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Comprehensive Diabetes Tests

Apr 7, 2018
 

Mr. Hernandez is a 45-year-old plumber of Hispanic heritage who has excessive weight (BMI 30 kg/m2). He 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 blood test, 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:

Correct

Correct answer: D. urine ketones

Educational Critique: 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 tests 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, FGP, 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 GFDR
  • TSH in type 1 diabetes, dyslipidemia or women over age 50 years
Incorrect