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Thursday, December 12, 2013
Non-diabetic individuals with elevated blood
I am an RN who completes cholesterol testing in workplaces and community. Frequently individuals who have not had any elelvations in blood glucose readings will have elevations after 12 hours of fasting. Most individuals will say that they have never had an elevation before. Is the elevation related to the fact that they have fasted so long that the body senses the glucose is low in the night and delivers glucago to reverse this phenonmena?
I don't think i can give a one-size-fits-all answer to that one. It depends on the testing methodology, the circumstances of testing and a certain amount of chance. If there is an abnormal result, the best approach is to see whether it is reproducible when tested under "ideal" circumstances: meaning a clinical lab glucose after an overnight fast with the sample handled properly handled and with appropriate carbohydrate intake in the preceding days. I can't discriminate how many of the abnormal results represent laboratory variation vs patients who were not indeed fasting. If they aren't on glucose lowering drugs or have an insulinoma or something that would have caused a recent insulin excursion, I doubt many are hyperglycemic from mounting a counter-regulatory response. It is really important to figure out how many of these people really have diabetes.
Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati