Diabetic Panel

Specimen Type Whole Blood, Serum and Urine 
Description: The Diabetes Panel combines tests to provide a comprehensive assessment of blood sugar levels and may be used to assist in the diagnosis of diabetes or to monitor diabetes treatment. The Diabetes Panel includes the Comprehensive Metabolic Panel (14), Lipid Panel, Complete Blood Count Panel and the Hemoglobin A1C. 
Requirements:  The Diabetes Panel requires fasting 10-12 hours prior to going in for blood collection. 
Collection for urine

The following samples are acceptable:

1.  24-hour collection

2.  Overnight (8-12-hour) collection

3.  1 to 2-hour collection

4.  First-morning sample for simultaneous albumin and creatinine measurements.

Samples should not be collected after exertion, in the presence of urinary tract infection, during acute illness, immediately after surgery, or after an acute fluid load.  Specimens should be collected without preservatives.  Specimens visibly contaminated with blood are not suitable for analysis of albumin concentration.

 
Test Includes:  Alanine aminotransferase (ALT/SGPT); albumin:globulin (A:G) ratio; albumin, serum; alkaline phosphatase, serum; aspartate aminotransferase (AST/SGOT); bilirubin, total; BUN; BUN:creatinine ratio; calcium, serum; carbon dioxide, total; chloride, serum; creatinine, serum; eGFR calculation; globulin, total; glucose, serum; potassium, serum; protein, total, serum; sodium, serum; Total Cholesterol; High-Density Lipoprotein (HDL) Cholesterol; Low-Density Lipoprotein (LDL) Cholesterol (calculation); Triglycerides; Very Low-Density Lipoprotein (VLDL) Cholesterol (calculation); Hematocrit; hemoglobin; mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); mean corpuscular hemoglobin concentration (MCHC); red cell distribution width (RDW); platelet count (RBC); red cell count; white blood cell count (WBC); Lymphocytes (LYM); Monocytes (MON); Granulocytes (GRA); Hemoglobin A1c; Microalbumin, urine
Volume:  Fill tube to capacity.
Container:  Lavender-top (EDTA) tube; Gel-barrier tube (send entire tube) is preferred. Red-top tube or green-top (heparin) tube is acceptable; Plastic urine container
Collection:  For lavender-top invert tube 8 to 10 times immediately after tube is filled at the time of collection. For Gel-barrier tube (If red-top tube or green-top tube is used) centrifuge within 45 minutes of draw, remove the serum or plasma, and place in a transport tube and tightly stopper the tube.
Storage Instructions for Whole Blood and Serum:  Refrigerate
Storage instructions for Urine: Room temperature
 Limitations:

Any cause of shortened erythrocyte survival will reduce exposure of erythrocytes to glucose with a consequent decrease in Hb A1c (%). Causes of shortened erythrocyte lifetime might be.

Causes for Rejection: Hemolysis; tube not filled with minimum fill volume; specimen drawn in any anticoagulant other than EDTA; specimens diluted or contaminated with IV fluid; clotted specimen; improper labeling; transfer tubes with whole blood; lavender-top (EDTA) tubes received with plasma removed.
Methodology:  Automated cell counter and RXL Dimension

Stability for Whole Blood: 

Temperature Period
Refrigerated (2-8 ⁰C) 16 Days

Stability for Serum: 

Temperature Temperature
Room temperature 3 days
Refrigerated 3 days
Frozen 14 days
Freeze/thaw cycles Stable x2

Stability for Urine: 

Temperature Period
Room Temperature 2 Days
Refrigerated (2-8 ⁰C) 14 Days

Reference Range: 

 Test Type  Males Females
White Blood Cell (WBC) 4.0-10.5 103/µL 4.0-10.5 103/µL
Red Blood Cell (RBC) 4.6-6.2 106/µL 4.2-5.4 106/µL
Hemoglobin (HGB) 13.5-18 g/dL 12-16 g/dL
Hematocrit (HCT)  40-54% 38-47%
Mean Corpuscular Volume (MCV) 80-97 fL 80-97 fL
Mean Corpuscular Hemoglobin (MCH) 27-33 pg 27-33 pg
Mean Corpuscular Hemoglobin Concentration (MCHC) 31.5-35.7 g/dL 31.5-35.7 g/dL
Red Cell Distribution Width (RDW) 12.3-15.4% 12.3-15.4 %
Platelet Count (PLT) 150-450 103/µL 150-450 103/µL
Lymphocytes (LYM) 25-40% 25-40%
Monocytes (MON) 2-8% 2-8%
Granulocytes (GRA) 55-80% 55-80%

Reference Range for Lipid Panel Tests:

Total Cholesterol 100-199 mg/dL
Triglycerides 0-149 mg/dL
HDL Cholesterol Calc. >39 mg/dL
LDL Cholesterol Calc. 0-99 mg/dL
VLDL Cholesterol Calc. 5-40 mg/dL
Total Cholesterol/HDL Ratio 0.0-5.0 ratio units
LDL/HDL Ratio 0.0-3.5 ratio units

 

Use: As a screening test to evaluate overall health; detect and/or identify a wide range of hematologic disorders; assist in managing medications/chemotherapeutic decisions.
White Blood Cell (WBC): Blood contains a variety of white blood cells, the body’s defense system against infections. Elevated counts usually indicate infection or inflammation. A mild decrease in white blood cells is frequently seen in viral infections. Extremely elevated or decreased counts may indicate an active disease process, requiring medical evaluation by your physician.
 Red Blood Cell (RBC): Red blood cells are the major component of blood. They are made in the bone marrow and released into the circulating blood. This count is a good indicator of the body’s ability to transport oxygenated blood to body tissues. A decreased number of red blood cells is associated with anemias, and other diseases affecting production of new red blood cells.
 Hemoglobin (HGB): Approximately one-third of each red cell is comprised of hemoglobin, which contains iron. Hemoglobin carries oxygen from the lung to body tissues. Men tend to have higher hemoglobin levels than women. Low values may indicate anemia, blood loss, and other conditions associated with iron loss.
Hematocrit (HCT): The HCT is the comparison of the cellular portion of the blood to the serum (fluid) portion. This comparison is reported as a percentage. A low number of red blood cells causes a low HCT. Men tend to have higher hematocrits than women. The hematocrit is often used along with a hemoglobin to evaluate anemias.

MCV, MCH, and MCHC: 

These calculations help your physician determine if significant abnormalities are present requiring additional testing. The MCV measures the actual size of the average red blood cell. The MCH represents the weight of hemoglobin in an average red blood cell. The MCHC uses the MCV and the MCH to compare the size of the red blood cell to the amount of hemoglobin present. These calculations are helpful in classifying anemias.
Red Cell Distribution Width (RDW): The red cell distribution width or RDW is an analysis of the variation in size of all red blood cells tested. This evaluation is helpful in classifying anemias.
Platelet Count: Platelets play a vital role in the blood clotting process. The platelets stop bleeding by sticking together and forming “plugs.” A variety of disease conditions can cause low numbers of platelets; these individuals tend to bleed more easily and excessively. Extremely low or high platelet counts may indicate blood disorders which require additional testing.
WBC Differential: Five major types of white blood cells are normally found in the blood: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. The “differential count” gives the percentage of each cell type. Increases or decreases in the cell percentages are consistent with certain medical conditions. These percentages assist your physician in determining a specific diagnosis or disease state.
Cholesterol, Total: This test is used to determine the risk of developing coronary heart disease and hyperlipidemias. Cholesterol is a sterol in the blood. Knowing your cholesterol may be as important as knowing your blood pressure. Elevated cholesterol is associated with an increasing risk of coronary heart disease. Reference Range: 100-199 mg/dL
Triglycerides (Blood Fats): This test is used to identify the risk of developing coronary heart disease, or when disorders in fat metabolism are suspected. Triglycerides are fat in the blood responsible for providing energy to
HDL Cholesterol (“Good” Cholesterol): This test measures alpha lipoprotein and is used to predict heart disease. High-density lipoproteins are believed to take cholesterol away from cells and transport it back to the liver for processing or removal. They have become known as the “good” cholesterol. Persons with high levels of HDL may have less risk of heart disease. Low levels of HDL could be the result of smoking or lack of exercise.
VLDL Cholesterol (Very Low-Density Lipoprotein): This test measures very low density lipoprotein, which contains the highest amount of triglycerides (blood fats). Elevated levels are associated with an increased risk of coronary heart disease. Reference Range: 5-40 mg/dL
LDL Cholesterol (“Bad” Cholesterol): This test measures beta lipoproteins and is also used to predict heart disease. Low-density lipoproteins contain the greatest percentage of cholesterol and are responsible for depositing cholesterol on the artery walls. Reference Range: 0-99 mg/dL
Use: The A1c test is used to monitor the glucose control of diabetics over time. The goal of those with diabetes is to keep their blood glucose levels as close to normal as possible. This helps to minimize the complications caused by chronically elevated glucose levels, such as progressive damage to body organs like the kidneys, eyes, cardiovascular system, and nerves. The A1c test result gives a picture of the average amount of glucose in the blood over the last few months. This can help the diabetic person and his doctor know if the measures that are being taken to control his diabetes are successful or need to be adjusted.
Hemoglobin A1c: A1c is frequently used to help newly diagnosed diabetics determine how elevated their uncontrolled blood glucose levels have been over the last 2-3 months. The test may be ordered several times while control is being achieved, and then several times a year to verify that good control is being maintained.

The A1c test may be used to screen for and diagnose diabetes. However, A1c should not be used for diagnosis in pregnant women, people who have had recent severe bleeding or blood transfusions, those with chronic kidney or liver disease, and people with blood disorders such as iron-deficiency anemia, vitamin B12 deficiency anemia, and some hemoglobin variants (e.g., patients with sickle cell disease or thalassemia). In these cases, a fasting plasma glucose or oral glucose tolerance test should be used for screening or diagnosing diabetes.

Elevated Hb A1C may be an indication of diabetes.