May I add a personal comment as regards the level at which random
glucoses are flagged as abnormal.
About a year ago, my elderly mother attended her local GP for a routine
BP check; he took blood from her for U&E, TFTs and glucose. This was
collected by the GP at around 9 am, about an hour after she's had her
usual winter breakfast of porridge. The result was reported as 8.1
mmol/L and flagged as 'HI' by the lab, who quoted 7.8 as the upper limit
of normal for a random glucose.
The GP called her back and told her she was diabetic and needed a GTT,
as it would take her about 3 weeks to get an appointment for this, she
should in the meantime cut down the carbohydrate in her diet. In fact,
she eats a remarkably healthy diet (much more so than mine!) she eats
relatively little carbohydrate apart from her porridge and the odd
potato.
When she told me this I had her to stay for a few days, gave her a good
carbohydrate intake for a few days and did the GTT myself - it was, of
course, entirely normal.
The moral?
1) Doctors do take ref ranges as black and white; if a result is above
the upper limit quoted, it's abnormal
2) Neither does the average GP understand about the need for proper
pre-GTT diet. What if the GTT had been done after a very low CHO diet
for 3 weeks - and the 2 hour glucose was 9.0 mmol/L? An 88 y old lady
would have been inappropriately labelled as diabetic, with all the
lifestyle consequences of that.
We have to be very careful when we quote 'normal' ranges!
Cathryn
Cathryn Corns
Head of Biochemistry & Clinical Director
Southend Hospital NHS Trust
01702 435555 ext 4058
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Paul Eldridge
Sent: 06 January 2005 15:34
To: [log in to unmask]
Subject: Re: Random Plasma Glucose
In the Lewisham PCT Diabetes NSF Guidelines we only do GATS on patient
with impaired fasting glucose.
We have written the need for a repeat GTT in the asymptomatic patient
into the flow chart. I add on an HbA1c on all the diabetic response
GATS.
There are very few repeat GATS. Presumably the clinical features are
more obvious once the GTT has been done.
Random glucose reference range upper limit set at 7.8 mmol/L for
similar reasons as others.
Tempted to replace it either with an autocomment or 6.0 mmol/L, the
figure suggested in our PCT guidelines as indicating the need to check a
fasting glucose. For the reason previously quoted, the result flag, the
latter is the likely option.
Dr Paul Eldridge
Clinical Biochemist
University Hospital Lewisham
London SE13 6LH
UK
Phone: (44) 020 8333 3255
Fax: (44) 020 8690 8891
[log in to unmask]
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