Fasting Blood Glucose(FBG) and Glycosylated Hemoglobin (HbA1C)

1
Fasting Blood Glucose(FBG) and Glycosylated
Hemoglobin (HbA1C)

• Presented by
• Geraldine Charles
• Tracy Herring
• Kara Thompson

2
Case Study

• Patient M.V, 51 years old last seen 3 months
  agoPMH NIDDM, Hyperlipidemia, Gastritis,
  migrainesSHX Cholecystectomy 1991,
  Hysterectomy 1989FHX mother- cervical Ca,
  father- DM, HTN

3
Medications

• Metformin 500mg BID
• Omeprazole 20mg daily
• Imitrex 100mg as needed for migraines
• Lisinopril 10 mg daily

4
Vital Signs

• Temp-98.1, HR- 68, RR-16, BP-132/84
• Wt-176 lbs( baseline 188lbs)
• HT- 52
• Allergies- NKDA

5
Purpose of

• FBG useful in diagnosing prediabetes and diabetes
• HbA1C gives us an insight into mean plasma
  glucose concentration over 2-3 months
• Both tests are used to document degree of
  glycemic control at the time of diagnosis and as
  part of continuing care

6
Uses across the life span

• Test used for all ages
• Normal range of FBG across the age spectrum
• Fasting adults- lt or 110mg/dl
• Fasting children (2-18) 60-100mg/dl
• Fasting young children ( 0-2)-60-110mg/dl
• Fasting premature infants- 40-65mg/dl

7
Uses in infants

• Infants with tremor, convulsion or respiratory
  distress should have stat FBG especially with
  maternal diabetes or with hemolytic disease of
  the newborn
• Newborns that are too small or too large should
  have FBG
• Few diseases related to neonatal hypoglycemia

8
Screening Guidelines

• New NIH guidelines diabetic testing for all
  adults 45 and older every 3 years
• The ADA recommends the following guidelines
• Testing be considered for patients 45 and older
• Testing is strongly recommended if patients 45
  and older and overweight
• Testing should be considered if patient younger
  than 45 and overweight with another risk factor

9
Diagnosis of Diabetes

• FBG of over 126mg/dl with classic symptoms of
  diabetes polyuria,polydipsia,unexplained weight
  loss
• Without symptoms these tests should be repeated
  on a different day

10
FASTING BLOOD SUGAR AND HbA1c
11
Fasting Blood Sugar-Patient Education

• Explain to patient purpose of test
• Explain the blood drawing procedure
• Explain to patient that he must have nothing to
  eat or drink 8 12 hours prior to test
• If patient is diabetic , no insulin or oral
  hyperglycemic agent prior to test

12
(No Transcript)
13
External factors that can cause increased glucose

• Certain drugs can cause elevated glucose
• Pregnancy
• Heavy smoking
• Alcohol
• Illness
• Emotional stress
• Caffeine
• Eating less than 8 hours priors

14
External factors that can decrease glucose

• Hematocrit greater than 55
• Intense exercise
• Certain drugs

15
HbA1C

• Your doctor may order this test if you have
  diabetes. It is used to measure your blood sugar
  control over several months. In general, the
  higher your HbA1c, the higher the risk that you
  will develop problems such as eye disease, kidney
  disease, nerve damage, heart disease, and stroke.
  This is especially true if your HbA1c remains
  high for a long period of time.

16
Patient education prior to test

• Explain the test
• No preparation is required
• Fasting not required
• Explain that this test is not meant for short
  term diabetes mellitus management instead it
  assesses the efficacy of long term management of
  diabetes

17
External factors that effect the results-

• Anemia
• Thalessemia- Hb H- falsely elevate results
• Sickle cell- Hb S- can falsely decrease results
• For these patients the use of fructosamine/40
  HbA1C

18
THE GLUCOSE CONTINUUM

DIABETES
gt OR 126MG/DL

lt 126MG/DL PRE-DIABETES gt OR 110MG/DL
lt110MG/DL NORMAL
19
(No Transcript)
20
Lab Values

• Normal Range
• FBG 60-100 mg/dl
• HbgA1C lt 6
• Low Range
• FBG lt 60 mg/dl (diagnosis of hypoglycemia)
• High Range leads to diagnosis of DM
• FBG equal or gt 126 mg/dl
• HbgA1C gt or equal to 6

21
Chart comparing HbA1c vs FBG

• HbgA1C FBG
• 6 135 mg/dl
• 7 170 mg/dl
• 8 205 mg/dl
• 9 240 mg/dl
• 10 275 mg/dl
• 11 310 mg/dl
• 12 345 mg/dl

22
Panic Values

• Hypoglycemia
• FBGlt40mg/dl may cause brain damage in women and
  children
• FBGlt50mg/dl in men
• What to do when in panic range?
• If person sufficiently conscious orange juice,
  sugar containing candy
• In the acute care setting IV glucose
• ( D50)

23
Panic Values

• Hyperglycemia
• FBG gt 350 mg/dl (diagnosis of DKA)
• HbgA1C gt or equal to 11

24
What to do when in panic range?

• Goals
• 1) Get patient to medical facility
• 2) After confirming FBG level will want to
• A) Correct Dehydration
• B) Normalize Electrolytes
• C) Correct Acidosis
• 3) Done by
• - Administration of insulin continuous low dose
• - 1-2 L normal saline or lactated ringer solution
• - electrolyte balance most often potassium
  supplement
• - Bicarbonate therapy for pH of 7.0 or below
• 4) Following recovery Explore and Educate

25
Follow up visit

• Lab results-
• HbA1c- 10
• FBG 284
• Recommendations-
• Maximize medical therapy for DM management
• Follow up FBG in 2 weeks
• Repeat HbA1C in 6 weeks

26
Questions??????
27
References

• American Diabetes Association (ADA). Retrieved
  from http//www.diabetes.org/about-diabetes.jsp
• Dunphy, L., Brown, J., Porter, B.. (2007).
  Primary Care The Art Science of Advanced
  Practice Nursing. Philadelphia Davis Company.
• Fischbach, F (2004). A manual of laboratory and
  diagnostic tests. Lippincott Williams and
  Wilkins. s

28
References

• Friesen, J (2003). Case Study Symptoms in a
  Diabetes Client Type 1, Type 2, or Type 1.5? .
  Retrieved January 18, 2008, from Clinical
  Diabetes Web site http//clinical.diabetesjournal
  s.org/cgi/content/full/21/2/93
• Hurd, Robert (08/11/2006). Baylor Health Care
  System. Retrieved January 18, 2008, Web site
  http//www.baylorhealth.com/healthinformation/2/19
  723.htm
• Uphold, C, Graham, M (2003). Clinical
  Guidelines.Florida Barmarrae Books.