Mr. Hernandez is an overweight (BMI 30 kg/m2), 45-year old plumber of Hispanic heritage who arrives at your office for a first-time visit. He has not been to a physician during the last 7 years because he hasn’t always had health insurance and “doesn’t like going to the doctor.” However, he has been noticing lately that his vision seems a little blurry and he’s developed a red, itchy rash in his groin. He is a non-smoker and recalls being told a long time ago that he should eat a low salt diet, but he can’t remember why. On examination, his BP is 154/96 mm/Hg, and his pulse is 72, RR 22. His physical exam is notable for signs of a yeast infection in his groin. You order a CBC and A1C to be drawn that day before he leaves. You advise him how to treat his skin infection. When you receive the results of the chem 12 panel, it shows a random plasma glucose of 162 mg/dL and A1C 7.3%. You call Mr. Hernandez and ask him to return the next morning, before he has eaten, for additional labs.
In this individual, you might order all the following labs EXCEPT:
Urine and/or blood ketone tests are usually ordered to monitor the progress of patients being treated for ketoacidosis or who present with symptoms of acute/moderate-severe hyperglycemia, ketosis, ketonuria or ketoacidosis. The other listed test are all part of the initial laboratory evaluation. In order to meet the ADA’s criteria for the diagnosis of diabetes, initial lab results showing elevated A1C, FPG or OGTT levels, need to be confirmed by repeat testing. The laboratory components of a comprehensive diabetes evaluation are:
- A1C, if results not available in the past 2-3 months
- Fasting lipid profile
- Liver function tests
- Test for urine albumin excretion with urine albumin-to-creatinine ratio
- Serum creatinine and calculated GFR
- TSH in type 1 diabetes, dyslipidemia or women over age 50 years
American Diabetes Association. Standards of medical care in Diabetes – 2013. Diabetes Care. January 2013; 36(Suppl. 1):S11-S66. Available at http://care.diabetesjournals.org/content/36/Supplement_1/S11.full. Accessed Jan. 11, 2013.