Wednesday, January 23, 2013

Fasting Glucose Test . The best test of the day ?

Continued from yesterday.

What is the best home test to help you keep track of who is winning the day? 

1)     A1c test 
2)     after meal glucose test
3)     Fructosamine  test
4)     Fasting blood glucose
5)     3 AM glucose test


The correct answer is # 4 , Fasting glucose

Discussion points

  *The primary fuel for our body is glucose.       ( especially optimal brain function )
                                                                                  ( insulin is not required for glucose use in the brain)   
                                                                                      
 * Our liver acts as a storage depot for glucose       ( we have about an 8 hour gas tank)
 * that is supplied from carbohydrates in our diet    ( at least 130 gms/day is recommended )
                                                                                         Diabetes care vol 35, supplement1 jan. 2012
 * Insulin allows glucose to be stored in our liver        (and used in our muscles and other tissues)
 *Glucagon regulates glucose release from the liver    ( to maintain stable glucose levels)

Discussion
Beta cells and Alpha cells in the pancreas are involved

People with type 1 and type 2 diabetes have a deficiency in insulin( beta cells), effecting glucose metabolism in the liver and other tissues.

They also have a dysfunctional release of glucagon from alpha cells in the pancreas causing unpredictable release of glucose from the liver resulting in high blood glucose  levels. Having adequate circulating insulin helps  control the dysfunctional alpha cells and lower glucagon levels.

The fasting glucose is not usually effected by food intake

The fasting glucose test is the best home indicator of a persons ability to produce enough insulin to lower glucagon levels and control the release of glucose from the liver.

Take home message

*The fasting blood glucose test is the best home indicator of your basal insulin production. *  

*Persistant elevation of the fasting blood glucose test  above your target range is a reason to talk with your physician  and discuss medication options.*

The other choices ------my opinion

1)     A1c test  - a good way to look at your 3 month average glucose results and also provides an
                          indicator for long term complication risk.

2)     after meal glucose test - Provides a method of determining if you have enough insulin to control
                                                the glucose contained in the carbohydrates in the meal you just 
                                                enjoyed. This assumes you started the meal with a normal blood 
                                                glucose level.
        
3)     Fructosamine  test -   This test evaluates you average glucose for the last month. (More on this 
                                             later)

4)     Fasting blood glucose - correct answer

5)     3 AM glucose test- one cause for elevated fasting  glucose results and  a good way to detect
                                        unrecognized hypoglycemia ( more on this later )

More questions

 #1 Can you name one cause of elevated Fasting Glucose Tests not related to insulin deficiency ?

#2  Can you name 2 groups of diabetes medications , other than insulin , that helps control the 
      dysfunctional  glucagon  problems ?

Have fun , be smart and check and understand your Fasting Blood Glucose test
David Calder, MD
We will get to the rest of the discussion on recording and presenting glucose test to your physician or diabetes educator
                                                                                                                    


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Your comments and questions are appreciated. David Calder,MD