Screening & Diagnosis

Screening of diabetes should be considered in all adults who are overweight whose BMI is more than >25 kg/m². Other risk factors for diabetes are listed below:

Physical inactivity/ sedentary lifestyle
First degree relative with diabetes
Women who have delivered a baby weighing more than 9 Ib or have been diagnosed with gestational diabetes during pregnancy.
Hypertensive/ high blood pressure ( blood pressure ≥ 140/90 mm of Hg ) or taking medicine for high blood pressure
High density lipoprotein – good cholesterol (HDL) less than 35 mg/ dl and triglyceride level > 250 mg/ dl.
Women with poly cystic ovary syndrome. (PCODs)
HbA1C ≥ 5.7 %
History cardio vascular disease.

Fasting	Blood Sugar
Normal for person without diabetes ADA recommendation for someone with diabetes	70-99 mg/dl 80-130 mg/dl
Two Hours After Meal	Blood Sugar
Normal for person without diabetes ADA recommendation for someone with diabetes	Less than 140 mg/dl Less than 180 mg/dl
HbA1C	Blood Sugar
Normal for person without diabetes ADA recommendation for someone with diabetes	Less than 5.7% 7% or less

Diagnosis of Diabetes

Diabetes can be diagnoised using any of the below methods. Depending upon the case history, medical practitioners recommend two or more of the below tests to diagnose diabetes. Taking any kind of medications can affect the diagnosis. Hence, its advisable to discuss the medicines (if any) that you are taking prior to get tested.

Glycosylated hemoglobin (HbA1C)

HbA1 c is proposed for the diagnosis of pre diabetes and diabetes. As the concentration of glucose in blood increases, more of it gets attached to hemoglobin forming glycosylated hemoglobin (HbA1c). Once the hemoglobin molecules are glycosylated it remains that way. A build up HbA1c with in the normal cell reflects the average level of glucose to which the cell has been exposed during its life cycles of 120 days and therefore shows the general trends of glucose levels in the blood during previous 2-3 months.

Normal Range – vary from 5-6 % in normal subjects while in diabetes it increases to over 6 %.

Generally, HbA1c level of 5% reflects average blood glucose levels of 90 mg/dl and every 1% increase in HbA1c corresponds to 30 mg/dl increase in blood glucose. Thus HbA1c level of 6 % corresponds to blood glucose level of 120 mg/dl.

Duration to check HbA1C – Every 3 months and 6 months, a diabetic patient should check HbA1c parameter.

Random Plasma Glucose Level

One may diagnose diabetes in person with symptoms of diabetes if the random (any time of day unrelated to last meal) plasma glucose level are more than 200 mg/dl

Fasting Blood Glucose Level

Fasting blood glucose should be 12 hrs. of fasting. It means if someone finishes the last meal at 8 pm night, then fasting blood sugar should be check after 12 hrs. of fasting in morning at 8 am. It is a common way to diagnose prediabetes, diabetes or gestational diabetes. Patient is not allowed to eat or drink anything (except water) during these 12 hours. Patient is not allowed to exercise or undertake any strainous work before the samples for fasting blood glucose are collected. These can affect the results.

Postprandial Blood Glucose Level

Postprandial means after meal. This test is conducted 2 hours after a person has had a meal. This test is a common way to diagnose prediabetes, diabetes or gestational diabetes. This test is done to check if your body is preparing enough insulin to keep the blood glucose level under control. It is essential for the blood glucose to return to normal within 2 hours of having a complete meal.
The 2 hours time starts from when a patient has started having the meal. It is expected that a patient should complete his/her meal in 15-20 mins.

Oral Glucose Tolerance Test (OGTT)

OGTT is conducted to measure body's ability to use sugar after a person has a sugary drink. The test is conducted after 12 hours of fasting. A patient is provided 75 grams of glucose dissolved in 300 ml of water or 1.75 grams per kg of body weight. Blood glucose level is measured after two hours of having glucose. Patient is expected to rest and should not smoke or have any drugs during these two hours.
If the2 hour’s blood glucose level is between 140-199 mg/ dl, the person is labeled as having IGT, a type of pre diabetes called as Impaired Glucose Tolerance.
A level at or above 200 mg/dl is required to defines Diabetes mellitus but needs to be confirmed again if patient has no symptoms of (polyuria, polydipsia/ weight loss).
In an asymptomatic person if confirmed by a second test, a 2 hours glucose level of 200 mg/dl or above should mean the person has Diabetes.