Diabetes: Screening Guidelines

Type 1 diabetes manifests itself quite suddenly and is the primary cause for the checking of blood sugar levels. Other forms of diabetes, as well as pre-diabetes, make their presence felt in a more gradual manner.

Who Needs to Get Tested for Diabetes?

The American Diabetes Association (ADA) has developed screening guidelines for diabetes and recommends that the following people be screened for diabetes:

• Any person whose body mass exceeds 25 (overweight), age notwithstanding, who is also susceptible to other risk factors. These include having a close relative who suffers from diabetes, a history of cardiac problems, cholesterol levels of a high order, a lifestyle that’s primarily sedentary, and high blood pressure. This category also includes child-bearing women who have delivered a baby weighing in excess of nine pounds, or whose medical history includes diabetes during pregnancy, or polycystic ovary syndrome.

• Any person older than 45. Such a person must subject himself/herself to a screening for blood sugar, initially, and assuming that the results are okay, must consent to be screened, every three years, thereafter.

Tests for Type 1 and Type 2 Diabetes

• Glycated hemoglobin (A1C) screening: The result of this screening will reveal what your blood sugar level has been on average during the last 2-3 months.

  • It estimates the proportion of blood sugar carried by hemoglobin, the protein that transports oxygen within red blood cells. Your blood sugar level is considered to be directly proportional to the amount of hemoglobin with sugar attached.
  • The surest indication that you have diabetes is when two separate tests reveal your A1C level to be 6.5 percent or more. It is possible that there might be some inconsistency in the results of the two tests, or that the test might not be available or even that the A1C test might be rendered inaccurate owing to conditions such as pregnancy or having an uncommon hemoglobin variant. In such cases, your doctor may diagnose diabetes with the following alternative methods:

• Random screening of blood sugar: As the name indicates, the screening will involve taking a blood sample at a random time. Irrespective of the time of your last meal, if your blood sugar level registers 200 or more milligrams per deciliter, you will be diagnosed with diabetes.

• Post-fasting screening of blood sugar: In this type of screening, an overnight fast must precede the obtaining of the blood sample. If the sugar level in your blood registers between 100 and 125 mg/dL it will be diagnosed as pre-diabetes. If your count is 126 mg/dL or more on two disparate tests, you’ll be diagnosed as being diabetic.

• If your doctor suspects type 1 diabetes, he is likely to subject you to a blood test aimed at uncovering diabetes antibodies. Additionally, you must undergo a urine test aimed at discovering the presence of ketones, which is generated as a byproduct owing to the use of muscle and fat tissue for energy when the insulin in the body is insufficient to allow the use of the available glucose.

Tests for Gestational Diabetes

There is no established set of guidelines for screening gestational diabetes, some experts opine that gestational diabetes screening may be unnecessary in women who are younger than 25 and bear no risk factors. Other experts opine that pregnant women, regardless of age, must undergo screening if every case of gestational diabetes is to come to light. Risk factors of pregnant women are usually evaluated early in the pregnancy.

• Screening for diabetes is done during the first prenatal visit, for those women at high risk of gestational diabetes – the risk warnings include a body mass index (BMI) before pregnancy of 30 or more and having a diabetic parent, sibling or child.

• Screening for diabetes is done during the second trimester, for those women at average risk of gestational diabetes – such a test could occur some time between 24 and 28 weeks of pregnancy.

Tests for Pre-Diabetes

• Preliminary glucose screening: The doctor will ask you to consume a glucose solution, an hour before measuring the level of your blood sugar. If the level is found to be lower than 130 to 140 milligrams per deciliter, you have nothing to worry about though it would depend on the clinic or lab you do your test in. If your blood sugar level is extraordinarily high, it indicates a strong risk of gestational diabetes. The doctor’s diagnosis will succeed a follow-up test.

• Post glucose tolerance screening: The follow-up screening involves testing your blood sugar level after having you fast overnight. First you will be made to ingest a glucose solution of even higher concentration than during the preliminary screening. Thereafter your blood sugar level will be tested, on the hour, every hour, for three hours. A diagnosis of gestational diabetes will result if a higher than normal blood sugar level is established in at least two of the three screenings.

• Glycated hemoglobin (A1C) screening: This screening is done to establish the level of your blood sugar on average during the previous 2-3 months. The greater the proportion of blood sugar found attached to hemoglobin – a protein that transports oxygen within red blood cells – the greater the amount of hemoglobin with blood sugar attached. Pre-diabetes is diagnosed if the A1C level registers between 5.7 – 6.4 percent. During the inability to do A1C screening, owing to any reason, such as your pregnancy or your having hemoglobin of an uncommon type, the doctor’s diagnosis will depend on one of the following forms of screening:

• Post-fasting blood sugar screening: Overnight fasting will be followed by the taking of a blood test. If the level of blood sugar registers 100-125 mg/dL, it would indicate pre-diabetes, with the normal level pegged at below 100 mg/dL.

• Post glucose tolerance screening: Your blood sugar screening is done after overnight (or eight hours of) fasting. You are required to drink a glucose solution before the blood sample is taken. If the level of blood sugar registers 140-199 mg/dL, it would indicate pre-diabetes (or impaired glucose tolerance (IGT)), while 140 mg/dL would be considered normal.

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Dr. Stephen Anthony, MD

Dr. Anthony is a qualified medical doctor and has penned many credible articles to educate the public about general health issues. Dr. Anthony has been involved in more than 30 multi-national clinical research trials and has worked with leading medical research companies such as Novartis, Pfizer, Merck etc.

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