The Test

1. How is it used?
2. When is it ordered?
3. What does the test result mean?
4. Is there anything else I should know?

How is it used?

The blood glucose test is ordered to measure the amount of glucose in the blood right at the time of
sample collection. It is used to detect both hyperglycemia and hypoglycemia, to help diagnose diabetes,
and to monitor glucose levels in persons with diabetes. Blood glucose may be measured on a fasting
basis (collected after an 8 to 10 hour fast), randomly (anytime), post prandial (after a meal), and/or as
part of an oral glucose tolerance test (OGTT / GTT). An OGTT is a series of blood glucose tests. A
fasting glucose is collected; then the patient drinks a standard amount of a glucose solution to
"challenge" their system. This is followed by one or more additional glucose tests performed at specific
intervals to track glucose levels over time. The OGTT may be ordered to help diagnose diabetes and as
a follow-up test to an elevated blood glucose.

The American Diabetes Association recommends either the fasting glucose or the OGTT to diagnose
diabetes but says that testing should be done twice, at different times, in order to confirm a diagnosis of
diabetes.

Most pregnant women are screened for gestational diabetes, a temporary form of hyperglycemia,
between their 24th and 28th week of pregnancy using a version of the OGTT, a 1-hour glucose
challenge. If either fasting glucose or a random glucose is above the values used to diagnose diabetes
in those who are not pregnant, the woman is considered to have gestational diabetes and neither the
screening nor the glucose tolerance test is needed. If the 1-hour level is higher than the defined value, a
longer OGTT is performed to clarify the patient's status.

Diabetics must monitor their own blood glucose levels, often several times a day, to determine how far
above or below normal their glucose is and to determine what oral medications or insulin(s) they may
need. This is usually done by placing a drop of blood from a skin prick onto a glucose strip and then
inserting the strip into a glucose meter, a small machine that provides a digital readout of the blood
glucose level.

In those with suspected hypoglycemia, glucose levels are used as part of the "Whipple triad" to confirm
a diagnosis. (See "Is there anything else I should know?" section).

The urine glucose is seldom ordered by itself. At one time, it was used to monitor diabetics, but it has
been largely replaced by the more sensitive and “real time” blood glucose. The urine glucose is,
however, one of the substances measured when a urinalysis is performed. A urinalysis may be done
routinely as part of a physical or prenatal checkup, when a doctor suspects that a patient may have a
urinary tract infection, or for a variety of other reasons. The doctor may follow an elevated urine glucose
test with blood glucose testing.
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When is it ordered?

Blood glucose testing can be used to screen healthy, asymptomatic individuals for diabetes and pre-
diabetes because diabetes is a common disease that begins with few symptoms. Screening for glucose
may occur during public health fairs or as part of workplace health programs. It may also be ordered
when a patient has a routine physical exam. Screening is especially important for people at high risk of
developing diabetes, such as those with a family history of diabetes, those who are overweight, and
those who are more than 40 to 45 years old.

The glucose test may also be ordered to help diagnose diabetes when someone has symptoms of
hyperglycemia, such as:

 Increased thirst

 Increased urination
 Fatigue
 Blurred vision
 Slow-healing infections

or symptoms of hypoglycemia, such as:

 Sweating

 Hunger
 Trembling
 Anxiety
 Confusion
 Blurred Vision

Blood glucose testing is also done in emergency settings to determine if low or high glucose is
contributing to symptoms such as fainting and unconsciousness. If a patient has pre-diabetes
(characterized by fasting or OGTT levels that are higher than normal but lower than those defined as
diabetic), the doctor will order a glucose test at regular intervals to monitor the patient’s status. With
known diabetics, doctors will order glucose levels in conjunction with other tests such as hemoglobin
A1c to monitor glucose control over a period of time. Occasionally, a blood glucose level may be
ordered along with insulin and C-peptide to monitor insulin production.

Diabetics may be required to self-check their glucose, once or several times a day, to monitor glucose
levels and to determine treatment options as prescribed by their doctor.

Pregnant women are usually screened for gestational diabetes late in their pregnancies, unless they
have early symptoms or previously have had gestational diabetes. When a woman has gestational
diabetes, her doctor will usually order glucose levels throughout the rest of her pregnancy and after
delivery to monitor her condition.
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What does the test result mean?

High levels of glucose most frequently indicate diabetes, but many other diseases and conditions can
also cause elevated glucose. The following information summarizes the meaning of the test results.
These are based on the clinical practice recommendations of the American Diabetes Association.

Fasting Blood Glucose

GLUCOSE LEVEL INDICATION

From 70 to 99 mg/dL (3.9 to 5.5 mmol/L) Normal fasting glucose

From 100 to 125 mg/dL (5.6 to 6.9 mmol/L) Impaired fasting glucose (pre-
diabetes)

126 mg/dL (7.0 mmol/L) and above on more than one testing Diabetes
occasion

Oral Glucose Tolerance Test (OGTT)

Levels applicable except during pregnancy. Sample drawn 2 hours after a 75-gram glucose drink.

GLUCOSE LEVEL INDICATION

Less than 140 mg/dL (7.8 mmol/L) Normal glucose tolerance

From 140 to 200 mg/dL (7.8 to 11.1 mmol/L) Impaired glucose tolerance (pre-
diabetes)

Over 200 mg/dL (11.1 mmol/L) on more than one testing Diabetes
occasion

Gestational Diabetes Screening: Glucose Challenge Test

Sample drawn 1 hour after a 50-gram glucose drink.

GLUCOSE LEVEL INDICATION

Less than 140* mg/dL (7.8 mmol/L) Normal screen

Sample drawn 1 hour after a 50-gram glucose drink.

GLUCOSE LEVEL INDICATION

140* mg/dL (7.8 mmol/L) and over Abnormal, needs OGTT (see below)

* Some use a cutoff of 130 mg/dL (7.2 mmol/L) because that identifies 90% of women with gestational
diabetes, compared to 80% identified using the threshold of 140 mg/dL (7.8 mmol/L).

Gestational Diabetes Diagnostic: OGTT

Sample drawn after 100-gram glucose drink (glucose load).

TIME OF SAMPLE COLLECTION TARGET LEVEL

Fasting* (prior to glucose load) 95 mg/dL (5.3 mmol/L)

1 hour after glucose load 180 mg/dL (10.0 mmol/L)

2 hours after glucose load 155 mg/dL (8.6 mmol/L)

3 hours after glucose load* 140 mg/dL (7.8 mmol/L

INDICATION:  If two or more values meet or exceed the target level, gestational diabetes is diagnosed.

* A 75-gram glucose load may be used, although this method is not as well validated as the 100-gram
OGTT; the 3-hour sample is not drawn if 75 grams is used.

Some of the other diseases and conditions that can result in elevated glucose levels include:

 Acromegaly

 Acute stress (response to trauma, heart attack, and stroke for instance)
 Chronic renal failure
 Cushing syndrome
 Drugs, including: corticosteroids, tricyclic antidepressants, diuretics, epinephrine, estrogens
(birth control pills and hormone replacement), lithium, phenytoin (Dilantin), salicylates,
 Excessive food intake
 Hyperthyroidism
 Pancreatic cancer
 Pancreatitis
Low to non-detectible urine glucose results are considered normal. Anything that raises blood glucose
levels also has the potential to elevate urine glucose levels. Increased urine glucose levels may be seen
with medications, such as estrogens and chloral hydrate, and with some forms of renal disease.

Moderately increased blood levels may be seen with pre-diabetes. This condition, if left un-addressed,
often leads to type 2 diabetes.

Low blood glucose levels (hypoglycemia) are also seen with:

 Adrenal insufficiency

 Drinking alcohol
 Drugs, such as acetaminophen and anabolic steroids
 Extensive liver disease
 Hypopituitarism
 Hypothyroidism
 Insulin overdose
 Insulinomas
 Starvation

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Is there anything else I should know?

Hypoglycemia is characterized by a drop in blood glucose to a level where first it causes nervous
system symptoms (sweating, palpitations, hunger, trembling, and anxiety), then begins to affect the
brain (causing confusion, hallucinations, blurred vision, and sometimes even coma and death). An
actual diagnosis of hypoglycemia requires satisfying the "Whipple triad." These three criteria include:

 Documented low glucose levels (less than 40 mg/dL (2.2 mmol/L) often tested along with
insulin levels and sometimes with C-Peptide levels)

 Symptoms of hypoglycemia
 Reversal of the symptoms when blood glucose levels are returned to normal.

Primary hypoglycemia is rare and often diagnosed in infancy. People may have symptoms of
hypoglycemia without really having low blood sugar. In such cases, dietary changes such as eating
frequent small meals and several snacks a day and choosing complex carbohydrates over simple
sugars may be enough to ease symptoms. Those with fasting hypoglycemia may require IV glucose if
dietary measures are insufficient.