How is diabetes diagnosed?

Diabetes can be diagnosed in a number of ways. In fact, there are 4 different tests that can be
done to diagnose diabetes, as recommended by the Diabetes Canada clinical practice guidelines.
We’ll review them here.

1. Fasting blood glucose level. This is a simple blood test. Your healthcare team will draw a
sample of your blood and send it to a laboratory for analysis. A blood glucose level that is 7.0
mmol/L or higher means that a person has diabetes.

2. A1C. What is an A1C blood test?

The A1C test is a common blood test that measures the amount of glucose in the blood. The A1C
blood test goes by many other names, including A1C, HbA1C, glycated hemoglobin,
glycosylated hemoglobin or hemoglobin A1C.The test results reflect your average blood sugar
over the past 2-3 months. Specially, the A1C test measures what percentage of your red blood
cells are coated with sugar (glycated). As your red blood cells have a lifespan of around 3
months, this is why the test gives us an average of what has been going on in your blood for the
past few months.The higher your A1C level, the greater your risk of developing diabetes, and the
poorer your blood sugar control if you already have diabetes.

Why is the A1C test done?

The A1C blood test is one of the primary methods of diagnosing prediabetes, type 1 diabetes,
and type 2 diabetes.After diagnosis, the test is used to monitor your response to treatment, how
well your diabetes is being managed, and if any changes need to be made to medications or your
treatment plan. A1C is a better reflection of your diabetes management as it tells a story of your
blood sugar over a period of time, in comparison to the blood sugar levels you measure at home,
which are just a snapshot at a specific point in time.

Your doctor will likely repeat the A1C test a few months after diagnosis, and at least 2-4 times a
year thereafter depending on what type of diabetes you have, what medications you are taking, if
you use insulin, if there are any changes to your treatment plan, and how well your diabetes is
managed.

What A1C number is used to diagnose diabetes?

When an A1C is equal to or greater than 6.0%, this is diagnosed as pre-diabetes. When A1C is
equal to or greater than 6.5% this is a diagnosis of diabetes. A test should always be repeated on
a different day to be sure of the diagnosis.
What is the target A1C for a person with diabetes?

For most people, the A1C target should be 7% or lower (this is usually attained by having
pre-meal blood sugars of 4-7 mmol/L and post-meal blood sugars of 5-10 mmol/L).If a
person is very elderly or frail, a young child, or someone at risk of having low blood
sugars, then the A1C target can be a bit higher (8% or 8.5 %). It is important to
individualize your A1C target with your diabetes team. What does it mean when the A1C
and the blood sugars don’t match?

Sometimes a person’s A1C doesn’t seem to match their blood sugar readings at home. If this is
the case, it usually means that they are not measuring their blood sugars often enough to see the
fluctuation in blood sugars. For example, an A1C might be elevated (for example 9%) but the
person gets very normal readings in the morning (7 mmol/L). However, they may not be testing
later in the day when their readings might be very high (12 mmol/L).

Why does a person need to test their blood sugars if they can get an A1C?

The A1C is only an “average” blood sugar reading. This can be made up of highs and lows. If
someone is on a treatment that doesn’t cause lows (for example, only metformin), then they
don’t need to do blood tests as often and the A1C is fairly representative of their average blood
sugar. However, blood testing will give specific information on the ‘pattern’ of their blood
sugars, showing when they are high and low, and what lifestyle factors such as food and exercise
cause them to be higher or lower.

If a person is on insulin, self-monitoring their blood sugars is extremely important because it can
give moment-to-moment information on how to adjust insulin. If a person’s blood sugars are out
of range, then testing gives information on what time of day to target therapy. For instance, if the
morning numbers are higher, they may need nighttime insulin. Or if the morning numbers are at
target but blood sugar is high after supper, they may need more medication at suppertime.

3. Oral glucose tolerance test (OGTT). This test measures your body’s ability to use a type of
sugar – called glucose – which is the body’s main source of energy. The OGTT test is usually
done in the morning, and you will be asked to fast (not eat anything) the night before. A blood
sample will be taken when you arrive: this is your fasting blood glucose value and provides a
basis for comparing other glucose values.

After your blood is drawn, you will be asked to drink a liquid containing 75 grams of glucose.
Because it is very sweet – and rather unpleasant tasting! – it is best to drink the liquid quickly.
After two hours have passed, your healthcare team will draw your blood once again, and both
blood glucose results will be analyzed in a laboratory. A blood glucose level of 11.1 mmol/L or
higher two hours after you’ve consumed the sweet drink means that a person has diabetes.

For gestational diabetes, the diagnosis – according to the Diabetes Canada guidelines – is slightly
different than type 1 or type 2 diabetes diagnoses. Women who are being tested for gestational
diabetes have a 50-gram OGTT (instead of the 75-gram test), and their blood glucose is
measured one hour later. If the woman has a blood glucose level of11.1 mmol/L or higher at that
time, it means she has gestational diabetes.

4. Random blood glucose test. If your healthcare team suspects you may be at high risk for
diabetes, they may draw your blood to be tested when you visit them, regardless of whether you
have been fasting or have eaten recently. If the laboratory test confirms a blood glucose level of
11.1 mmol/L or higher, it means that a person has diabetes.

While it’s impossible to predict whether and when a person will develop type 1 diabetes, the risk
factors for type 2 diabetes are very clear: being overweight, being over 40 years of age, having a
sedentary lifestyle (not getting much physical activity), and having a close family history (for
example, if your mother or father has diabetes). If you think you might be at risk for diabetes,
visit your healthcare team to be tested.

As well, if you think you might be experiencing symptoms of diabetes, visit your healthcare
team to discuss the matter further. For information about the symptoms of type 1 diabetes, click
here. For information about type 2 diabetes symptoms, click here.