Showing posts with label Diseases. Show all posts

May 10, 2025

Mar 11, 2015

Hepatic Failure News.....

Hepatic failure can result from acute liver injury, causing acute liver failure (ALF) or fulminant hepatic failure (FHF), or progressive chronic liver disease such as cirrhosis. An alteration in hepatocyte functioning affects the liver metabolism, detoxification process, protein synthesis, manufacture of clotting factors, and preservation of immunocompetence. FHF occurs when severe hepatic injury results in encephalopathy and severe coagulopathy within 28 days of the onset of symptoms in patients without a history of chronic liver disease. Liver transplant is the only viable treatment option for patient with FHF. The most commonly identified cause of FHF is drug induced, with acetaminophen the most common culprit, followed by viral hepatitis. Other causes include infection (cytomegalovirus [CMV], adenovirus), metabolic disorders and severe ischemic insult or shock.

Signs and Symptoms

Manifestation depends on the complications associated with the liver dysfunction.
Patient behavior may range from agitation to frank coma.
Evidence of GI bleeding, renal failure, or respiratory distress may also be present.
The initial manifestation in FHF is commonly bleeding from coagulopathy.

Physical Examination

Vital signs

BP: < 90 mm Hg (with shock)
HR: > 120 beats/min (with shock)
Temperature may be mildly elevated
RR: tachypnea initially progressing to respiratory depression associated with encephalopathy.

Neurologic

Mildly confused to coma
Personality changes
Asterixis

Pulmonary

Crackles
Labored respirations

Gastrointestinal

Hematemesis and melena
Ascites
Hepatomegaly may be present
Splenomegaly may be present
Factor hepaticus
Diarrhea

Skin

Jaundice
Ecchymosis and petechiae
Pruritus
Edema

Acute Care Patient Management

Nursing Diagnosis: Deficient fluid volume related to ascites secondary to hypoalbumineia, bleeding secondary to decreased clotting factors or variceal hemorrhage, and diuretic therapy.
Outcome Criteria

BP 90 TO 120 mm Hg
Central venous pressure 2 to 6 mm Hg
Serum albumin 3.5 to 5 mg/dl
Platelet count >50,000/mm3
Urine output 30 ml/hr
Serum sodium 135 to 145 mEq/L
Serum potassium 3.5 to 5 mEq/L
Intake approximates output

Patient Monitoring

Obtain pulmonary artery pressure, central venous pressure, and blood pressure until the patient’s condition is stable, then hourly.
Continuously monitor ECG for lethal dysrhythmias that may result from electrolyte and acid-base imbalances.
Monitor fluid volume status. Measure intake and output hourly.

Patient Assessment

Assess hydration status. Note skin turgor on inner thigh or forehead, condition of buccal memranes, and development of edema and crackles.
Assess for signs and symptoms of bleeding.
Measure abdominal girth once each shift to determine progression of ascites.
Assess respiratory status.

Diagnostic Assessment

Review serial serum ammonia, albumin, bilirubin, platelet count, PT, PTT and ALT to evaluate hepatic function.
Review serial serum electrolytes.
Review urine electrolyte, BUN, and creatinine to evaluate renal function.

Patient Management

Administer intravenous crystalloids as ordered.
Administer potassium as ordered. Validate adequate urine output before potassium administration.
Sodium restriction of 0.5 g/day and fluid restriction to 1000 ml/day may be ordered.
Vitamin K or fresh frozen plasma (FFP) may be required to promote the clotting process.
Institute bleeding precautions. Avoid razor blades and use soft-bristled toothbrushes.
Paracentesis may be performed if abdominal distention is severe.
Prepare the patient and family for liver transplant, as indicated.

Jan 12, 2012

Vasculitis-Prevention, Diagnosis, and Management....

Vasculitis is an inflammation and necrosis of the blood vessels, leading to hemorrhage, ischemia, and infarction.. Treatment of the condition is entirely dependent on the extent of the disease. In many instances, cutaneous vasculitis is a self-limited condition, relieved by leg elevation, avoidance of standing, and therapy with non-steroidal anti-inflammatory drugs (NSAIDs). However, more extensive or severe disease can prove more difficult to manage.

Treatment of vasculitis should begin with a confirmatory diagnosis to eliminate conditions with a similar appearance. A tissue biopsy may confirm diagnosis of cutaneous vasculitis, and can sometimes be used to identify the type of immunoglobin involved. Once a diagnosis is confirmed histologically, other organ systems should be evaluated to identify potential causative factors.

The first and preferred treatment for cutaneous vasculitis should always be avoidance of triggers known to exacerbate the condition, such as excessive standing, infection, or drugs. For mild recurrent or persistent disease, colchicine and dapsone are first-choice agents.

Severe cutaneous disease requires treatment with systemic corticosteroids or more potent immunosuppression (azathioprine, methotrexate, or cyclophosphamide are typical treatments). A combination of corticosteroids and cyclophosphamide is required therapy for systemic vasculitis, which is associated with a high risk of permanent organ damage or death. Intravenous immunoglobin or plasmapheresis may be useful in the treatment of severe, refractory vasculitis, or in patients who have contraindications to traditional immunosuppression.

New biologic therapies that act via cytokine blockade or lymphocyte depletion, such as the tumor necrosis factor-α inhibitor infliximab and the anti-B-cell antibody rituximab, respectively, appear to offer some benefit in certain settings, such as connective tissue disease and anti-neutrophil cytoplasmic antibody-associated vasculitis.

This is article 3 in a series of four articles pertaining to vasculitis. To read the additional articles click title link, or click here.

Vasculitis is the inflammation of blood vessels. There are many types of vasculitis. Diseases in which vasculitis is a primary process are called primary systemic vasculitides. Vasculitis may also occur as a secondary feature in other rheumatic diseases and syndromes

WHAT YOU NEED TO KNOW ABOUT VASCULITIS

What is vasculitis?
Vasculitis is a general term that refers to the inflammation of blood vessels. When blood vessels become inflamed, they can only react in limited ways. They may become weakened, stretch and increase in size, or become narrow – even to the point of closing off entirely.

What are the consequences of vasculitis?
In an extreme situation, when a segment of a blood vessel becomes weakened, it may then stretch and bulge (called an “aneurysm”). The wall of the blood vessel can become so weak that it ruptures and bleeds. Fortunately, this is a very rare event.

If a blood vessel becomes inflamed and narrowed, blood supply to that area may be partially or completely eliminated. If collateral blood vessels (thought of as alternate routes of blood supply) are not available in sufficient quantity to carry the blood to such sites, the tissue supplied by the affected blood vessels will die. This is called infarction.

Because vasculitis can occur in any part of the body, any tissue or organ can be at risk.

Who is affected by vasculitis?
Vasculitis can affect people of all ages from childhood to adulthood. There are some types of vasculitis that occur in certain age groups more than others.

What are the causes of vasculitis?
Vasculitis may occur secondary to an identified underlying disease or trigger. Occasionally, an allergic reaction to a medicine may trigger vasculitis. Vasculitis can sometimes develop in conjunction with an infection. Usually in these cases, the infection causes an abnormal response in the person’s immune system, damaging the blood vessels. Viral hepatitis (a type of liver infection), is a specific infection that can be associated with vasculitis. Vasculitis may also be related to other diseases of the immune system that the patient had for months or years. For example, vasculitis could be a complication of rheumatoid arthritis, systemic lupus erythematosus, or Sjögren’s syndrome.

In many cases though, the causes of vasculitis are not known. These diseases are collectively sometimes referred to under the broad heading of primary forms of vasculitis. In such settings, the appearance and location of the vasculitis often behaves in a distinct way allowing it to be diagnosed as a unique type of vasculitis and is given a specific name.

What are the types of primary vasculitis?
There are many types of primary vasculitis including disease entities such as Wegener’s granulomatosis, microscopic polyangiitis, Henoch-Schönlein purpura, polyarteritis nodosa, Kawasaki disease, giant cell arteritis, Takayasu’s arteritis, and Behçet’s disease. Some are named after doctors (Wegener, Takayasu, Kawasaki) who were among those to provide the best original descriptions of the illness or are named based on features seen on biopsies (giant cell arteritis, angiitis, arteritis nodosa) of affected tissues or blood vessels. Although most of these are systemic (or generalized) vasculitides where the vasculitis may affect many organ systems at the same time, they often differ a great deal among each other. Some of the primary systemic vasculitic diseases may be quite mild and require little or even no treatment. Other forms may be severe, affecting critical organs and, if left untreated, may lead to death within days or months.
Some forms of primary vasculitis may be restricted in their location to certain organs (these are called isolated forms of vasculitis). Examples include vasculitis that only occurs either in the skin, eye, brain (isolated CNS vasculitis) or certain internal organs.

What are the symptoms of vasculitis?
Because any organ system may be involved, an enormous number of symptoms are possible. If the skin is involved, there may be a rash. If nerves suffer loss of blood supply, there may initially be an abnormal sensation followed by a loss of sensation. Vasculitis in the brain may cause a stroke, or in the heart may result in a heart attack. Kidney inflammation usually is not associated with symptoms and is detected by the doctor by examination of the urine. This is important to recognize as inflammation in the kidneys can lead to kidney failure unless promptly detected.

Sometimes the symptoms are nonspecific. When inflammation is present in the body, we tend to respond in ways that tell us that we are not well, but those responses may not be unique to vasculitis at all. For example, along with the symptoms mentioned previously, a person with vasculitis may also have a fever or experience loss of appetite, weight loss and loss of energy.

How is vasculitis treated?
Treatment depends entirely upon the diagnosis, the organs that are affected, and the severity of the vasculitis. When vasculitis represents an allergic reaction, it may be “self limiting,” or will go away on its own and not require treatment. There are other instances also where minimal to no treatment is required and the person can be closely observed.

In instances where critical organs such as the lungs, brain or kidneys are involved, the outlook is less positive and aggressive and timely treatment is necessary. For most forms of systemic vasculitis, treatment generally includes corticosteroid medications (prednisone is the most commonly prescribed).

For some forms of vasculitis, treatment must also include another immunosuppressive medication used in combination with the prednisone. Some of these medications are chemotherapy agents like those used to treat cancer, but are given in doses considerably lower than people with cancer may receive. The goal of this type of chemotherapy is to suppress the abnormal immune response that has led to blood vessel damage.

What is the outlook for people with vasculitis?
The outlook for a person who has vasculitis will vary with the type of vasculitis that is present, what organs are being affected, how severe the vasculitis is, and how the person responds to treatment. Knowing the type of vasculitis allows the doctor to predict the likelihood of illness severity and outcome.

Prior to the time of available treatment, people with severe vasculitis may have had anticipated survival of only weeks to months. However, today with proper treatment, normal life spans are possible. The success of therapy is related to prompt diagnosis, aggressive treatment and careful follow-up to be sure that side effects from medications do not develop.

Once vasculitis is under control (often referred to as “remission”), medications may be cautiously withdrawn, with the hope that the patient will sustain a long remission, independent of treatment. Because some forms of vasculitis can recur (referred to as a “relapse”) after a period of remission, it is very important for patients with vasculitis to remain under the care of a knowledgeable physician.

Jan 9, 2012

Diabetes Animation...Maintaining Blood Glucose Homeostasis.....

Adherence to Post MI Medications

Stroke Risk Associated With Diet Quality, Energy Intake Overall.....

Clinical Context...

Undernutrition before birth, as well as in infancy, childhood, and adulthood, is associated with an increased risk for stroke in later life. However, the mechanism of increased stroke risk is poorly understood.

In addition, overnutrition also increases stroke risk. The likely mechanism is by hastening the onset of obesity, hypertension, hyperlipidemia, and diabetes. The objective of this review by Hankey was to describe recent evidence regarding the effects of nutrition on stroke risk.

Study Synoposis and Perspective

The overall quality of a person’s diet and the balance between caloric intake and caloric expenditure appear to be more important determinants of stroke risk than the actual foods and nutrients consumed, according to a new review published in the January 2012 special issue of the Lancet Neurology.

In general, the 2 biggest threats to health and risk of stroke are overeating and excess salt, author Graeme J. Hankey, from Royal Perth Hospital, Perth, Western Australia, writes.

"These behaviors are a normal response by people to an abnormal environment," Dr. Hankey notes. "Our living environments have become more conducive to consumption of energy and less conducive to expenditure of energy in developed and increasingly in developing regions."

He writes that between 1970 and 2008, the incidence of stroke in high-income countries fell by 42%, probably as a result of increased public awareness about the dangers of high blood pressure, high cholesterol, and cigarette smoking.

But in poorer countries, the incidence of stroke increased by more than 100% during this period. This rise coincided with food and lifestyle changes associated with industrialization and urbanization.

Small Number of Trials

In his review, Dr. Hankey examines the evidence linking nutrition and diet to the risk of stroke. He searched PubMed articles published in English from 1970 to October 2011, using a variety of search terms.

The review included a small number of randomized trials and large observational and epidemiological studies.

He found that the findings from these studies were diverse, owing to the fact that most were epidemiological and therefore "prone to substantial methodological challenges of bias, confounding, and measurement error."

For example, one observational study found that a high intake of a healthy diet was associated with an increased risk of stroke, whereas another observational study found just the opposite.

Dr. Hankey's review also revealed the following effects of individual foods and beverages on the risk of stroke:

Fish: 3 servings a day associated with a 6% lower risk of stroke
Fruits and vegetables: >5 servings a day associated with a 26% lower risk of stroke
Meat: Each daily serving associated with a 24% increased risk of stroke
Reduced-fat milk: associated with a lower risk of stroke vs full-fat milk
Chocolate: High consumption associated with a 29% lower risk of stroke
Coffee: 3 to 4 cups per day associated with a 17% lower risk of stroke
Tea: ≥3 cups per day associated with a 21% lower risk of stroke
Sugar-sweetened beverages: high intake associated with increased obesity, diabetes, metabolic syndrome, and coronary heart disease
Whole grains: high intake associated with a 21% lower incidence of cardiovascular events
Rice: intake not associated with risk of stroke

"Further research is needed to improve the quality of evidence relating to the association of many nutrients, foods, and dietary patterns with stroke risk," Dr. Hankey suggests.

This requires adequately powered, large randomized trials with carefully described patient populations and interventions. The outcomes of such trials should also distinguish first-ever and recurrent stroke, as well as ischemic and hemorrhagic stroke, and their different etiologies.

Dr. Hankey also suggests that population-wide salt reduction programs led by governments and with industry cooperation could be highly cost effective.

"In the USA, modest, population-wide reductions in dietary salt of up to 3 g per day…are projected to reduce the annual number of new cases of stroke by 32,000 to 66,000, similar to the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels," he writes.

Dr. Hankey told Medscape Medical News that he hopes his study will stimulate conclusive studies "by means of large, randomized controlled trials of the effect of dietary nutrients, foods, and patterns on stroke and its pathological and etiological subtypes."

The current evidence associating dietary nutrients, foods, and patterns with stroke is generally suboptimal for providing reliable conclusions about causality, he reiterated.

"The effect of only a few supplements on stroke risk have been studied by means of large, randomized controlled trials, and all of those have shown no benefit of antioxidant vitamins, B-vitamins, and calcium supplements in preventing stroke, despite large, more suboptimal, epidemiological studies claiming they should be beneficial," he said.

Best Diet Still Uncertain

Commenting on this study for Medscape Medical News, Eugene Storozynsky, MD, a cardiologist from the University of Rochester Medical Center, Rochester, New York, said that he agrees with Dr. Hankey's conclusions.

"This is a good review of the literature as to what role diets and their components would have on reducing stroke, and what it tells us is that there still is a lot of uncertainty about the best diet. One study suggests benefit of a certain food or strategy, the other may come to the opposite conclusion," Dr. Storozynsky said.

The take-home message here is as Dr. Hankey notes, Dr. Storozynsky continued. "We need rigorously done randomized controlled trials to really monitor the long-term effects of diets and nutrients, rather than observation studies that look at individual factors, to see whether or not there is any benefit to adopting certain strategies."

Dr. Storozynsky also noted what he considers to be an important omission from Dr. Hankey's review.

"This review did not look at the effect of exercise and how it affects nutrition or stroke results. Does routine daily exercise mitigate the effect of intermittent poor eating? Exercise definitely needs to be part of the equation," he said.

Helmi L. Lutsep, MD, from the Oregon Stroke Center at Oregon Health Science University in Portland, added, "My quick read of the article suggests that it is a very nicely written, comprehensive review of our current knowledge regarding nutrition and stroke."

Dr. Lutsep, who is also a spokesperson for the American Academy of Neurology, added, "While I haven't seen all of these pieces summarized in one place before, I don't think that the article provides novel observations."

Dr. Hankey reports that he was the principal investigator of the VITAmins TO Prevent Stroke (VITATOPS) trial and has financial relationships with Sanofi-Aventis, Johnson & Johnson, Bristol-Myers Squibb, Boehringer Ingelheim, Bayer, and Pfizer Australia. Dr. Storozynsky and Dr. Lutsep have disclosed no relevant financial relationships.

Lancet Neurol. 2012;11:66-81. Abstract

The National Stroke Association provides a comprehensive discussion for patients about stroke prevention.

Study Highlights

On the basis of a literature review, the reviewer noted the following findings:
- Vitamin A supplementation increases all-cause mortality risk.
- β-carotene supplementation increases cardiovascular and all-cause mortality risks and does not prevent stroke.
- Vitamin C supplementation does not prevent stroke.
- Vitamin E supplementation increases all-cause mortality risk and does not prevent stroke.
- Although folic acid supplementation does not prevent stroke in populations with high folate intake, deficiency in regions of low folate intake may be a causal and treatable risk factor for stroke.
- Vitamin D deficiency is associated with hypertension, cardiovascular disease, and stroke, but to date, supplementation has not been shown to prevent cardiovascular events. Randomized trials are underway.
- Salt supplementation by 5 g per day is linked to a 23% increase in stroke risk (95% confidence interval [CI], 6 - 43).
- Although decreasing salt intake has not been shown to reduce stroke risk, lowering consumption by 2 g per day is associated with a 20% decrease in cardiovascular events (95% CI, 1 - 36), and lower salt intake is also linked to blood pressure reduction.
- Potassium supplementation by 1 g per day is associated with an 11% reduction in the risk for stroke (95% CI, 3 - 17), but supplementation is not proven to prevent stroke.
- Potassium supplementation by 0.8 g per day is associated with a decrease in blood pressure by 5/3 mm Hg.
- Calcium supplementation exceeding 0.5 g per day is linked to a 31% increase in the risk for myocardial infarction (95% CI, 2 - 67), does not prevent stroke, and may actually increase stroke risk.
- High intake of total fat, trans fats, and saturated fats is not associated with an increased risk for stroke, and reduced total fat intake does not lower stroke risk.
- High intake of plant n-3 polyunsaturated fats is associated with a reduced risk for stroke.
- Marine n-3 polyunsaturated fat supplementation lowers cardiovascular events and death by 8% (95% CI, 1 - 15), but in a randomized trial, it did not reduce stroke risk.
- High intake of carbohydrates with high glycemic index and glycemic load is associated with increased blood glucose levels, body weight, and stroke mortality.
- High fiber intake is linked to lower blood pressure, blood glucose levels, and low-density lipoprotein cholesterol levels.
- High protein intake is not associated with stroke risk.
- High intake of a healthy diet was linked to an increased risk for stroke in one observational study and a reduced risk for stroke in another observational study.
- High intake of an unhealthy diet was linked to an increased risk for stroke and a population-attributable risk for stroke of 19% (99% CI, 11 - 30).
- In women, a prudent diet or Dietary Approaches to Stop Hypertension (DASH)–style diet is associated with a lower risk for stroke, and a Western diet is linked with a higher risk for stroke.
- In women, the Mediterranean diet is associated with lower risks for stroke, cardiovascular disease, cardiovascular mortality, and all-cause mortality.
- The effects of a vegetarian diet and a Japanese diet on stroke risk are unknown.

Clinical Implications

Reliable evidence from randomized trials suggests that dietary supplementation with antioxidant vitamins, B vitamins, and calcium does not reduce the risk for stroke. However, methodologic limitations of studies to date preclude firm conclusions regarding the effect of many other nutrients on stroke risk.
Less reliable evidence suggests that stroke can be prevented by prudent diets; Mediterranean or DASH-type diets; diets that are low in salt and added sugars and high in potassium; and diets that meet, but do not exceed, energy requirements. The overall quality of dietary pattern and the balance between energy intake and expenditure seem to affect stroke risk to a greater extent than individual nutrients and foods.

Borrowed from- Medscape Education Clinical Briefs

Study in monkeys raises hope for HIV .......vaccines

Study in monkeys raises hope for HIV vaccines

Click the Above link to read the Article....

Jan 2, 2012

Human Atlas Videos | Health Information | Alberta Health Services

Check out these Amazing 3-D videos .....

Human Atlas Videos | Health Information | Alberta Health Services

Dec 23, 2011

Glucose Testing....

Glucose

Also known as: Blood sugar; Fasting blood sugar; FBS; Fasting blood glucose; FBG; Fasting plasma glucose; FPG; Blood glucose; Oral Glucose Tolerance Test; OGTT; GTT; Urine glucose

Formal name: Blood Glucose; Urine Glucose

Related tests: Urinalysis; Insulin; C-Peptide; A1c; Microalbumin; CMP; BMP

At a Glance

Why Get Tested?

To determine if your blood glucose level is within a healthy range; to screen for, diagnose, and monitor high blood glucose () or low blood glucose (), diabetes, and pre-diabetes; to check for glucose in your urine

When to Get Tested?

Blood glucose: as part of a regular physical, when you have symptoms suggesting hyperglycemia or hypoglycemia, and during pregnancy; if you are diabetic, self-checks up to several times a day to monitor blood glucose levels
Urine glucose: usually as part of a urinalysis

Sample Required?

A blood sample drawn from a vein in your arm or a drop of blood from a skin prick; sometimes a is used. Some diabetic patients may use a continuous glucose monitor, which is a small sensor wire inserted beneath the skin of the abdomen that measures blood glucose every five minutes.

Test Preparation Needed?

In general, it is recommended that you fast - nothing to eat or drink except water - 8 hours before having a blood glucose test. In persons with diabetes, glucose levels are often checked both while fasting and after meals to provide the best control of diabetes. For random, timed, and post-meal glucose tests, follow your doctor's instructions.

The Test Sample

What is being tested?

This test measures the amount of glucose in the blood or urine. Glucose is the primary energy source for the body’s cells and the only energy source for the brain and nervous system. A steady supply must be available for use, and a relatively constant level of glucose must be maintained in the blood.
During digestion, fruits, vegetables, breads and other carbohydrates are broken down into glucose (and other nutrients); they are absorbed by the small intestine and circulated throughout the body. Using glucose for energy production depends on insulin, a produced by the pancreas. Insulin facilitates transport of glucose into the body's cells and directs the liver to store excess energy as for short-term storage and/or as triglycerides in adipose (fat) cells.
Normally, blood glucose rises slightly after a meal and insulin is released by the pancreas into the blood in response, with the amount corresponding to the size and content of the meal. As glucose moves into the cells and is metabolized, the level in the blood drops and the pancreas responds by slowing, then stopping the release of insulin.
If the blood glucose level drops too low, such as might occur in between meals or after a strenuous workout, glucagon (another pancreatic hormone) is secreted to induce the liver to turn some glycogen back into glucose, raising the blood glucose level. If the glucose/insulin is working properly, the amount of glucose in the blood remains fairly stable. If the balance is disrupted and the glucose level in the blood rises, then the body tries to restore the balance, both by increasing insulin production and by eliminating excess glucose in the urine.

There are a few different conditions that may disrupt the balance between glucose and the pancreatic hormones, resulting in high or low blood glucose. The most common cause is diabetes. Diabetes is a group of disorders associated with insufficient insulin production and/or a resistance to insulin. People with untreated diabetes are not able to process and use glucose normally. Those who are not able to produce enough insulin to process glucose are diagnosed as having type1 diabetes while people who are resistant to insulin have type 2. Either type of diabetic may have and/or increased blood glucose levels.
Severe, acute high blood glucose () or low blood glucose () can be life-threatening, causing organ failure, brain damage, coma, and, in extreme cases, death. Chronically high blood glucose levels can cause progressive damage to body organs such as the kidneys, eyes, heart and blood vessels, and nerves. Chronic hypoglycemia can lead to brain and nerve damage.
Some women may develop hyperglycemia during pregnancy, which is termed gestational diabetes. If untreated, this can cause these mothers to give birth to large babies who may have low glucose levels. Women who have had gestational diabetes may or may not go on to develop diabetes.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm or a drop of blood is taken by pricking the skin, typically on a finger, with a small, pointed lancet (fingerstick). Sometimes, a is collected. Some diabetics may use a continuous glucose monitor, which is a small sensor wire inserted beneath the skin of the abdomen and held in place with an adhesive patch. The sensor measures blood glucose levels every five minutes and sends the results to a device that is attached to the person's clothing. A digital readout on the device lets the person know the blood glucose level in real time.

Is any test preparation needed to ensure the quality of the sample?

For screening purposes, fasting is generally recommended - nothing to eat or drink except water - at least 8 hours before a blood glucose test. Those who have been diagnosed with diabetes and are monitoring glucose levels are often tested both while fasting and after meals. For random and timed tests, follow the doctor's instructions. A glucose tolerance test requires that you fast for the first blood sample and then drink a liquid containing a specified amount of glucose. Subsequent blood samples are drawn at specified times.

The 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.

When is it ordered?

Blood glucose testing can be used to screen healthy, 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 (), such as:

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

or symptoms of low blood glucose (), 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.

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.

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, , 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.

Common Questions

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.

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.

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.

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.

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

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.

Article Sources

(Revised 2011 February). Know your Blood Sugar Numbers. National Diabetes Education Program [On-line information]. PDF available for download at http://ndep.nih.gov/media/knownumbers_eng.pdf through http://ndep.nih.gov. Accessed May 2011.
Olatunbosun, S. (Updated 2011 April 19). Glucose Intolerance. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/119020-overview through http://emedicine.medscape.com. Accessed May 2011.
Dugdale, D. (Updated 2010 May 23). Glucose test – blood. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm. Accessed May 2011.