Diabetes Part 3: Diagnosis and Self-Monitoring

If you or someone you know is experiencing symptoms of diabetes it is vitally important to seek medical care ASAP, both to confirm the diagnosis and to initiate an appropriate treatment plan.  Diabetes is diagnosed through various blood tests which include the following:

· HbA1C test. This blood test (which does not require fasting) shows the average blood sugar level for the previous 2 to 3 months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. An A1C level of 6.5% or higher on two separate tests means that you have diabetes. **Because it looks at the average blood glucose levels over an extended period of time, the A1C test is one of the primary tests utilized to diagnose diabetes.

· Random blood sugar test. A blood sample will be taken at a random time regardless of when food or drink was last consumed. A blood sugar level of 200 mg/dl or higher is suggestive of diabetes.

· Fasting blood sugar test. This is a blood sample taken after not eating or drinking anything (other than water) for a minimum of 8 hours. A fasting blood sugar of 126 mg/dL or higher on two separate tests indicates diabetes.

· Glucose tolerance test. For this test, overnight fasting is required. The fasting blood sugar level is then obtained followed by drinking a sugary liquid and additional blood sampling regularly (every 30-60 min) for the next two hours. A reading of more than 200 mg/dL after two hours is a diagnosis for diabetes.

Following an official diagnosis of diabetes, a key component of every treatment plan is self-monitoring. Self-monitoring involves checking one's own blood sugar.  For some people with diabetes, self-monitoring may be required 4-6 times (or more) per day, while for others it may be a once daily requirement.  Self-monitoring can be done using a portable electronic device (called a glucometer).  With this device, a finger stick is done to obtain a small drop of blood on a test strip which is then inserted into the meter which usually gives the result within a minute or less.  

A newer device, known as a continuous glucose monitor (CGM) is one that measures blood sugar levels throughout the day and night with a tiny sensor that is inserted under the skin, usually on the upper arm or abdomen. For people who have to check their blood sugar more frequently, this is a more convenient way to self-monitor that avoids multiple finger-sticks and offers real-time data which is especially useful for those requiring tight glucose control.

Regular monitoring helps individuals understand how different foods, activities, and medications affect their blood glucose levels. This information is essential for making appropriate decisions regarding adjustments with diet, exercise, and medication as necessary relative to one's blood glucose level.  Self-monitoring is a key part of managing diabetes effectively.