Glucose Tests

How is it used?

The blood glucose test may be used to:

• Detect high blood glucose (hyperglycemia) and low blood glucose (hypoglycemia)
• Screen for diabetes in people who are at risk before signs and symptoms are apparent; in some cases, there may be no early signs or symptoms of diabetes. Screening can therefore be useful in helping to identify it and allowing for treatment before the condition worsens or complications arise.
• Help diagnose diabetes, prediabetes and gestational diabetes
• Monitor glucose levels in people diagnosed with diabetes

A few different testing protocols may be used to evaluate blood glucose levels, depending on the purpose.

Screening and Diagnosis
The following tests may be used for screening and diagnosis of type 1, type 2 or prediabetes. (Gestational diabetes testing is different—see below.) If the initial screening result from one of the tests is abnormal, the test is repeated on another day. The repeat result must also be abnormal to confirm a diagnosis of diabetes.

• Fasting glucose (fasting blood glucose, FBG) – this test measures the level of glucose in the blood after fasting for at least 8 hours.
• 2-hour glucose tolerance test (GTT) – for this test, the person has a fasting glucose test done (see above), then drinks a 75-gram glucose drink. Another blood sample is drawn 2 hours after the glucose drink. This protocol "challenges" the person's body to process the glucose. Normally, the blood glucose level rises after the drink and stimulates the pancreas to release insulin into the bloodstream. Insulin allows the glucose to be taken up by cells. As time passes, the blood glucose level is expected to decrease again. When a person is unable to produce enough insulin, or if the body's cells are resistant to its effects (insulin resistance), then less glucose is transported from the blood into cells and the blood glucose level remains high.
• A different test called hemoglobin A1c may be used as an alternative to glucose testing for screening and diagnosis. (For more, see the article on A1c.).

Sometimes a blood sample may be drawn and glucose measured when a person has not been fasting, for example, when a comprehensive metabolic panel (CMP) is performed. If the result is abnormal, it is typically followed up with a fasting blood glucose test or a GTT.

Glucose blood tests are also used to screen pregnant women for gestational diabetes between their 24th and 28th week of pregnancy. The American Diabetes Association and the U.S. Preventive Services Task Force recommend that pregnant women not previously known to have diabetes be screened and diagnosed, using either a one-step or two-step approach. The American College of Obstetricians and Gynecologists (ACOG) recommends the two-step approach.

• One-step 2-hour oral glucose tolerance test (OGTT). After a fasting glucose level is measured, a woman is given a 75-gram dose of glucose to drink and her glucose levels are measured at 1 hour and 2 hours after the dose. Only one of the values needs to be above a cutoff value for diagnosis.
• Two-step
  • Perform a glucose challenge test as a screen: a woman is given a 50-gram glucose dose to drink and her blood glucose level is measured after 1 hour.
  • If the challenge test is abnormal, perform a 3-hour oral glucose tolerance test. After a woman's fasting glucose level is measured, she is given a 100-gram glucose dose and her glucose is measured at timed intervals. If at least two of the glucose levels at fasting, 1 hour, 2 hour, or 3 hour are above a certain level, then a diagnosis of gestational diabetes is made.

Glucose testing is also used to test women who were diagnosed with gestational diabetes 6-12 weeks after they have delivered their baby to detect persistent diabetes.

Monitoring
Diabetics must monitor their own blood glucose levels, often several times a day, to determine how far above or below normal their glucose is and to determine what oral medications or insulin(s) they may need. This is usually done by placing a drop of blood from a skin prick onto a glucose strip and then inserting the strip into a glucose meter, a small machine that provides a digital readout of the blood glucose level.

Urine
Urine glucose is one of the substances tested when a urinalysis is performed. A urinalysis may be done routinely as part of a physical or prenatal checkup. The health practitioner may follow up an elevated urine glucose test with blood glucose testing. Urine glucose testing is a screening tool, but it is not sensitive enough for diagnosis or monitoring.

Other tests, such as diabetes autoantibodies, insulin, and C-peptide, may sometimes be performed along with these tests to help determine the cause of abnormal glucose levels, to distinguish between type 1 and type 2 diabetes, and to evaluate insulin production.

When is it ordered?

Several health organizations, including the American Diabetes Association (ADA) and the U. S. Preventive Services Task Force (USPSTF), recommend diabetes screening when a person is age 45 or older or when a person of any age has risk factors. Examples of risk factors include:

• Overweight, obese, or physically inactive
• A close (first degree) relative with diabetes
• A woman who delivered a baby weighing more than 9 pounds or with a history of gestational diabetes
• A woman with polycystic ovary syndrome
• High-risk race or ethnicity such as African American, Latino, Native American, Asian American, Pacific Islander
• High blood pressure (hypertension) or taking medication for high blood pressure
• Low HDL cholesterol level (less than 35 mg/dL or 0.90 mmol/L) and/or a high triglyceride level (more than 250 mg/dL or 2.82 mmol/L)
• A1c equal to or above 5.7%
• Prediabetes identified by previous testing
• History of cardiovascular disease (CVD)

If the screening test result is within normal limits, the ADA recommends retesting within 3 years, while the USPSTF recommends yearly testing. People with prediabetes may be monitored with annual testing.

See the screening articles for Children, Teens, Young Adults, Adults and Adults 50 and Up for additional details.

A blood glucose test may also be ordered when someone has signs and symptoms of high blood glucose, such as:

• Increased thirst, usually with frequent urination
• Fatigue
• Blurred vision
• Slow-healing wounds or infections

or symptoms of low blood glucose, such as:

• Sweating
• Hunger
• Trembling
• Anxiety
• Confusion
• Blurred vision

Diabetics are often required to self-check their glucose, up to several times a day, to monitor glucose levels and to determine treatment options as prescribed by their health practitioner. The healthcare provider may order blood glucose levels periodically in conjunction with other tests such as A1c to monitor glucose control over time.

Pregnant women are usually screened for gestational diabetes between their 24th and 28th week of pregnancy, unless they have early symptoms or have had gestational diabetes with a previous pregnancy. A woman may be tested earlier in her pregnancy if she is at risk of type 2 diabetes (overt diabetes), says the ADA. When a woman has type 1, type 2 or gestational diabetes, her health practitioner will usually order glucose levels throughout the rest of her pregnancy and after delivery to monitor her condition.

What does the test result mean?

Blood Glucose

High levels of glucose most frequently indicate diabetes, but many other diseases and conditions can also cause elevated blood glucose.

In a person with signs and symptoms of diabetes or high blood glucose, a non-fasting glucose level (random blood sample) that is equal to or greater than 200 mg/dL (11.1 mmol/L) indicates diabetes.

The following information summarizes the meaning of other test results.

Fasting Blood Glucose

Glucose Level	Indication
From 70 to 99 mg/dL (3.9 to 5.5 mmol/L)	Normal fasting glucose
From 100 to 125 mg/dL (5.6 to 6.9 mmol/L)	Prediabetes (impaired fasting glucose)
126 mg/dL (7.0 mmol/L) and above on more than one testing occasion	Diabetes

2-Hour Oral Glucose Tolerance Test (OGTT)

Levels applicable except during pregnancy. Sample drawn 2 hours after a 75-gram glucose drink.

Glucose Level	Indication
Less than 140 mg/dL (7.8 mmol/L)	Normal glucose tolerance
From 140 to 199 mg/dL (7.8 to 11.1 mmol/L)	Prediabetes (impaired glucose tolerance)
Equal to or greater than 200 mg/dL (11.1 mmol/L) on more than one testing occasion	Diabetes

Gestational Diabetes One-Step Approach (as one option recommended by the ADA)

Samples drawn fasting and then 1 hour and 2 hours after a 75-gram glucose drink. Diagnosis of GDM is made when any of the values exceed the limit.

Time of sample collection	glucose level
Fasting	Equal to or greater than 92 mg/dL (5.1 mmol/L)
1 hour	Equal to or greater than 180 mg/dL (10.0 mmol/L)
2 hour	Equal to or greater than 153 mg/dL (8.5 mmol/L)

Gestational Diabetes Two-Step Approach (as currently recommended by ACOG and as one option from the ADA): Step One

Step One: Glucose Challenge Screen. Sample drawn 1 hour after a 50-gram glucose drink.

Glucose Level	Indication
Less than 140* mg/dL (7.8 mmol/L)	Normal screen
140* mg/dL (7.8 mmol/L) and over	Abnormal, needs OGTT (see Step two below)

*Some experts recommend a cutoff of 130 mg/dL (7.2 mmol/L) because that identifies 90% of women with gestational diabetes, compared to 80% identified using the threshold of 140 mg/dL (7.8 mmol/L). ACOG recommends a lower threshold of 135 mg/dL (7.5 mmol/L) in high-risk ethnic groups with higher prevalence of gestational diabetes.

Gestational Diabetes Two-Step Approach (as currently recommended by ACOG and as one option from the ADA): Step Two

Step Two: Diagnostic OGTT. Samples drawn at fasting and then 1, 2 and 3 hours after a 100-gram glucose drink. If two or more values meet or exceed the target level, gestational diabetes is diagnosed. One of two sets of criteria may be used to establish a diagnosis.

Time of sample collection	target levels**
Fasting (prior to glucose load)	95 mg/dL (5.3 mmol/L)
1 hour after glucose load	180 mg/dL (10.0 mmol/L)
2 hours after glucose load	155 mg/dL (8.6 mmol/L)
3 hours after glucose load	140 mg/dL (7.8 mmol/L)

**Some labs may use different numbers.

Some other diseases and conditions that can result in an elevated blood glucose level include:

• Acromegaly
• Acute stress (response to trauma, heart attack, and stroke for instance)
• Chronic kidney disease
• Cushing syndrome
• Excessive consumption of food 
• Hyperthyroidism
• Pancreatic cancer
• Pancreatitis
   

A low level of glucose may indicate hypoglycemia, a condition characterized by a drop in blood glucose to a level where first it causes nervous system symptoms (sweating, palpitations, hunger, trembling, and anxiety), then begins to affect the brain (causing confusion, hallucinations, blurred vision, and sometimes even coma and death). A diagnosis of hypoglycemia uses three criteria known as the Whipple triad. 

A low blood glucose level (hypoglycemia) may be seen with:

• Adrenal insufficiency
• Drinking excessive alcohol
• Severe liver disease
• Hypopituitarism
• Hypothyroidism
• Severe infections
• Severe heart failure
• Chronic kidney (renal) failure
• Insulin overdose
• Tumors that produce insulin (insulinomas)
• Starvation
• Deliberate use of glucose-lowering products
   

Urine Glucose

Low to undetectable urine glucose results are considered normal. Any condition that raises blood glucose such as diabetes or the other conditions listed above also has the potential to elevate the concentration of glucose in the urine.

Increased urine glucose may be seen with medications, such as estrogens and chloral hydrate, and with some forms of kidney disease. Some people naturally leak glucose in their urine when blood levels are normal. Some medications used to treat diabetes work by increasing the elimination of glucose in the urine.

Is there anything else I should know?

Extreme stress can cause a temporary rise in blood glucose. This can be a result of, for example, trauma, surgery, heart attack or stroke.

Drugs, including corticosteroids, tricyclic antidepressants, diuretics, epinephrine, estrogens (birth control pills and hormone replacement), lithium, phenytoin, and salicylates, can increase glucose levels, while drugs such as acetaminophen and anabolic steroids can decrease levels.

Can I test myself at home for blood glucose levels?

If you are not diabetic or prediabetic, there is usually no reason to test glucose levels at home. Screening done as part of your regular physical should be sufficient.

If you have been diagnosed with diabetes or gestational diabetes, however, your health practitioner or diabetes educator will recommend a home glucose monitor (glucometer, or one of the newer methods that use very tiny amounts of blood or tests the interstitial fluid -- the fluid between your cells -- for glucose). You will be given guidelines for how high or low your blood sugar should be at different times of the day. By checking your glucose regularly, you can see if the diet and medication schedule you are following is working properly for you.

Can I test my urine glucose instead of my blood?

Not in most cases. Glucose will usually only show up in the urine if it is at sufficiently high levels in the blood so that the body is "dumping" the excess into the urine, or if there is some degree of kidney damage and the glucose is leaking out into the urine. Urine glucose, however, is sometimes used as a rough indicator of high glucose levels and the urine indicator strip (dipstick) that measures the glucose is occasionally useful for tracking the presence of protein and ketones in the urine.

What are the usual treatments for diabetes?

For type 2 diabetes, which is the most common type of diabetes, losing excess weight, eating a healthy diet that is high in fiber and restricted in carbohydrates, and getting regular amounts of exercise may be enough to lower your blood glucose levels. In many cases, however, oral medications that increase the body's secretion of and sensitivity to insulin are necessary to achieve the desired glucose level. With type 1 diabetes (and with type 2 diabetes that does not respond well enough to oral medications), insulin injections several times a day are necessary. See the article on Diabetes for more on treatment.

How can a diabetic educator help me?

If you are diabetic, a diabetic educator (often a nurse with specialized training) can make sure that you know how to:

• Recognize and know how to treat both high and low blood sugar
• Test and record your self-check glucose values
• Adjust your medications
• Administer insulin (which types in which combinations to meet your needs)
• Handle medications when you get ill
• Monitor your feet, skin, and eyes to catch problems early
• Buy diabetic supplies and store them properly
• Plan meals; diet is extremely important in minimizing swings in blood glucose levels. A registered dietician can help you learn how to plan meals and a diabetic educator can help with this as well.

How is hypoglycemia diagnosed?

An actual diagnosis of hypoglycemia requires satisfying the "Whipple triad." These three criteria include:

• Documented low glucose levels (less than 40 mg/dL (2.2 mmol/L), often tested along with insulin levels and sometimes with C-peptide levels)
• Symptoms of hypoglycemia when the blood glucose level is abnormally low
• Reversal of the symptoms when blood glucose levels are returned to normal

Primary hypoglycemia is rare and often diagnosed in infancy. People may have symptoms of hypoglycemia without really having low blood sugar. In such cases, dietary changes such as eating frequent small meals and several snacks a day and choosing complex carbohydrates over simple sugars may be enough to ease symptoms.

How is glucose different from table sugar?

Table sugar (sucrose) is a combination of two simple sugars, glucose and fructose, that are both released when table sugar is digested. Because glucose is the body's primary energy source, the blood glucose test is often informally referred to as a "blood sugar" test.