Type 1 Diabetes Diagnosis
Children and adults who develop the early symptoms of type 1 diabetes should see a healthcare provider as early as possible. Diabetes screening tests are ordered when a person's symptoms suggest diabetes or pre-diabetes. Diabetes screening tests are also ordered for people without symptoms who are at high risk of developing diabetes, such as people with a family history of diabetes, people who are obese, or people over 45 years old.
The standard diabetes screening tests measure blood glucose levels before and after meals, and then compare the results to the normal blood glucose ranges.
Insulin's Effect on Blood Glucose Levels
During digestion, the carbohydrates in food are broken down into glucose (and a few other simple sugars), which enters the bloodstream. Insulin enables the body's cells to absorb the glucose and convert it into energy. Any excess glucose is stored in the liver as glycogen and released back into the bloodstream when the body needs additional glucose. Various factors increase the body's need for glucose, such as exercise, infection, or injury.
Blood glucose levels normally increase after meals and start decreasing as the cells absorb the glucose in the blood. When the body doesn't produce enough insulin, blood glucose levels remain high.
The normal range for blood glucose levels:
- Before meals is 70 to 99 mg/dL (milligrams per deciliter).
- After meals is less than 140 mg/dL
The pre-diabetes range for blood glucose levels:
- Before meals is 100 to 125 mg/dL (milligrams per deciliter).
- After meals is less than 140 to 200 mg/dL
The diabetes range for blood glucose levels:
- Before meals is over 126 mg/dL (milligrams per deciliter).
- After meals is over 200 mg/dL
Blood Glucose Tests
Diabetes is diagnosed by testing a person's blood glucose level. Blood glucose tests measure either before meals (fasting) or after meals (non-fasting) blood glucose levels. People typically are first given a non-fasting test. If the results are positive for diabetes, a confirmation test that also measures fasting blood glucose is given on another day.
The values of the following tests may vary for different laboratories.
Fasting blood glucose test
A fasting blood glucose test measures blood glucose after at least 8 hours without eating. The test is used to diagnose diabetes and pre-diabetes. The fasting test results are:
- Normal = 99 mg/dL and below
- Pre-diabetes = 100 to 125 mg/dL
- Diabetes = 126 mg/dL
A positive diagnosis is confirmed by repeating the test on a different day.
Oral glucose tolerance test
An oral glucose tolerance test measures blood glucose after at least 8 hours without eating and 2 hours after drinking 75 grams of glucose dissolved in water.The test is used to diagnose diabetes or pre-diabetes. The oral glucose tolerance test is more sensitive than the fasting blood glucose test for diagnosing pre-diabetes. In addition to providing a fasting blood sugar test result, it also provides a non-fasting blood glucose test result 2 hours after a person consumed glucose disolved in water.
The fasting blood glucose test results are:
- Normal = 99 mg/dL and below
- Pre-diabetes = 100 to 125 mg/dL
- Diabetes = 126 mg/dL
The test results two hours after the glucose drink are:
- Normal = 139 mg/dL and below
- Pre-diabetes = 140 to 199 mg/dL
- Diabetes = 200 mg/dL and above
A positive diagnosis is confirmed by repeating the test on a different day.
Random (non-fasting) blood glucose test
A random blood glucose test measures blood glucose levels at any time regardless of whether or not people have eaten recently. A random blood glucose level of 200 mg/dL or greater in addition to the following diabetes symptoms is used to diagnose diabetes but not pre-diabetes:- Increased thirst
- Frequent urination
- Unexplained weight loss
A positive diagnosis is confirmed by a fasting blood glucose or an oral glucose tolerance test on another day.
Additional Tests
After a person tests positive for diabetes, a doctor usually orders a test to determine if the person has type 1 or type 2 diabetes. Throughout treatment, the doctor orders additional tests to:
- Monitor the person's blood glucose levels for the past few months.
- Diagnose if the person has developed any diabetes complications.
C-peptide test
The C-peptide test determines if a person's pancreas is producing sufficient insulin on its own, if a person is insulin resistant, or if a person needs insulin injections or an insulin pump.Hemoglobin A1C test
The hemoglobin A1C test (or glycosylated hemoglobin test) measures the amount of blood sugar attached to hemoglobin molecules (in red blood cells). The test measures the amount of sugar in a person's blood over the past two to four months. For people newly diagnosed with diabetes, the test determines how long they have been been experiencing high blood sugar levels. For people with existing diabetes conditions, the test monitors the effectiveness of their diabetes treatment.
Insulin test
The insulin test measures the insulin level in a person's blood. It helps:- Evaluate insulin production.
- Diagnose an insulinoma (insulin-producing pancreatic islet cell tumor).
- Determine the cause of hypoglycemia.
Urinalysis
A urinalysis is a series of physical, chemical, and microscopic tests of a urine sample. It helps screen for:- Diabetic ketoacidosis (ketones)
- Kidney disease (blood cells and protein)
- Urinary tract infections (bacteria)
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