have impaired fasting glucose (a form of pre-diabetes).
- A blood sugar reading of 126 mg/dL or above indicates that you have either type 1 or type 2 diabetes. If this is the case you will be given another FPG test and the results of the two will be compared. If the results are consistent your doctor will diagnose you with diabetes and investigate further to determine whether it is type 1 or type 2.

2) ORAL GLUCOSE TOLERANCE TEST (OGTT):- This test measures blood sugar levels following the consumption of a sugary drink containing glucose. Unlike FPG this test can be used to diagnose all forms of diabetes including gestational diabetes (although the methodology does change slightly when testing for gestational diabetes).

If the OGTT is being used to test for pre-diabetes, type 1 diabetes or type 2 diabetes then it acts as an extension to the FPG test. You will be required to fast for eight hours and then have a blood sample taken (as you would for the FPG test). After this your doctor will give you a sugary drink that contains a measured amount of glucose (which should be between 75g and 100g). Following consumption of the glucose your doctor will take blood samples at regular intervals (usually one hour, two hours and three hours after consumption).

If the OGTT is being used to test for gestational diabetes the same procedure will be followed except you will not be required to fast before the test. However, your doctor may recommend that you perform the test first thing in the morning before you have eaten anything.

Whichever type of diabetes the OGTT is measuring, the final blood sample will provide a good indicator as to whether you have diabetes or not:

- A blood sugar reading of 140 mg/dL or below is considered normal.
- A blood sugar reading of between 140 mg/dL and 199 mg/dL indicates that you have impaired glucose tolerance (a form of pre-diabetes).
- A blood sugar reading of 200 mg/dL or above indicates that you have either type 1, type 2 or gestational diabetes. If this is the case your doctor will either diagnose you with gestational diabetes (if the OGTT was to test for gestational diabetes) or investigate further and diagnose you with either type 1 or type 2 diabetes.

3) RANDOM BLOOD GLUCOSE (RBG) TEST:- Unlike the above tests, a RBG test can be performed at any time regardless of when you ate. It can also be performed at home, without the assistance of a doctor, using a glucose meter (a medical device which calculates the approximate level of glucose in the blood). No fasting is required for this type of test. The idea behind this is that although eating does affect blood sugar levels they should not fluctuate hugely if tested at random intervals during the day. This test can be used to test for all forms of diabetes but should not be used as the only basis for diagnosis because there are concerns regarding the accuracy of RBGs.

This test is relatively simple compared with the above tests. You simply prick your finger using a lancing device (a device which pricks your skin in a very controlled way to draw a small drop of blood) then place a single drop of blood on a disposable test strip. You then place this test strip into your glucose meter and it will give you an approximate blood sugar reading. Diagnosis from a RBG is very similar to an FBG with a blood sugar level of 200 mg/dL or over indicating that you have diabetes.

Although this type of test is easier and more convenient than other tests, there are problems with accuracy. Glucose meters are believed to have just 10% of the accuracy of a laboratory test. This is because their main function is to monitor blood sugar levels in diabetics - NOT diagnosing diabetes. Therefore, home RBG tests should only be used to identify the warning signs of diabetes. If this home testing indicates that you may have diabetes do not attempt to self diagnose. Instead, consult your doctor immediately and they will be able to perform further, more accurate tests and give you a proper diagnosis.

4) KETONE TEST:- This test looks for ketones (substances produced by the body when it breaks down fat for energy) in your urine or your bloodstream. The presence of ketones indicates that your body is burning too much fat because; you are not getting enough carbohydrates in your diet OR your body is not using glucose properly. High levels of ketones in your body are a warning sign for all types of diabetes. However, type 1 diabetics are the most likely to experience this because their body produces no insulin (people suffering from gestational diabetes and type 2 diabetes often produce limited insulin). The presence of excessive ketones can also be a sign of diabetic ketoacidosis, a potentially life threatening blood chemical imbalance.

You can test for ketones using either a blood test or a urine test. The blood test is the more accurate but the urine test is the most commonly used because it is more convenient. Blood testing is performed by your doctor and involves a blood sample being taken from your arm. Your doctor will then take this blood sample and test it for the presence of ketones. If ketones are found in your bloodstream your doctor will investigate to determine the cause and then give you further advice.

The urine test can be performed at home using special test strips that are available from your doctor and over the counter at some chemists. It involves urinating in a clean container and then placing a test strip into the urine. If the test strip changes colour there are ketones present in your urine and you should seek the advice of your doctor immediately. They will then be able to investigate further and determine the cause of the ketones in your urine.

5) URINE GLUCOSE TEST:- Urine usually contains little to no glucose. However, when blood sugar levels start to reach 180 mg/dL and above, glucose starts to spill over into the urine. The urine glucose test is not an accurate way to diagnose diabetes because glucose can also appear in the urine when your kidneys get damaged or diseased. However, it does indicate possible diabetes and your doctor will usually follow up with one of the above blood glucose tests if sugar is found in your urine.

To perform a urine test you urinate in a plastic container and then give it to your doctor who will pass it on to the laboratory for analysis. As I mentioned above, the urine test is not used to diagnose diabetes. The chances are that you will be having a urine test for something completely unrelated. If the analysis uncovers glucose in your urine you will then be given further tests for diabetes as a precaution.

6) GLYCOSYLATED HAEMOGLOBIN TEST:- When glucose binds with haemoglobin in the blood, glycosylated haemoglobin is created. The glucose stays attached to the haemoglobin for the life of the blood cell (usually between two to four months). Glycosylated haemoglobin levels increase in people who are not managing their diabetes properly. Therefore, the glycosylated haemoglobin test can be used to measure a person’s blood sugar levels over the last two to four months and check how effective any diabetes treatments have been.

This test is performed in the same way as a normal blood test. Your doctor will take a blood sample (usually from a vein in your arm) and the levels of glycosylated haemoglobin in this sample are then measured. Your doctor will interpret the results as follows:

- Non-diabetics should have a glycosylated haemoglobin level of between 4% and 6%.
- Diabetics who are treating the condition effectively should have glycosylated haemoglobin of less than 7%.
- Levels of glycosylated haemoglobin above 7% indicate that your current diabetes treatment is not performing effectively and needs to be changed. However, the results will need to be further interpreted by your doctor because other factors can affect your glycosylated haemoglobin levels.

As you can see there are a lot of ways that you can test for diabetes with some being more accurate and others being more convenient. However, the best way to test for diabetes is by consulting your doctor. All the tests discussed above measure the number of ketones or the level of glucose in your body. Whilst high blood sugar and high levels of ketones are a good indicator of diabetes there can be other factors affecting them. For example, your blood sugar levels often rise when you are unwell and ketones may be present in your blood if you are not eating enough. Your doctor has the professional skills to look at these signs, determine the cause and make the call as to whether it is diabetes or not.

Whilst every intention has been made to make this article accurate and informative, it is intended for general information only. Diabetes is a medical condition and this article is not intended as a substitute for the advice of your doctor or a qualified medical practitioner. If you have any concerns regarding any form of diabetes you should seek the advice of your doctor immediately.

Sources:
Blood Sugar/Glucose Information (Wikipedia)
Blood Sugar Test Results Information (Mayo Clinic)
Diabetes and Ketones Information (Diabetes.co.uk)
Diabetic Ketoacidosis Information (Yahoo Health)
Fasting Plasma Glucose Test (Diabetes Self Management)
Glucose Meter Information (Wikipedia)
Glucose Urine Test Information (Web MD)
Glycosylated Haemoglobin Information (Med Terms)
Glycosylated Haemoglobin Test (Health A to Z)
Haemoglobin Information (Wikipedia)
Impaired Fasting Glucose Information (Wikipedia)
Insulin Information (Wikipedia)
Ketone Test (Web MD)
Oral Glucose Tolerance Test (Web MD)
Screening for Diabetes (Patient UK)
Type 1 Diabetes Diagnosis Information (Health A to Z)
Type 2 Diabetes Diagnosis Information (Health A to Z)

Pre-Diabetes Explained

Diabetes occurs when your blood glucose/sugar levels (the body’s primary source of energy) are elevated because the body is not producing enough insulin (the hormone which helps your body to break down sugar/glucose) or the insulin in the body is not working as it should be. Pre-diabetes usually precedes full type 2 diabetes and describes a person with higher than normal blood glucose levels. Their glucose levels are not high enough to be classified as type 2 diabetes but pre-diabetes almost always leads to type 2 diabetes if preventative action is not taken. Pre-diabetes is a critical stage for the individual because at this point they can still make the lifestyle choices which will slow down or even halt the development of type 2 diabetes.

Pre-diabetes is linked to a number of risk factors which promote its development. These risk factors include:

- Age: As you age you generally get less active and gain weight, increasing your chances of pre-diabetes.

- Obesity: The more fatty tissue you have, the more resistant your body’s cells become to insulin increasing the likelihood of higher than normal glucose levels.

- Race: It is unclear why race influences the development of pre-diabetes but unfortunately it does. In particular blacks, Hispanics, American Indians and Asian-Americans have a greater chances of developing pre-diabetes.

- Relatives: If your family has a history of type 2 diabetes then unfortunately this also increases the chances of you contracting pre-diabetes.

- Sedentary Lifestyle: Exercise reduces your chances of contracting pre-diabetes because it uses glucose for energy and also helps you moderate your body fat levels. Therefore, inactivity increases your chances of developing pre-diabetes.

There are also a number of symptoms related to type 2 diabetes that you should look out for in pre-diabetes. These include:

- Increased Thirst Levels.
- Increased Hunger Levels.
- Increased need to Urinate.
- Nausea or Vomiting.
- Blurred Vision.
- Increased Tiredness.

However, many of these symptoms do not manifest themselves during pre-diabetes. The most reliable way to determine whether you have pre-diabetes is to get tested by your doctor. They can perform a number of tests which will confirm whether or not you are a sufferer. Two of the most common tests are outlined below:

1) FASTING PLASMA GLUCOSE TEST (FPG):- For this test you will be required to eat nothing for eight hours. Then a blood sample will be taken and your blood glucose levels will be tested. A level of 99 milligrams per decilitre (mg/dL) or below is considered normal. If your blood glucose level is between 100 mg/dL or 125 mg/dL this indicates pre-diabetes. If your blood glucose level is 126 mg/dL this could indicate full diabetes. If this is the case the test will then be repeated and confirmed for accuracy. Failing this test (having blood sugar levels over 100 mg/dL) means that you have impaired fasting glucose.

2) ORAL GLUCOSE TOLERANCE TEST (OGTT):- For this test you are also required to fast for at least eight hours. After this your doctor will take a blood sample and give you a sugary drink (glucose). A further blood sample will then be taken two hours later. In this case a blood glucose level below 140 mg/dL is considered normal. Blood glucose levels between 140-199 mg/dL indicate pre-diabetes and blood sugar levels of 200 mg/dL or over suggest full diabetes. Failing this test (having blood sugar levels over 140 mg/dL) means that you have impaired glucose tolerance.

If you fail either test then your doctor will inform you that you have pre-diabetes. Whilst this may not sound like good news, it really is. Being diagnosed with pre-diabetes means that the condition is at a stage where you can still control it by making positive changes to your lifestyle. Your doctor will give you further advice to prevent the development of type 2 diabetes but there are two major things you can do. First, you will need to modify your diet by eating more regularly, reducing your intake of refined sugar, moderating your intake of fats and eating lots of complex carbohydrates (bread, pasta, rice), fruits and vegetables. Second, you will need to become more active. Try and get at least 30 minutes of moderate intensity exercise each day whether this be in the form of walking, jogging, swimming, cycling or playing sports.

More and more people across the globe are being diagnosed with diabetes. Diabetes.co.uk estimate that the condition currently affects 200 million people worldwide and the International Diabetes Federation believe that this will rise to 330 million people by 2025. To avoid becoming one of these statistics follow the advice in this article and deal with your pre-diabetes before it develops fully.

Whilst every intention has been made to make this article accurate and informative it is intended for general information only. Diabetes is a medical condition and this article is not intended as a substitute for the advice of your doctor or a qualified medical practitioner. If you have any concerns regarding pre-diabetes or diabetes you should seek the advice of your doctor immediately.

Sources:
Blood Glucose/Sugar Information (Wikipedia)
Global Diabetes Information (Diabetes.co.uk)
International Diabetes Federation
Insulin Information (Wikipedia)
Obesity Information (Wikipedia)
Pre-Diabetes Causes (Mayo Clinic)
Pre-Diabetes Facts (Diabetes.co.uk)

Gestational Diabetes Explained

I have covered diabetes in a number of my previous articles. However, these articles were written when this blog was just starting out and after re-reading a lot of these early articles I am cringing at how much information I missed out. The main thing I noticed is that although these articles contain a lot of good information I did not actually explain what diabetes is. A general definition of diabetes is a condition where blood glucose/sugar levels (the body’s primary source of energy) are high because the body is not producing enough insulin (the hormone which helps your body to break down sugar/glucose) or the insulin in the body is not working properly. However, there are various types of diabetes and this broad definition is not really enough. In my next few articles I will be explaining gestational diabetes, pre-diabetes, type 1 diabetes and type 2 diabetes. This article is going to cover gestational diabetes.

Gestational diabetes (also known as gestational diabetes mellitus or the abbreviated GDM) is when pregnant women with no previous record of diabetes start to suffer from elevated blood glucose levels during pregnancy. It usually develops during the second half of pregnancy and disappears after the baby is born. In other words GDM is a type of diabetes which develops during pregnancy and only lasts temporarily.

Although no specific cause has been identified it is generally accepted that GDM is brought on by the changes that your body goes through during the second and third trimester of pregnancy. During this time the placenta produces hormones that resist insulin to ensure that the growing baby is getting enough glucose. As a result a pregnant woman’s insulin needs usually increase by two or three times the normal rate. GDM develops when your body when your body cannot produce enough additional insulin to meet this demand.

According to Diabetes.co.uk 5% of women suffer from GDM. It is not known why certain women suffer from GDM and others do not. However, according to BUPA you are more at risk if you:

- Have a family history of GDM.
- Have previously given birth to a large baby (over 4.5kg/9lb).
- Have previously had a stillbirth.
- Are overweight or obese.
- Have polycystic ovary syndrome (PCOS) (a complex condition affecting the ovaries).

Your doctor should perform tests during your pregnancy to see if you are suffering from GDM. Generally, your doctor will perform an oral glucose tolerance test (OGTT) between the twenty fourth and twenty eighth week of your pregnancy. You are usually required to fast for eight hours before an OGTT but when screening for GDM no fasting is required. However, the doctor may recommend that you take the test first thing in the morning before you have eaten anything. To begin the test your doctor will administer glucose orally (usually via a sugary drink) and then take blood samples at different intervals to see how your body breaks down the glucose over time. If you are worried that this test is being performed too late, there is no need to panic. Testing earlier than this is often of little value because the hormonal changes discussed above will not have taken place.

As discussed in previous articles, the symptoms of diabetes (including gestational diabetes) are generally hard to identify. However, people with hyperglycaemia (high blood sugar levels) often exhibit the following symptoms:

- Increased Thirst Levels.
- Increased Hunger Levels.
- Increased need to Urinate.
- Nausea or Vomiting.
- Blurred Vision.
- Increased Tiredness.

GDM is not an immediate risk to your health. However, this does not mean it can be taken lightly. If it is not properly managed GDM can lead to; pre-eclampsia (a form of high blood pressure which is induced by pregnancy), premature labour and macrosomia (a new born baby with an excessive birth weight) which increases the complications surrounding giving birth. Poorly managed GDM also increases your risk of contracting GDM during future pregnancies and increases the likelihood of getting type 2 diabetes later in life.

Luckily GDM can usually be managed with a healthy diet and regular exercise. Very few women require additional insulin to manage GDM. Your doctor will be able to help you formulate an eating plan but a general recommendation is to eat lots of starchy foods (wholemeal bread, pasta, potatoes) and consume at least 5 portions of fruit and vegetables daily. You are also be advised to participate in regular, moderate intensity exercise for at least 30 minutes per day. Suggestions include; walking, cycling or swimming.

If your blood sugar stays high even after making these positive lifestyle changes your doctor may prescribe daily insulin injections to help you manage your glucose levels. If this is the case your doctor will be able to fully advise you on how and when to administer these injections.

Finding out that you have GDM may be a shock to you initially. However, remember that in most cases it is not your fault (it is caused by hormonal changes), it is temporary and it can be properly managed by making sensible changes to your diet and increasing the amount of daily exercise you perform.

Whilst every intention has been made to make this article accurate and informative it is intended for general information only. Diabetes is a medical condition and this article is not intended as a substitute for the advice of your doctor or a qualified medical practitioner. If you have any concerns regarding GDM or diabetes you should seek the advice of your doctor immediately.

Sources:
Blood Glucose/Sugar Information (Wikipedia)
Gestational Diabetes Facts (Diabetes.co.uk)
Gestational Diabetes Facts (BUPA)
Insulin Information (Wikipedia)
Macrosomia (Emedicine)
Polycystic Ovary Syndrome Information (Net Doctor)
Pre-Ecalmpsia Information (Preeclampsia.org)

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If you are still concerned about gestational diabetes after reading this article you may want to also read Overcoming Gestational Diabetes by Diane Ball, a writer who specialises in materials for parents and parents to be. In this detailed ebook Diane discloses the results of her 6 months research into gestational diabetes and explains how it develops, the complications it can cause and how it can be effectively managed.

Alcohol and Diabetes: Controlling your Consumption

If you are diabetic then you need to moderate the level of alcohol you consume. Otherwise you could find yourself facing some serious health problems. First, alcohol does not combine well with chemical medication. Secondly, whilst alcoholic drinks do contain calories, they do not have the minerals, vitamins and nutrients that you get in your food. Thirdly, alcoholic beverages contain a lot of sugar which will impact on your blood sugar (glucose) levels.

One of the key things you need to do as a diabetic is control your blood sugar levels. Getting adequate rest, consuming lots of fluids and eating the right foods will all help you control your diabetes. However, monitoring what you eat and drink is a major factor because everything you eat and drink will affect your glucose levels either positively or negatively. Most foods will assist diabetics by keeping their blood sugar levels even but alcohol is not one of these foods.

It is a well known fact that alcohol causes dehydration which is one of the reasons you always want more to drink after consuming an alcoholic beverage. Alcohol also has a very high calorie count. If you consume high levels of alcohol you will gain weight and the amount of fat in your bloodstream will increase. This in turn makes it even harder to control your blood sugar levels.

If your diabetes is not fully under control then you should avoid alcohol completely. However, if your diabetes is under fairly tight control, consuming alcohol in moderation is fine. Just make sure that you follow both your doctor’s advice and the guidelines below.

• A diabetic man can safely consume 1-2 alcoholic beverages per day.
• A diabetic woman can consume 1 alcoholic beverage per day.
• A diabetic who is 65 or over can consume 1 alcoholic beverage per day.

When consumed, alcohol goes directly into your bloodstream and your liver - it does not get metabolised. The human body can only break down one ounce of alcohol per hour. If you are not eating enough good food and drinking large quantities of alcohol you are putting yourself at risk of hypoglycaemia (having lower than normal glucose in the blood). Alcohol reduces the level of glucose in your blood. This causes the liver to change carbohydrate reserves into glucose which makes the situation of low blood sugar levels even worse. If you are going to consume alcohol make sure that you also eat a good meal to maintain your glucose levels.

White and red wines, dry sherry, dry light beers and spirits (including whiskey, gin and vodka) with diet or sugar free mixers are all acceptable for diabetics to consume in moderation. However, alcoholic beverages with high sugar content (sweet wines or sherries, ports, heavy or dark sweetened beers, wine coolers, spirits with normal mixers, cocktails and liqueurs) and alcoholic beverages with very high alcohol concentration such as neat, undiluted spirits, should be consumed with extreme caution.

Although these are good guidelines to follow when considering the consumption of alcohol with your diabetes, they are not a substitute for medical advice. If you are diabetic you should always consult your doctor before drinking alcohol.

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If you found the above article useful but you are struggling to moderate your consumption of alcohol you may find the following ebook on How to give up Alcohol useful. It is written by Rahul Nag, a person who was not an alcoholic but found himself drinking to excess for a number of reasons. In this 114 page ebook Rahul explains how he made the decision to give up alcohol and how you can do it too.

3 Natural Remedies for Diabetes

As I have discussed in my previous articles, diabetes is a very serious medical which can often be managed by improving your diet and doing more exercise.  Depending upon the type and severity of the diabetes, insulin treatment may also be required.  However, there are also a number of natural remedies that can be used to help treat diabetes.  Naturopathy (natural treatment) can be a very effective way to supplement your existing diabetes treatments.  In this article I will be discussing three of these naturopathic approaches:

1) FISH OIL, BORAGE OIL AND OMEGA 3 OIL:- A number of research studies have shown that omega-3 and omega-6 essential fatty acids are a very effective way of treating cardiovascular complications that can be related to diabetes. In particular, GLA (gamma-linolenic acid), is one essential fatty acid that helps your system regulate your metabolism of the faulty fatty acids that can make your diabetes worse. Borage oil contains GLA. Omega-3 fatty acids can also be used to combat diabetes. In a 2002 study a sample of overweight men were given 1.8 grams of fish oil with their breakfast whilst another sample were not given fish oil with their breakfast. 70% of the participants who took fish oil had better insulin responses than those who did not. Another study showed that consuming seafood is an effective, natural method to treat diabetes.

2) HYDROTHERAPY:- Water is another useful treatment for diabetes. Water absorbs and conducts heat so it is a great way to reduce your glucose levels, improve your mood (which will make you feel better) and also help you sleep better.

3) MASSAGE AND REFLEXOLOGY:- A good massage will help you relax which will help control your diabetes. A massage works your muscles and soft tissues in ways that affect your nerves and blood circulation.

Hopefully, these natural remedies for diabetes help control your condition.  Naturopathy is not for everyone but it is definitely an option worth considering, especially if other treatments are not having the desired effect.  When considering naturopathy, remember that it is not a suitable replacement for the usual diabetes treatments of diet, exercise and possible insulin injections.  You should never stop taking insulin in favour of fish oil or start eating lots of sugary foods because you have started hydrotherapy.  As with most things related to diabetes, you should go see your doctor and talk to him about any naturopathic methods you may be considering.  They will then be able to tell you what you can expect and if the proposed naturopathic remedies would conflict with your existing diabetes treatment.

Whilst every intention has been made to make this article accurate and informative it is intended for general information only. Diabetes is a medical condition and this article is not intended as a substitute for the advice of your doctor or a qualified medical practitioner. If you have any concerns regarding diabetes you should seek the advice of your doctor immediately.