Diabetes Mellitus Q 17

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Gregory is a 52-year-old man identified as high-risk for diabetes mellitus. Which laboratory test should a nurse anticipate a physician would order for him? Select all that apply.

  

    A. Fasting Plasma Glucose (FPG)

    B. Two-hour Oral Glucose Tolerance Test (OGTT)

    C. Glycosylated hemoglobin (HbA1C)

    D. Fingerstick glucose three times daily

    E. Urinalysis and urine culture

    

Correct Answer: A & B.

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When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. An FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal.

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Option A: Current laboratory recommendations for plasma glucose measurement are to draw fasting blood samples in the morning rather than later in the day, as glucose levels tend to be higher in the morning than in the afternoon.

Option B: The OGTT requires a fasting blood glucose measurement in the morning. After the measurement, the patient receives oral glucose (usually a glucose load of 75g anhydrous glucose dissolved in water) that the patient consumes. The plasma glucose levels are measured again at 1-hour and 2-hours to analyze the glucose level changes.

Option C: HbA1C evaluates long-term glucose control. The hemoglobin A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a person’s level of glucose control. The test shows an average of the blood sugar level over the past 90 days and represents a percentage. The test can also be used to diagnose diabetes.

Option D: A fingerstick glucose three times daily spot-checks blood glucose levels. The use of glucose meters is common in physician offices or by patients to monitor blood glucose levels and establish patterns of glucose fluctuations over time with regular use and recording.

Option E: Urinalysis and urine cultures, in which bacteria from a urine sample are grown in a laboratory, are done to diagnose a urinary tract infection. Urine should be cultured in all men and all patients with diabetes mellitus, who are immunosuppressed, and women who are pregnant. Classic teaching on urine culture sets the gold standard for infected urine at greater than 10 colony forming units (CFU).

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