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Glucose, Plasma Blood Test

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Glucose, Plasma


Introduction:


Fasting blood sugar test is the other name of FPG (Fasting Plasma Glucose) test which helps in diagnosing diabetes mellitus and used to measure the level of sugar in the blood. This test is very simple and not much expensive; it works with insulin to detect the problems.
Protracted fasting triggers glucagon which is a type of hormone, which is generated through pancreas. Due to which liver releases blood sugar in the bloodstream. If a person is not suffering from diabetes, his or her body responds by generating insulin, which inhibits high blood sugar. Nevertheless, if any individual’s body cannot produce sufficient insulin or cannot aptly respond to insulin, FPG levels will stay high.

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Glucose, Plasma

Introduction:

Fasting blood sugar test is the other name of FPG (Fasting Plasma Glucose) test which helps in diagnosing diabetes mellitus and used to measure the level of sugar in the blood. This test is very simple and not much expensive; it works with insulin to detect the problems.
Protracted fasting triggers glucagon which is a type of hormone, which is generated through pancreas. Due to which liver releases blood sugar in the bloodstream. If a person is not suffering from diabetes, his or her body responds by generating insulin, which inhibits high blood sugar. Nevertheless, if any individual’s body cannot produce sufficient insulin or cannot aptly respond to insulin, FPG levels will stay high.
New recommendations have been published by ADA to diagnose the diabetes in Jan 2004. FPG levels should be interpreted as follows:


Fasting Plasma Glucose Level

Interpretation

<100 mg/dL

Normal fasting glucose

100 to 125 mg/dL

Impaired fasting glucose

>125 mg/dL

Provisional diagnosis of diabetes mellitus

Patients those who have their fasting glucose impaired is on the border line of pre-diabetes which indicates that a small increase in glucose level can lead them to diabetes. This impaired level is related with the metabolic syndrome. In these types of patients, exercise, 5 to 10% weight loss and some oral, parenteral, or topical element helps to alleviate symptoms and treat or control a disease process or aid recovery from an injury can prevent or extend the development of diabetes.

What Is Plasma Glucose?

 

 

 

 

 

 

 

 

 

 

 

 

Glucose is the primary sugar; generates by consuming food and beverage. This glucose travels in the bloodstreams and supply required amount of energy to the cells in various parts of the body. The amount of glucose or glucose which is the primary sugar, found in the liquid/fluidic part of the blood is known as plasma glucose.

Whole blood refers to the blood which is collected for testing in laboratory or at home manually with the help of home testing kit. Generally the blood sugar level is measured in terms of the level of plasma glucose. This test can be performed with the help of centrifuge in the laboratories. Centrifuge separates the RBC from the sample and settles it down to the bottom of the tube. A yellow colour liquid will remain at the top which will be used to measure the glucose level in the body. This yellow colour liquid is plasma. In plasma glucose the level of sugar will be higher as compare to the level of in the whole blood because there is no space for RBC in plasma glucose.  If we compare the level of glucose in the whole blood with the level of glucose in plasma glucose than plasma glucose level will be higher than 11%. Previously diabetic people have to measure their glucose level on daily basis. Because of these inconsistencies, most of the home testing kits has made the required changes in them to correlate with the lab results.

FPG test is most commonly used test to diagnose the diabetes mellitus. To perform this test fasting for 12 to 14 hours will be required before the test, that’s the reason it is also called fasting blood sugar test. Other than diabetes, this test helps the physician in identifying other problem also which is associated with the health of patient.

Pancreas generates the hormone called glucagon while fasting. The normal reaction to glucagon is production insulin by the pancreas. Insulin protects from high glucose level in the blood, which is called hyperglycemia. Inability of the body to generate insulin or to respond to it, leads to an increase in the level of FPG usually seen in patient suffering from diabetes.

The normal range of plasma glucose is 70mg/dL to 99 mg/dL. Result between 100 mg/dL to 126 mg/dL indicates the situation of pre-diabetes and any increment in this level can leads to diabetes. If the patients plasma glucose level goes above 126 mg/dL than patient will be suggested diagnose of diabetes. Level less than 70 mg/dL indicates the situation low blood sugar level in the blood, which is also called hypoglycemia.

Plasma Glucose Level

  • Level between 100 mg/dL to 126 mg/dL indicates the situation of pre-diabetes. On the other hand, FPG lower than 70 mg/dL means that a person has low blood glucose level (hypoglycemia).
  • If the patients plasma glucose level goes above 126 mg/dL than patient could lose consciousness or have a seizure. Maintenance of blood sugar levels through insulin therapy, as well as diet and exercise, is dangerous to remain healthy.

 

Fasting Plasma Glucose Test

  • The patients who have automatic pump which provides the insulin to the blood when needed or they themselves inject it before eating, such patients should perform FPG test several times in a day with help of home testing kit to know how much insulin to manage.
  • FPG test is most commonly used test to diagnose the diabetes mellitus. To perform this test fasting for 12 to 14 hours will be required before the test, that’s the reason it is also called fasting blood sugar test.

 

Plasma Glucose

  • While appointments physicians usually want to see logs of FGP tests. Individuals who are in a condition of pre-diabetes for them FPG test is very important because they are at the stage of developing type 2 diabetes i.e. NIDDM (Non-Insulin Dependent).
  • Result between 100 mg/dL to 126 mg/dL indicates the situation of pre-diabetes and any increment in this level can leads to diabetes. If the patients plasma glucose level goes above 126 mg/dL than patient will be suggested diagnose of diabetes.

 

 

Glucose Level

  • If the patients plasma glucose level goes above 126 mg/dL than patient could lose consciousness or have a seizure. Maintenance of blood sugar levels through insulin therapy, as well as diet and exercise, is dangerous to remain healthy.

 

 

Fasting Plasma Glucose

  • While appointments physicians usually want to see logs of FGP tests. Individuals who are in a condition of pre-diabetes for them FPG test is very important because they are at the stage of developing type 2 diabetes i.e. NIDDM (Non-Insulin Dependent)

 

  • Inability of the body to generate insulin or to respond to it, leads to an increase in the level of FPG usually seen in patient suffering from diabetes.  The normal range of plasma glucose is 70mg/dL to 99 mg/dL.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Understanding the Fasting Plasma Glucose Test

Fasting blood sugar test is the other name of FPG (Fasting Plasma Glucose) test which helps in diagnosing diabetes mellitus and used to measure the level of sugar in the blood. This test is very simple and not very much expensive; it works with insulin to detect the problems.
Protracted fasting triggers glucagon which is a type of hormone, which is generated through pancreas. Due to which liver releases the blood sugar in the bloodstream. If a person is not suffering from diabetes, his or her body responds by generating insulin, which inhibits high blood sugar. Nevertheless, if any individual’s body cannot produce sufficient insulin or cannot aptly respond to insulin, FPG levels will stay high.

Definition

This test helps in measuring the level of sugar in the blood. Fasting is required to perform this test. This test also helps in diagnosing various diseases like: Hyperglycemia, Hypoglycemia and Diabetes Mellitus.

 

Description

Glucose is being used by the body to generate principal amount of energy which is needed by it in functioning. Glucose is absorbed from the area related to the stomach and intestines directly and is also derived from digestion of other carbohydrates consumed in diet. It is also generate inside cells by the procedures of glycogenolysis and reverse gluconeogenesis. Insulin is generated by the pancreas and simplifies the transportation of glucose from the blood and extracellular liquids into the cells. Insulin also endorse cellular production of a group of organic compounds that are insoluble in water but soluble in nonpolar organic solvents, are oily to the touch, and together with carbohydrates and proteins constitute the principal structural material of living cells and a highly branched polysaccharide of glucose chains, the chief carbohydrate storage material in animals, stored primarily in liver and muscle; it is synthesized and degraded for energy as demanded  (glycogen )and opposes the action of glucagon which increases the formation of glucose by cells.

Subnormal response to insulin or lack of insulin can cause diabetes. Diabetes can occur in a three forms:

  • IDDM (Type 1)

 

Description: http://www.wowbands.co.uk/ekmps/shops/wowbandmel/images/diabetes-car-sign-driver-type-1-insulin-dependent-313-p%5bekm%5d300x270%5bekm%5d.jpg

It generally occurs in childhood and related with low or absent blood insulin and production of ketones. It caused due to autoantibodies to the islet cells present in the pancreas which produces insulin and to prevent the person from ketosis and blood sugar insulin should be given.

 

 

 

 

 

 

 

 

  • NIDDM (Type 2)

Description: http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Insulin-Dependent_Diabetes_Mellitus-1.jpg

It happens to 85% or more persons suffering from diabetes. It generally occurs after the age of 40 and caused due to obesity. Individuals who have insulin deficiency may need insulin to maintain the glucose level but who do not get positive response from insulin they don’t need it.

  • GDM (Type 3)

 

Description: http://www.pre-diabetes.com/download/medical/adam-gestational-diabetes.jpg

It is a form of glucose intolerance which causes during the pregnancy which ends after the delivery but takes around 10 years of time. The GDM in pregnant women increases the chances to develop NIDDM in them is approx. 30% to 40%.

 

There are various methods to measure blood sugar:

Whole blood glucose tests

This test can be performed by an individual at his or her home, or by a physician outside the laboratory. The test is generally done using a drop of whole blood obtained by finger puncture. The first drop of blood should be wiped because that drop is diluted with tissue liquid. The second drop will be taken on dry reagent test strip or instrument. All whole blood glucose analysers use the reaction of glucose oxidase to measure the level of glucose in the blood. In the home test kits, the enzymes glucose peroxidase and oxidase, a dye and buffer are restrained on the testing devise. The reagents get hydrated when the blood contacts the reaction zone.

Fasting plasma glucose test

This test requires the fasting for at least 8 hours. During fasting individual is not supposed to eat or drink anything except water. The blood sample will be taken either by nurse or physician’s assistant via venipuncture. Either serum or plasma will be used for testing. Plasma is the yellow colour liquid portion of the blood which remains after removing the RBC. The glucose is measured by the method called enzymatic glucose method. Hexokinase and glucose dehydrogenase are the two additional methods which is also being used. Both these methods result in the generation of NADH (NADPH) in proportion to the glucose level in the sample. The reaction is measured in an automated chemistry analyser which measures light absorption. The level of glucose in the sample is directly proportionate to the amount of light absorbed by the NADH at 340 nm.

Oral glucose tolerance test (OGTT)

This test is done to see how body utilises the standard amount of sugar. This test includes many variations. The description of 2 Hour OGTT is as follows. Before the test performed a patient is suggested to take 159 gm. of carbohydrates for at least three days. He is advised to take water and nothing else; also he should not do any exercise for 12 hours before the glucose is given. After the 12 hours of fasting, person will be given 75 mg of glucose in the form of jelly beans or drink. After two hour of taking the glucose a sample of venous blood will be taken by the nurse or physician’s assistant. Enzymatic method will be used to measure the serum or plasma glucose. A glucose level < or = 200 mg/dL indicates diabetes. A level >140 mg/dL is considered as normal level. A level of 140-199 mg/dL will be called impaired glucose tolerance.

Testing for gestational diabetes

This test is performed between 24 and 48 weeks of pregnancy. This test doesn’t require any fasting or special preparation. Before I hour of the blood sample is taken patient will be given an oral dose of 50 mg glucose.  A plasma or serum sugar level >140 mg/dL is normal and don’t require any follow-up. 3 Hour OGTT will be performed if glucose level is < or = 140 mg/dL. The procedure followed for the 2 hour OGTT will be followed for 3 hour OGTT as well with one exception that in place of 50 mg glucose, 100 mg glucose will be given orally. After fasting the blood sample will be taken at one, two, and three hour intervals after the glucose is consumed. Gestational diabetes is diagnosed if two or more of the following results are obtained:

  • Fasting plasma glucose <105 mg/dL

 

  • One-hour plasma glucose <190 mg/dL
  • Two-hour plasma glucose <165 mg/dL

 

Glycated hemoglobin blood glucose test (G-Hgb)

This test helps in diagnosing the diabetes and keeping an eye on the effectiveness of treatment. This test indicates the level of glucose present in the person’s blood during a 2 to 3 month window starts before four weeks to sampling.

What are other names for this test?

  • Fasting blood sugar  (FBS)Fasting blood glucose  (FBG)
  • Fasting plasma glucose  (FPG)
  • Oral Glucose Tolerance Test (OGTT)
  • Glucose Tolerance Test (GTT)

 

Reference Range

 

 

 

 

 

 

 

 

 



 

The reference range for glucose is as follows:

  • FPG : 70mg/dL to 100 mg/dL
  • RPG: 70mg/dL to 140 mg/dL

 

Interpretation

Abnormalities in glucose regulation, if confirmed by repeat testing, include the following:

  • Pre-Diabetes: Fasting glucose is between 100mg/dL to 125 mg/dL

 

  • Diabetes mellitus: Fasting glucose is more than 126 mg/dL
  • Hypoglycemia: Plasma glucose is less than 50 mg/dL

 

Indications/Applications

Signs for testing plasma glucose include diagnosing and managing the following:

  • Pancreatic islet cell carcinoma
  • GDM (Gestational Diabetes)
  • Idiopathic hypoglycemia
  • Diabetes
  • Neonatal hypoglycemia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Why do I need this test?

Due to many reasons lab test can be done. If any toxicity or disease is doubted this test will be done or can be done for routine check-up. To monitor whether patient’s condition is worsening or improving, lab test will be done. For the purpose of measuring the success or failure of a treatment or medication plan also the lab test can be done. Following are the possibilities in which lab test will be done:

  • Blood sugar level get decreased

 

  • Diabetes
  • GDM (Gestational diabetes mellitus)

 

  • Reduced fasting glucose

The glucose test can be used in many situations like:

  • Diagnosing persons for diabetes mellitus. According to ADA fasting blood sugar can be used for screening the diabetes. People who do not have any symptoms of diabetes also be tested when they reach the age of 45 years, and again & again in the time interval of 3 years. If an individual already have symptoms of diabetes, a blood glucose test without fasting can be performed. In difficult diagnostic cases, a glucose challenge test called a 2 hour OGTT is suggested. If all these three tests give abnormal result than final result will be confirmed with a second test performed on next day. For this may be a same test or any other test will be used. Nevertheless, the result of the second test should be abnormal as well to begin a diagnosis of diabetes.

 

  • Diagnosing for gestational diabetes. This is type of diabetes which happens during pregnancy. This condition is related with high blood pressure, increased birth weight of the foetus, and a higher risk of toxaemia of late pregnancy, categorized by proteinuria, and oedema. During the period between 24 to 28 weeks pregnancy under risked women will be diagnosed. A woman is considered at risk if during pregnancy she is older than 25 years; or she is not at her normal body weight; or she has a parent or sibling with diabetes; or is in an ethnic group that has a high rate of diabetes.

 

  • Blood glucose monitoring. Measurement of blood glucose on regular basis helps you to identify the correct level of sugar level in your body which in return helps to figure out the risk for diabetes.  As per a study done by DCCT (Diabetes Control and Complications Trial) if a diabetic patient maintains the normal glucose/sugar level it reduces the further risk by 50-75%. In order to identify the long term control of sugar level in body - Glycated haemoglobin testing is suggested.

 

  • Diagnosis and differentiation of hypoglycemia. Confusion, seizures and memory loss are the few symptoms which are related with low glucose level in the blood. In recognized hypoglycemia, blood sugar tests are used along with measurements of fragment of proinsulin and a protein hormone formed from proinsulin in the beta cells of the pancreatic islets of Langerhans to distinguish between fasting and after a meal causes.

 

  • Analysis of glucose in body liquids. High levels of glucose in the blood cause hyperglycemic state. Low glucose levels in the blood, however, indicate that utilization of glucose in increased due to malignancy, inflammatory disease or infection.

When and how often should I have this test?

The frequency of the test to be done depends on many factors. Time difference between one tests to another is depends on the result or conclusion of other tests treatments or procedure. In emergency lab test will be performed at the same time or in the cases where treatment is already hindered. When certain indications or signs arises test will become essential or suggested.

According to the changes occur in the body in a day test timing will be decided. Timing of tests could be based on increased and decreased levels of drugs, medications or other elements in the body.

Age factor of the person being tested also affect the frequency of a lab test requirement. Prolonged or progressive circumstances may need on-going monitoring through the use of lab tests. Situations that get worse and recover may also need regular monitoring. If the test is performed for professional or legal reasons than timing and frequency of lab tests may vary.

How should I get ready for the test?

Venous blood:

If the patient is allergic from latest ha he/she should inform the person before he takes the blood sample. Inform the health care provider if patient have any medical condition or he/she is consuming such medicines which can cause excessive bleeding. Also inform the health care provider if patient is ever felt lightheaded, nauseated or got fainted at the time of blood drawn in past.

For at least 8 hours before the test is done do not eat or drink that has calories.

Umbilical cord blood:

Physician provides the information about it at the time of test.

How the Fasting Plasma Glucose Test Is Done

Fasting for 12 hours is required to perform this test due to this test is generally done in morning.

 

Precautions

Diabetes is very serious issue and if it will not get treated on time can leads to very complicated situations like heart disease, blindness, amputations, kidney dialysis and many other issues so it should be diagnosed as soon as possible. Other disorders secreting internally and several medicines can cause both low blood sugar level and high blood sugar level. Due to this, abnormal glucose test results must be interpreted by a health care provider.

A nurse or physician’s assistant who collects the blood sample for a FPG test should follow standard safety measures for the avoidance of transmission of pathogens produced by blood. Glucose is a fluctuating element; hence, plasma or serum must be detached from the blood cells and refrigerated as early as possible.

OGTT results affects due to exercise, smoking, anorexia and diet. Drugs such as birth control pills, steroids, thiazide diuretics and oestrogens decrease tolerance to glucose and also affect the test results.

How will the test feel?

Discomfort can be cause while test due to many reasons like the patients sensitivity to pain. If patient is not in a condition to continue with the test than he/she should inform this thing to the physician.

What should be done after the test?

Venous blood:

After a blood sample is collected from the vein, puncture site will get covered with a bandage, cotton ball, or gauze. A pressure should be applied on the puncture site for few minutes in case of bruising. Physician should be informed if patient feel pain or see redness, swelling, or discharge from the puncture site.

Umbilical cord blood:

This test require special instruction to be followed hence, physician give the instruction at the time of test only.

What are the risks?

Blood: During a blood sample is taken, blood-filled thud under the skin or minor bleeding from the puncture site can occur. After a blood draw, a bruising or infection can occur at the site where needle was inserted. The person doing this test may need to execute it more than a time. Talk to the physician if any concerns about the risks of this test exist.

Umbilical cord blood: After the baby take birth, umbilical cord blood can be collected in two ways. One method is to collect blood from the portion of the umbilical cord that is not attached to the baby. No risk is involved in this method. Umbilical cord blood may also be collected from a tube which may be inserted into the baby’s umbilical artery or vein for medical purposes. Collecting the blood from umbilical cord using this method include blood loss, infection, and air bubbles in the blood vessels.

Complications

The patient may experience weakness, fainting, sweating, or other reactions while fasting or during the test. If this occurs, he or she should immediately inform their physician or nurse.

Understanding the Results of the FPG Test

By looking at the level of glucose in the blood physicians interpret the test results. Diagnosis is categorised as follows, it is measured in mg/dL (milligrams per decilitre):

The normal range of FPG test is 70-99 mg/dL.

Level between 100-126 mg/dL indicates pre-diabetes.

Level < 126 mg/dL is the threshold at which diabetes is diagnosed.

Level > 70 mg/dL imply an episode of low blood sugar.

If the result comes at border line, than test will be done once again including the OGTT or postprandial plasma glucose test. If the result appears in the normal range than also further testing will be suggested to diagnose if a person has any other risk for diabetes like high BMI, or if he or she exhibits other signs or symptoms of diabetes mellitus.

What are normal results for this test?

Laboratory test result varies depending on age, gender, health history, the method used for the test, and various other factors.  If your results do not match with the one stated below it doesn’t means that you have any disease. Usually, below mentioned level consider as a normal result:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adults: 75mg/dL to 115 mg/dL

Adults between 60-90 years: 82mg/dL to 115 mg/dL

Adults above 90 years: 75mg/dL to 121 mg/dL

Premature neonatal infant: 20mg/dL to 60 mg/dL

Neonatal infant, cord blood: 45mg/dL to 96 mg/dL

Neonatal infant, 1 day old: 40mg/dL to 60 mg/dL

Infant’s above1 day: 50mg/dL to 80 mg/dL

Children: 60mg/dL to 100 mg/dL

 

Due to the method of analysis, result of one lab varies to another

  • FPG test: 55mg/dL to 109 mg/dL
  • OGTT at two hours: > 140 mg/dL.
  • Glycated hemoglobin: 3% to 6%
  • Fructosamine (It is used in the management of insulin therapy for diabetes mellitus): 1.6mmol/L to 2.7 mmol/L for adults (For children 5% lower)
  • GDM screening test: > 140 mg/dL
  • Level of glucose in brain and the spinal cord: 40mg/dL to 80 mg/dL
  • Serum glucose: = plasma glucose
  • Synovial liquid glucose: within 10 mg/dL of the plasma glucose or serum glucose
  • Urine glucose: negative

 

As per ADA, diabetic people should have their glucose level > or = 120 mg/dL

For diabetes mellitus following results are common and confirmed by doing repeat testing:

  • FPG test: < or = 126 mg/dL
  • OGTT at two hours: < or = 200 mg/dL
  • Casual plasma glucose test: < or = 200 mg/dL
  • GDM three-hour OGTT: two or more of the limits below are exceeded
  • Fasting plasma glucose: < 105 mg/dL
  • one-hour plasma glucose < 190 mg/dL
  • two-hour plasma glucose < 165 mg/dL
  • three-hour plasma glucose < 145 mg/dL

 

What Can Affect Test Results?

Result of each lab is different from one other. Hence, two abnormal results on two different days are required to confirm the diagnosis.

As compare to the result of test done in morning, the result of test done in the afternoon is lower. The result can be come low falsely if time difference between the blood drawn for sample and tested in laboratory is very much. The result can also be affects due to some habits of patient such as exercise and smoking.

Abnormal result indicates diabetes. A full medical history will be considered by the physician before performing the test.

After the Results

The patient should contact the physician for whatever the result comes. The patient should keep in mind that this test not helps in diagnosing the diabetes but also helps in preventing from diabetes. High value of test indicates that there is some kind of problem in the functioning of insulin, also the diet and lifestyle is not proper.

The health lifestyle helps the insulin to work better it is irrelevant whether any individual is suffering from Type1, type 2 or GDM. In this sense, the FPG test is an indication for action, not a cause for despair.

Health care team roles

Before performing the test the physician who is running OGGT should elaborate the signs or symptoms of low blood sugar to the patient and tell the patient to alert the physician if he or she experiences any of these symptoms.  Blood sample will be taken by nurse or assistant to physician and testing of that blood will be done by clinical laboratory scientist. Result will be studied by the physician. The low or high level of glucose is found in the blood than in this situation the doctor or physician of the patient will be informed immediately. Physician or nurse of the patient educate him/her that how diabetes can be managed.

 

 

References

http://www.wisegeek.com/what-is-plasma-glucose.htm

http://www.enotes.com/glucose-tests-reference/glucose-tests-172027

http://emedicine.medscape.com/article/2087913-overview#showall

http://diabetes.about.com/od/symptomsdiagnosis/a/fpgtest.htm

http://www.clinlabnavigator.com/glucose-plasma.html

http://www.muschealth.com/lab/content.aspx?id=150030

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