While patients may be tested for diabetes due to a variety of reasons, the guidelines suggest the following groups be tested People who are overweight and have one or more risk factors Overweight adults include people with a BMI >25 kg/m Risk factors (link to risk factors tab) People who have signs of high blood sugar (link to HBS tab) People with several risk factors Women who are pregnant Confirming a Diabetes diagnosis will be based on one of the following lab values: A1c levels of 6.5% or higher indicate diabetes OR Fasting plasma glucose (FPG) > 126mg/dL OR 2-hour plasma glucose level of >200mg/dL during an oral glucose tolerance test using glucose load containing the equivalent to 75g of glucose dissolved in water OR Classic symptoms of hyperglycemia (polyuria, polydipsia, polyphagia) or hyperglycemic crisis, with a random plasma glucose of >200 mg/dL

High blood sugar is known as hyperglycemia and occurs when the amount of sugar in the blood is elevated. A blood sugar of more than 130 mg/dl is considered abnormal. While people with diabetes are at higher risk for hyperglycemia, not all people who have hyperglycemia will have diabetes. Causes of High Blood Sugar Too much food Not enough Insulin Stress Medications Normal Response to High Blood Sugar: When the amount of sugar in the blood is elevated the body signals the pancreas to secrete insulin. Insulin facilitates the transport of sugar into the cells to be used for immediate energy and storage of excess sugar in the liver and muscles for later use. Recommended Read:  Foods to Eat When You Have Low Blood Sugar Dangerously High Blood Sugar: When blood sugar levels become dangerously high it is considered a medical emergency and immediate medical attention is needed. Do not wait until your blood sugar is dangerously high to call your doctor. Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome can cause dangerously high blood sugar. Diabetic Ketoacidosis: A potentially life-threatening condition that results from a lack of insulin and elevated blood glucose. Since glucose is not being used for energy the body begins to break down fats which lead to ketoacidosis.

Low blood sugar is known as hypoglycemia and occurs when the amount of sugar (glucose) in the blood is low. A blood sugar of less than 70mg/dl is considered abnormal or low. While people with diabetes are at higher risk for hypoglycemia, due to effects from diabetes medications, not all people who have hypoglycemia will have diabetes. Causes of Low Blood Sugar Not enough food (glucose) Long periods of time between meals (>3-5 hours) Too much insulin Too much diabetes medications Strenuous exercise Illness Normal Response to Low Blood Sugar When the amount of sugar in the blood is low, the body will send signals to the pancreas indicating that the sugar is decreasing. The pancreas, in turn, signals the liver to break down the stored glucose in the liver and as a result blood sugar rises. In addition, physiological symptoms such as hunger and fatigue will be experienced, which is your body’s way of telling you that it is time to eat. Symptoms of Low Blood Sugar Hunger Fatigue and drowsiness Confusion Dizziness Shakiness Rapid Heart rate Blurred vision Mood changes and Irritability In extreme cases of low blood sugar, the person may experience loss of consciousness or have seizures Treatment for Low Blood Sugar:

Maintenance of diabetes is an ongoing process that requires regular testing. It is very important that patients with Diabetes keep a close eye on not only their blood sugar levels, but other conditions that also impact overall health such as blood pressure and cholesterol. Ideal Lab Values for Diabetes These blood work goals represent the lab values that should be maintained in order to reduce risk of complications in the diabetic patient. A1c  should be at <7.0 or lower Before meal glucose level should be between  70-130 mg/dL After meal glucose  levels should be less than 180 mg/dL Blood pressure should be below <130/80 Cholesterol LDL: less than <100 in those without heart disease  and less than <70 in those with cardiovascular disease HDL: greater than >40 in males  and greater than >50 in females TG:  should be below <150

Health Maintenance Schedule For Diabetes The maintenance schedules are used to ensure treatment goals are maintained. Schedules for checking lab values are individualized and the discretion of your provider, but guidelines suggest At least once a year test the following Kidney function tests (GFR, albumin in urine) Eye exam with ophthalmologist Foot exam with podiatrist Influenza vaccine Cholesterol if stable, more frequently if not at target or after starting a new medication and/or implementing lifestyle changes Every 3-6 Months Check A1c 2x year in controlled and 4x year in uncontrolled or after change in medication regimen Have a dental cleaning Every Doctor’s Visit Weight Blood pressure Foot exam