Type 1 diabetes; Insulin-dependent diabetes; Juvenile diabetes
Fasting Plasma Glucose. The fasting plasma glucose (FPG) test is the standard test for diagnosing diabetes. It is a simple blood test taken after 8 hours of fasting.
FPG levels indicate:
The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes, or if the tests are normal in people who have symptoms or risk factors for diabetes. Widespread screening of patients to identify those at higher risk for diabetes type 1 is not recommended.
Glucose Tolerance Test. The oral glucose tolerance test (OGTT) is more complex than the FPG and may overdiagnose diabetes in people who do not have it. Some doctors recommend it as a follow-up after FPG, if the latter test results are normal but the patient has symptoms or risk factors of diabetes. The test uses the following procedures:
OGTT levels indicate:
Patients who have the FPG and OGTT tests must not eat for at least 8 hours prior to the test.
Test for Glycosylated Hemoglobin (Hemoglobin A1c). This test examines blood levels of glycosylated hemoglobin, also known as hemoglobin A1c (HbA1c). The test is not affected by recent food intake so it can be taken at any time.
Elevated levels of glycosylated hemoglobin are strongly associated with most if not all of the complications of diabetes.
In general, most adults with diabetes should aim for HbA1c levels below 7%. Higher levels indicate poor blood glucose control.
Goal HbA1c levels for children are:
Schedule for HbA1c Monitoring:
Type 1 diabetes is characterized by the presence of a variety of antibodies that attack the islet cells. These antibodies are referred to as autoantibodies because they attack the body's own cells -- not a foreign invader. Blood tests for these autoantibodies can help differentiate between type 1 and type 2 diabetes.
Screening Tests for Heart Disease. All patients with diabetes should be tested for:
Screening Tests for Kidney Damage. The earliest manifestation of kidney disease is microalbuminuria, in which tiny amounts (30 - 300 mg per day) of protein called albumin are found in the urine. Microalbuminuria is also a marker for other complications involving blood vessel abnormalities, including heart attack and stroke.
People with diabetes should have an annual microalbuminuria urine test. Patients should also have their blood creatinine tested at least once a year. Creatinine is a waste product that is removed from the blood by the kidneys. High levels of creatinine may indicate kidney damage. A doctor uses the results from a creatinine blood test to calculate the glomerular filtration rate (GFR). The GFR is an indicator of kidney function; it estimates how well the kidneys are cleaning the blood.
Screening for Retinopathy. The American Diabetes Association recommends that patients with type 1 diabetes have an annual comprehensive eye exam, with dilation, to check for signs of retina disease (retinopathy). Patients at low risk may need exams only every 2 - 3 years.
Screening for Neuropathy. All patients should be screened for nerve damage (neuropathy), including a comprehensive foot exam. Patients who lose sensation in their feet should have a foot exam every 3 - 6 months to check for ulcers or infections.
Screening for Thyroid Abnormalities. Thyroid function tests should be performed.
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