Preliminary blood tests to check whether you are a diabetic

By Dr Harold Gunatillake - Health Writer

“If you were to choose what chronic disease you prefer if you are given a choice, diabetes should be the preference despite being the ‘gateway’ to other diseases and life-threatening complications.
It is one of those diseases you have full control of the management with proper education and your lifespan would never be hindered with self-discipline in the management. You are the captain of your ship

When your doctor suspects that you could be having diabetes, with symptoms like thirst, frequency in passing urine, tiredness and wasting of muscles, or with a family history, he would first organize a fasting blood sugar test, among other tests to check whether you have sugar in your blood far in excess to the normal range.

People older than age 45, obese people, and those having additional risk factors such as high blood pressure, high blood cholesterol levels, a sedentary form of life should go for a diabetic screening test annually.

If you are a non-diabetic your fasting blood sugar varies from 80-100mg/dl. This is measured in the morning after fasting for 8-12 hours from the previous night’s dinner. In a normal non-diabetic subject blood sugar 2 hours after meal would read less than 140mg/dl (4.4-7.2 mmol/L) If you are a diabetic your blood sugar reading 2 hours after a meal may be less than 180mg/dl (10.0 mmol/L) or more, the reason been that your pancreas does not manufacture enough insulin to courier the blood sugar for storage for energy purposes, to maintain a steady normal level in your blood.

Blood sugar levels depends on the regulation of it by the secretion of insulin from your beta cells in the pancreas. If your pancreas does not secrete enough insulin, or less sensitive to insulin, the blood sugar tests will clinch the diagnosis of diabetes.

Some people may have a normal fasting blood sugar reading, but their blood sugar may rise rapidly as they eat. For these people your doctor will decide to do a glucose tolerance test to make sure that you are not a diabetic.

If your doctor suspects that your fasting blood sugar is beyond the normal range, he would organize another test called HbA1c. A non-diabetic will record less than 5.7%, and if you are a diabetic it could go above 7%. The normal recommended value for HbA1c for a diabetic should be maintained below 7.0%. Bringing down your HbA1c to the non-diabetic’s level could give hypoglycaemic episodes and could be dangerous. Keeping your reading just below 7% is good enough

HbA1c is also called the glycated haemoglobin test. This test may be used to confirm diagnosis of diabetes after a fasting blood sugar test is above the normal range, and it is used to determine how well your diabetes is being controlled. This blood test does not require fasting and indicates the average blood sugar level for the past two to three months. It is a measure of the amount of glucose attached to the haemoglobin of the red blood cells, through a process called ‘glycation’

Is it required to fast for the morning blood sugar test?
It has been found that a greater percentage of people having diabetes who fast for 8-12 hours before the test got into a low blood sugar episode called ‘hypoglycaemia’ while waiting for the test in the collecting centre. Further, if you get hungry midnight, as diabetics do, that would disturb your sleep and could be unfit to travel in the morning on an empty stomach. This could be dangerous and now the thinking is that you need not fast for your morning blood sugar test unless it’s done for the first time on suspicion of diabetes.

Those patients most at risk of having low blood sugar levels while fasting are those on insulin or sulfonylurea meglitinide classes of medication. On the same token, the researchers feel that there is no need to fast for the cholesterol blood test, either. The only snag is that to check your triglycerides in your blood you may have to starve in the morning before the test.

Importance of checking your blood sugar level
When you are diagnosed having diabetes checking your fasting blood sugar level takes you no where and is a waste of money on strips and time. It is advisable to do random readings before lunch, 2-3 hours after lunch and before dinner. Such testing will develop confidence in looking after your diabetes. You still need to get your HbA1c test done every six months.

Such random testing gives you better understanding to adjust as required after certain foods, lifestyle influences such as travel, stress, illness and most importantly exercise. You’ll notice that with exercise both aerobic types and body muscle building you may need less medication. If you were to chose what chronic disease you prefer if you are given a choice, diabetes should be the preference despite being the ‘gateway’ to other diseases and life-threatening complications. It is one of those diseases you have full control of the management with proper education and your lifespan would never be hindered with self-discipline in the management. You are the captain of your ship.


New research
As mentioned, people having diabetes don’t have enough insulin-producing beta cells in the pancreas to control blood sugar levels. Beta cells are also called islet cells. Two drugs lately discovered may stimulate your pancreas to revive the dead beta cells and make more. Work has been done in the lab on rodents and this discovery may help in the future to try in humans.

Dr. Andrew Stewart the director at the Mount Sinai Diabetes, Obesity and Metabolism Institute in New York City explains that the release of these drugs at this stage may affect other cells and needs further studies. Researchers also found that a drug called harmine could prompt beta cell regeneration in the lab in mice.

Bottom line: Check you fasting blood sugar level once a year, if your doctor suspects you have early diabetes. When you are diagnosed as a diabetic, fasting levels do not carry you anywhere: do random tests and HbA1c memory test every six months.

Get well educated about lifestyle changes and the control of the disease, through medication, low glycaemic dietetic regimes, exercising daily (10,000 steps), among others.

Dr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of Cosmetic Surgery. Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic Surgery, Member of the International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US), Australian diplomat for the International Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the International Society of Aesthetic Surgery, Member of the American Academy of Aesthetic & restorative Surgery, Life Member of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery (Cey): Government scholar to UK for further studies.

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