Diabetes Diagnosis

In the majority of cases, diabetes shows little or no symptoms. Hence, early detection can be difficult. However, if there are any early symptoms that has been persisting for some time, then it is best to consult your general physician and get tested.

The common symptoms of diabetes are:

  • Frequent thirst
  • Tiredness
  • Feeling hungry in spite of eating
  • Blurry vision
  • Frequent urination
  • Cuts and sores that take time to heal

If one is overweight or obese, then it is prudent to get tested for diabetes even if there are no visible symptoms of the condition. In addition to that, testing should be done if:

  • You belong to a high-risk ethnic group
  • You have high blood pressure, low HDL cholesterol, heart disease or high triglycerides
  • There is a family history of diabetes
  • There is a medical history of abnormal blood sugar or signs of insulin resistance
  • You do not indulge in regular physical exercise
  • You have a history of polycystic ovary syndrome or gestational diabetes

If you are over the age of 45, it is recommended to undergo regular testing for diabetes. Periodic monitoring of glucose levels helps to establish a baseline as the risk of diabetes increases as one grows older.

The recommended tests for prediabetes, diabetes type 1 and type 2 are:

  • Glycated Haemoglobin or A1C test:

This test for diabetes does not require fasting and is an indicator for the average glucose level over the last two to three month period. The test typically gauges the percentage of glucose in the haemoglobin.

The haemoglobin is the oxygen-carrying protein in the red blood cells. If the haemoglobin has a higher percentage of the blood sugar levels, it basically implies that more sugar will be attached to it.

In case the results from Glycated Haemoglobin test are inconsistent, if the test is unavailable or there are other conditions that prevents the patient from taking the test such as pregnancy, then your healthcare provider may recommend other forms of diagnostic testing for diabetes. These tests may include:

  • Fasting Plasma Glucose or FPG Test:

This test requires the patient to fast and it provides the best outcomes if blood sample is collected in the morning. If the results show that the fasting glucose levels are between 100 to 125 mg/dL, it implies that you are on the brink with a form of prediabetes known as impaired fasting glucose or IFG. This means that you are likely to develop type 2 diabetes in the near future. However, if the outcome is 126 mg/dL or above, then the diagnosis of diabetes is confirmed.

  • Oral Glucose Tolerance Test or OGTT:

The OGTT, over the years has proven to be a more sensitive test in comparison to the FPG test when it comes to diagnosing prediabetes. However, the administering of the test can be quite cumbersome. For the OGTT, the patient in question has to fast for at least 8 hours before the test is taken. Initially, the plasma glucose is measured instantly before and after the patient has to drink a liquid that contains 75 grams of dissolved glucose in water.

If the outcome shows that the glucose levels are between the range of 140 and 199 mg/dL post the 2 hours after drinking the glucose liquid, it indicates a condition called impaired glucose tolerance or IGT, which is a form of prediabetes. This implies that the patient has a chance of developing type 2 diabetes quite soon. If the outcome is 200 mg/dL or above after the 2 hour period, it means that the patient has diabetes. The doctor may recommend the same test on another day to re-confirm the diagnosis.

  • Random Plasma Glucose Test:

If you have an outcome of 200 mg/dL or more along with the additional symptoms such as frequent urination, feeling thirsty and losing weight, it means that you have diabetes. Your healthcare provider may additionally request you to undergo the FPG or OGTT test to doubly confirm the diagnosis.

  • Haemoglobin A1C test:

Latest diabetes testing using the Haemoglobin A1C screening as a method for testing prediabetes checks the average blood sugar levels in a patient for over a period of several months. If the average levels of HbA1c are between 5.7% to 6.4%, then it definitely indicates prediabetes stage. This can be reversed by making specific lifestyle changes. If the level is more than 6.5%, it implies that the patient is diabetic.

  • Zinc transporter 8 autoantibody (ZnT8Ab) test:

Diabetes is a condition that requires repeated testing to confirm the levels of increasing or decreasing sugar in the blood. With your initial confirmation of diabetes, your healthcare provider may also suggest you take a zinc transporter 8 autoantibody (ZnT8Ab) test which can accurately help diagnose the type of diabetes leading to timely treatment.

  • Urine Testing for Diabetes:

Urine tests are not typically used to diagnose diabetes. However, doctors may recommend urine testing to check for type 1 diabetes as the body generates ketone bodies when the fat tissue is used to produce energy instead of glucose. The urine is tested for the presence of ketone bodies under laboratory conditions. If they outcome indicates that ketone bodies are present in moderate to large quantities in the urine, it may indicate that the body is not producing adequate amounts of insulin.

If your doctor suspects gestational diabetes, he may recommend the following diagnostic tests:

  • Initial Glucose Test:

You will be made to drink a glass of syrupy glucose solution. Your blood sample will be collected an hour later to measure the glucose levels. If the sugar level is below 140 mg/dL (7.8 mmol/L), then there is nothing to worry about as that falls within the normal range. If the level is over 140 mg/dL, you may be at risk of developing gestational diabetes during pregnancy, Follow-up tests may be prescribed at a later date to confirm the diagnosis.

  • Follow-up glucose tolerance testing:

You will have to fast overnight and the blood sample will be collected in the morning. Post the collection of the fasting sample, you will be requested to drink the sweet solution and blood samples will be taken every hour for three consecutive hours. If two of the three sample outcomes have blood sugar levels above the normal range, it confirms the diagnosis of gestational diabetes.

Given timely treatment, all forms of diabetes can be managed and controlled. However, type 1 diabetes lasts a patient’s life span and there is no known cure available. With lifestyle changes, following a strict diet and a combination of physical activity and keeping the weight in control, many be able to minimise the symptoms without any medications.

In terms of medical treatments to manage diabetes, Fortis Hospital, Mumbai can offer you the following:

  • Insulin injections on a daily basis are required to treat type 1 diabetes. Insulin can also be taken via a pump.
  • Oral medication is available for type 2 diabetes. If the blood sugar levels increase drastically, you may be prescribed insulin. This will be in combination with eating well and exercising.
  • Gestational diabetes may be treated via oral medications too.

Every diabetic patient’s needs are unique. Therefore, treatments have to be planned accordingly. Your diabetes care team at Fortis, Mumbai will be able to guide you in the right therapy direction. However, it is prudent to bear in mind that you are the most critical member of your care team as you alone know how you feel. Discuss your concerns and questions with your diabetes team at Fortis to get the best possible care under the circumstances.