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Why is blood sugar checked at home?
What units are used to measure blood sugar?
Glucose levels are measured in either:
1. Milligrams per deciliter (mg/dl)
2. Millimoles per liter (mmol/l), which can be acquired by dividing (mg/dl) by factor of 18.

Do blood glucose levels vary before and after meals and at various times of a day?
Yes, they do.

How is chronic hyperglycemia measured?
HbA1c

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?

Common Questions

1. Can I test myself at home for blood glucose levels?
2. Can I test my urine glucose instead of my blood?
3. What are the usual treatments for diabetes?
4. How can a diabetic educator help me?
5. How is hypoglycemia diagnosed?
6. How is glucose different from table sugar?

Blood glucose monitoring
Blood Glucose Monitoring Devices

What is HbA1c

Blood Glucose A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Glucose comes from carbohydrate foods. It is the main source of energy used by the body. Insulin is a hormone that helps your body's cells use the glucose. Insulin is produced in the pancreas and released into the blood when the amount of glucose in the blood rises. Normally, your blood glucose levels increase slightly after you eat. This increase causes your pancreas to release insulin so that your blood glucose levels do not get too high. Blood glucose levels that remain high over time can damage your eyes, kidneys, nerves, and blood vessels. Several different types of blood glucose tests are used. * Fasting blood sugar (FBS) measures blood glucose after you have not eaten for at least 8 hours. It is often the first test done to check for prediabetes and diabetes. * 2-hour postprandial blood sugar measures blood glucose exactly 2 hours after you start eating a meal. * Random blood sugar (RBS) measures blood glucose regardless of when you last ate. Several random measurements may be taken throughout the day. Random testing is useful because glucose levels in healthy people do not vary widely throughout the day. Blood glucose levels that vary widely may mean a problem. This test is also called a casual blood glucose test. * Oral glucose tolerance test is used to diagnose prediabetes and diabetes. An oral glucose tolerance test is a series of blood glucose measurements taken after you drink a sweet liquid that contains glucose. This test is commonly used to diagnose diabetes that occurs during pregnancy (gestational diabetes). For more information, see the medical test Oral Glucose Tolerance Test. This test is not commonly used to diagnose diabetes in a person who is not pregnant. Why It Is Done Blood glucose tests are done to: * Check for diabetes. * Monitor treatment of diabetes. * Check for diabetes that occurs during pregnancy (gestational diabetes). * Determine if an abnormally low blood sugar level (hypoglycemia) is present. A test to measure blood levels of insulin and a protein called C-peptide may be done along with a blood glucose test to determine the cause of hypoglycemia. For more information, see the medical test C-Peptide. Blood Glucose (continued) How To Prepare Fasting blood sugar (FBS) For a fasting blood sugar test, do not eat or drink anything other than water for at least 8 hours before the blood sample is taken. If you have diabetes, you may be asked to wait until you have had your blood tested before taking your morning dose of insulin or diabetes medicine. 2-hour postprandial blood sugar For a 2-hour postprandial test, start eating a meal exactly 2 hours before the blood sample is taken. A home blood sugar test is the most common way to check 2-hour postprandial blood sugar levels. Random blood sugar (RBS) No special preparation is required before having a random blood sugar test. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information formpdf(What is a PDF document?). How It Is Done The health professional taking a sample of your blood will: * Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein. * Clean the needle site with alcohol. * Put the needle into the vein. More than one needle stick may be needed. * Attach a tube to the needle to fill it with blood. * Remove the band from your arm when enough blood is collected. * Apply a gauze pad or cotton ball over the needle site as the needle is removed. * Apply pressure to the site and then a bandage. How It Feels The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch. Risks There is very little risk of a problem from having blood drawn from a vein. * You may develop a small bruise at the puncture site. You can reduce the risk of bruising by keeping pressure on the site for several minutes after the needle is withdrawn. * In rare cases, the vein may become inflamed after the blood sample is taken. This condition is called phlebitis and is usually treated with a warm compress applied several times daily. * Continued bleeding can be a problem for people with bleeding disorders. Aspirin, warfarin (Coumadin), and other blood-thinning medicines can also make bleeding more likely. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your health professional before your blood is drawn. Normal A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Results are often ready in 1 to 2 hours. Glucose levels in a blood sample taken from your vein (called a blood plasma value) may differ a little than glucose levels checked with a finger stick. The normal values listed here-called a reference range-are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what’s normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

**Blood glucose**
Fasting blood glucose:	70-99 milligrams per deciliter (3.9-5.5 mmol/L)
2 hours after eating (postprandial):	70-145 mg/dL (3.9-8.1 mmol/L)
Random (casual):	70-125 mg/dL (3.9-6.9 mmol/L)

Many conditions can change your blood glucose levels. Your doctor will discuss any significant abnormal results with you in relation to your symptoms and past health. High values You may have diabetes. But your doctor will not use just one test result to diagnose you with the condition. * The American Diabetes Association (ADA) criteria for diagnosing diabetes are met when any of the following results have been repeated on at least two different days: o A fasting blood glucose level is 126 mg/dL (7.0 mmol/L) or higher. o A 2-hour oral glucose tolerance test result is 200 mg/dL (11.1 mmol/L) or higher. For more information, see the medical test Oral Glucose Tolerance Test. o Symptoms of diabetes are present and a random blood glucose test is 200 mg/dL (11.1 mmol/L) or higher. Symptoms of diabetes include increased thirst and frequent urination (especially at night), unexplained increase in appetite, unexplained weight loss, fatigue, erection problems, blurred vision, and tingling or numbness in the hands or feet. * If your fasting blood glucose level measures in the range of 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L), you are considered to have prediabetes (impaired fasting glucose), and you have an increased chance of getting diabetes. * Other conditions that can cause high blood glucose levels include severe stress, heart attack, stroke, Cushing's syndrome, medicines such as corticosteroids, or excess production of growth hormone (acromegaly). Low values A fasting glucose level below 40 mg/dL (2.2 mmol/L) in women or below 50 mg/dL (2.8 mmol/L) in men that is accompanied by symptoms of hypoglycemia may mean you have an insulinoma, a tumor that produces abnormally high amounts of insulin. Blood Glucose (continued) What Affects the Test Reasons you may not be able to have the test or why the results may not be helpful include: * Eating or drinking less than 8 hours before a fasting blood test or less than 2 hours before a 2-hour postprandial test. * Drinking alcohol. * Illness or emotional stress, smoking, and caffeine. Taking a medicine, such as birth control pills, medicines used to treat high blood pressure, phenytoin (Dilantin), furosemide (Lasix), triamterene (Dyrenium, Dyazide), hydrochlorothiazide (Esidrix, Oretic), niacin, propranolol (Inderal), or corticosteroids (prednisone), can cause changes in your test results. Make sure that your doctor knows about any medicines you take and how often you take them. What To Think About * Other tests are needed to accurately diagnose diabetes. A blood glucose test may not identify some people with prediabetes or early diabetes. Many experts recommend using a glucose tolerance test if your fasting blood glucose level measures in the range of 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L). This range is above the normal range but below the range that indicates diabetes. For more information, see the medical test Oral Glucose Tolerance Test. * Glucose levels in urine can also be measured. Many people with diabetes have glucose in their urine. But the level in the blood must be very high before glucose can be detected in the urine. For this reason, tests for glucose in urine are not used to diagnose or monitor diabetes. For more information, see the medical test Urine Test. * If you have diabetes, you will be able to measure your blood glucose levels at home. For more information, see the medical test Home Blood Glucose Test. * A glycohemoglobin test can help monitor the long-term control of blood glucose levels in people with diabetes. This test is the preferred method of monitoring long-term control of blood sugar levels. For more information, see the medical test Glycohemoglobin (GHb). * An oral glucose tolerance test may be done with a blood glucose test to confirm a diagnosis of diabetes. An oral glucose tolerance test is most commonly done to screen pregnant women for gestational diabetes. For more information, see the medical test Oral Glucose Tolerance Test.

How is it used?

The blood glucose test may be used to:

Screen for both high blood glucose (hyperglycemia) and low blood glucose (hypoglycemia)
Help diagnose diabetes
Monitor glucose levels in persons with diabetes

Depending on the purpose of testing, 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 challenge or tolerance test (OGTT / GTT).

Screening
Blood glucose is often measured as part of a group of tests, such as a CMP (Comprehensive Metabolic Panel), during routine physicals. This is done to screen for diabetes, which often causes no symptoms early in its course, and for pre-diabetes – moderately increased blood glucose levels that indicate an increased risk of developing type 2 diabetes. For screening purposes, a CMP or blood glucose test is performed on a fasting basis (fasting blood glucose, FBG).

Many 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 (GCT). For this test, a woman is given a standard amount of a glucose solution to drink. After one hour, her glucose level is measured and if the level is higher than a defined value, then a longer OGTT (usually 2 or 3 hours) is performed to clarify the woman's status. This is the recommendation of the American Congress of Obstetricians and Gynecologists.

In 2011, the American Diabetes Association adopted guidelines that recommend changes in the way women are tested for gestational diabetes. Instead of the GCT described above, a 2-hour OGTT, using a 75-gram glucose drink, is performed. If one or more of her glucose levels at fasting, 1 hour, or 2 hours are above a certain level, then she is diagnosed as having gestational diabetes.

The ADA’s new recommendations follow those proposed in 2010 by the International Association of Diabetes and Pregnancy Study Group (IADPSG). This group based their recommendations on results of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) trial. This large study found that risk to babies increases with the gradual increase of maternal glucose levels; it determined that there is an increased risk of adverse outcomes for a baby even when only one of the mother’s glucose levels is below the cutpoints used to diagnose gestational diabetes, and slightly lowered some of the cutpoints from those used in older guidelines. (For more on this, read the article Panel Suggests New Criteria for Gestational Diabetes.)

Diagnosis
The American Diabetes Association recommends a fasting glucose or a different test, the hemoglobin A1c (A1c), to diagnose diabetes but says that testing should be done twice, at different times, preferably with the same test in order to confirm a diagnosis of diabetes. Another way to diagnose diabetes, especially if the screening test is not diagnostic, is the OGTT test. This test is a series of blood glucose tests. A fasting glucose is collected; then the person being tested 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.

In those with suspected hypoglycemia in which an initial FBG result is low, the glucose test is used as part of the "Whipple triad" to confirm a diagnosis. (See Common Questions #5).

Monitoring
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.

Urine
Urine glucose is one of the substances tested 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 person may have a urinary tract infection or for a variety of other reasons. The doctor may follow up 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 with a glucose test may occur during public health fairs or as part of workplace health programs. It may also be ordered when someone 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 high blood glucose (hyperglycemia), such as:

Increased thirst, usually with frequent urination
Fatigue
Blurred vision
Slow-healing infections

or symptoms of low blood glucose (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.

Pre-diabetes is characterized by fasting or OGTT levels that are higher than normal but lower than those defined as diabetic. The doctor may order a glucose test at regular intervals to monitor the person's status.

With known diabetics, doctors will order glucose levels periodically in conjunction with other tests such as A1c to monitor glucose control over time. Occasionally, a blood glucose level may be ordered along with insulin and C-peptide to evaluate insulin production.

Diabetics are often required to self-check their glucose, up to 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 have had gestational diabetes with a previous pregnancy. 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?

Blood Glucose

High levels of glucose most frequently indicate diabetes, but many other diseases and conditions can also cause an elevated blood 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 occasion	Diabetes

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 occasion	Diabetes

Gestational Diabetes Screening: Glucose Challenge Test (as currently recommended by the American Congress of Obstetricians and Gynecologists)

Sample drawn 1 hour after a 50-gram glucose drink.
Glucose Level	Indication
Less than 140* mg/dL (7.8 mmol/L)	Normal screen
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

In 2011, the American Diabetes Association adopted new guidelines that recommend a 2-hour glucose tolerance test rather than a 3-hour OGTT as still recommended by the American Congress of Obstetricians and Gynecologists. Details from both are included below.
Time of Sample Collection	Current ACOG Target LEVEL	ADA Target Level
	Glucose load: Samples drawn after 100-gram glucose drink	Glucose load: Samples drawn after 75-gram glucose drink
Fasting (prior to glucose load)	95 mg/dL (5.3 mmol/L)	92 mg/dL (5.1 mmol/L)
1 hour after glucose load	180 mg/dL (10.0 mmol/L)	180 mg/dL (10.0 mmol/L)
2 hours after glucose load	155 mg/dL (8.6 mmol/L)	153 mg/dL (8.5 mmol/L)
3 hours after glucose load	140 mg/dL (7.8 mmol/L)	Not applicable
Results interpretation	If TWO or more values meet or exceed the target level, gestational diabetes is diagnosed.	If ONE or more values meet or exceed the target level, gestational diabetes is diagnosed.

Moderately increased blood glucose levels may be seen in those with pre-diabetes. Left un-addressed, pre-diabetes increases the risk of developing type 2 diabetes.

Some other diseases and conditions that can result in an elevated blood glucose level include:

Acromegaly
Acute stress (response to trauma, heart attack, and stroke for instance)
Chronic kidney failure
Cushing syndrome
Excessive food intake
Hyperthyroidism
Pancreatic cancer
Pancreatitis

A low level of glucose may indicate hypoglycemia, a condition 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). A diagnosis of hypoglycemia uses three criteria known as the Whipple triad. (See the common questions section.).

A low blood glucose level (hypoglycemia) may be seen with:

Adrenal insufficiency
Drinking excessive alcohol
Severe liver disease
Hypopituitarism
Hypothyroidism
Insulin overdose
Insulinomas
Starvation

Urine Glucose

Low to undetectable urine glucose results are considered normal. Any condition that raises blood glucose such as diabetes or the other conditions listed above also has the potential to elevate the concentration of glucose in the urine.

Increased urine glucose may be seen with medications, such as estrogens and chloral hydrate, and with some forms of kidney disease.

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Is there anything else I should know?

Extreme stress can cause a temporary rise in blood glucose. This can be a result of trauma, surgery, heart attack or stroke, for example.

Drugs, including corticosteroids, tricyclic antidepressants, diuretics, epinephrine, estrogens (birth control pills and hormone replacement), lithium, phenytoin, and salicylates, can increase glucose levels, while drugs such as acetaminophen and anabolic steroids can decrease levels.

Can I test myself at home for blood glucose levels?

Can I test my urine glucose instead of my blood?

What are the usual treatments for diabetes?

How can a diabetic educator help me?

How is hypoglycemia diagnosed?

How is glucose different from table sugar?

1. Can I test myself at home for blood glucose levels?

If you are not diabetic or pre-diabetic, there is usually no reason to test glucose levels at home. Screening done as part of your regular physical should be sufficient.

If you have been diagnosed with diabetes, however, your doctor or diabetes educator will recommend a home glucose monitor (glucometer, or one of the newer methods that use very tiny amounts of blood or tests the interstitial fluid -- the fluid between your cells -- for glucose). You will be given guidelines for how high or low your blood sugar should be at different times of the day. By checking your glucose regularly, you can see if the diet and medication schedule you are following is working properly for you.

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2. Can I test my urine glucose instead of my blood?

Not in most cases. Glucose will usually only show up in the urine if it is at sufficiently high levels in the blood so that the body is "dumping" the excess into the urine, or if there is some degree of kidney damage and the glucose is leaking out into the urine. Urine glucose, however, is sometimes used as a rough indicator of high glucose levels and the urine indicator strip (dipstick) that measures the glucose is occasionally useful for tracking the presence of protein and in the urine.

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3. What are the usual treatments for diabetes?

For type 2 diabetes, which is the most common type of diabetes, losing excess weight, eating a healthy diet that is high in fiber and restricted in carbohydrates, and getting regular amounts of exercise may be enough to lower your blood glucose levels. In many cases, however, oral medications that increase the body's secretion of and sensitivity to insulin are necessary to achieve the desired glucose level. With type 1 diabetes (and with type 2 diabetes that does not respond well enough to oral medications), insulin injections several times a day are necessary.

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4. How can a diabetic educator help me?

If you are diabetic, a diabetic educator (often a nurse with specialized training) can make sure that you know how to:

Recognize and know how to treat both high and low blood sugar.
Test and record your self-check glucose values.
Adjust your medications.
Administer insulin (which types in which combinations to meet your needs).
Handle medications when you get ill.
Monitor your feet, skin, and eyes to catch problems early.
Buy diabetic supplies and store them properly.
Plan meals. Diet is extremely important in minimizing swings in blood glucose levels. A registered dietician can help you learn how to plan meals and a diabetic educator can help with this as well.

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5. How is hypoglycemia diagnosed?

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 when the blood glucose level is abnormally low

• 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

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6. How is glucose different from table sugar?

Table sugar (sucrose) is a combination of two simple sugars, glucose and fructose, that are both released when table sugar is digested. Because glucose is the body's primary energy source, the blood glucose test is often informally referred to as a "blood sugar" test.

http://labtestsonline.org/understanding/analytes/glucose/tab/faq