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Rita, Even separating within 30 minutes is unrealistic for anyone who works in a routine lab. I would like to know what difference it makes to any clinician treating a patient. The strict cutoffs have always been an odd approach. When I was an SR in Bristol I would sign out the GTTs with the QC results and running means and write a comment on how the results were slightly high and to be interprets with caution. Grey zones would be better and then slight variations would be acceptable and we would not be having this turmoil. Does it make a real difference if the result is 7 or 8 mmol/L. Not when you are administering insulin or altering oral hypoglycemics. If we are going to diagnose someone a diabetic because they are 0.5mmol above any of the cutoffs then we have a problem with the inter lab variabity. Most doctors do not respond to these variations. Why are we making life so difficult for ourselves. Analytical, biological, preanalytical errors are always going to be there. Trying to eliminate them is part of the law of diminishing returns. No doctor will start treatment because you are 11.3 but will advise you on diet and exercise. She will do the same for a glucose of 10.3mmol/L What will all of this achieve? Every patient in my hospital must now have two tubes of blood taken instead of one. They will become more anaemic. All of our in-patients on chemo are neutropenic and have bloods taken daily including glucose. Do they now have two tubes or do we do CBGM and risk infection of their finger tips. Do they get put on Vancomycin with a temp of 38.2C because their finger tip is sore and they might have a Staph infection not coveted by their other antibiotics. Now do we make sure they become positive for VRE by giving vanco ( it must be now continued until they have a source of the infection or no longer neutropenic. I do not see this as a good thing, I see this as looking at things in silos. But I do thank you for replying and I can see from your previous answer that a lot of work and thought has gone into this. I just don't agree, perhaps as I also practice as an Internist. But a very sincere thanks Elizabeth On 2011-08-17, at 8:06 PM, Rita Horvath <[log in to unmask]> wrote: > Elizabeth, the guideline says separate in 30 mins and not to analyse in 30 mins... > > Regards, Rita > Prof. Andrea Rita Horvath > Clinical Director > SEALS North, Department of Clinical Chemistry > Level 4, Campus Centre, Prince of Wales Hospital > Barker Street, Randwick, NSW 2031, Sydney, Australia > Tel: (+612)-9382 9078 > Fax: (+612)-9382 9099 > Mobile No: (+61)-404 027 843. > > > > > -----Original Message----- > From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Elizabeth MacNamara > Sent: Thursday, 18 August 2011 9:21 AM > To: [log in to unmask] > Subject: Re: GTT > > This is nonsense and impracticable. If you look at any EQA scheme you will see at least a 1 mmol/L error between labs not to mention time sampling errors. Clinically it makes little or no sense. The rate of change of glucose does not require instant immersion in ice slurry and analysis within 30 minutes > > Elizabeth Mac Namara > Jewish General Hospital > Montreal > > > > On 2011-08-17, at 6:28 PM, Webster Craig <[log in to unmask]> wrote: > >> To minimize glycolysis, one should place the sample tube immediately in an ice–water slurry, and plasma should be separated from the cells within 30 min. If that cannot be achieved, a tube containing a rapidly effective glycolysis inhibitor, such as citrate buffer, should be used for collecting the sample. Tubes with only enolase inhibitors, such as sodium fluoride, should not be relied on to prevent glycolysis. >> >> Does anyone know if a tube manufacturer produces the required tubes (rapidly effective glycolysis inhibitor, such as citrate buffer) ? Forgive my ignorance but I'm assuming this is not the standard citrate tube? >> >> Cheers >> Craig >> >> >> >> On 17 Aug 2011, at 22:14, Joseph WAWA wrote: >> >> NACB guidelines >> >> >> This e-mail and any attachments may contain confidential and >> privileged information. If you are not the intended recipient, >> please notify the sender immediately by return e-mail, delete this >> e-mail and destroy any copies. Any dissemination or use of this >> information by a person other than the intended recipient is >> unauthorized and may be >> illegal.**************************************************************** >> ****** >> This email contains proprietary information some or all of which >> may be >> legally privileged. >> It is for the intended recipient(s) only. 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