glucose, blood (Blood sugar, Fasting blood sugar [FBS])

Type of test Blood

Normal findings

Cord: 45-96mg/dL or 2.5-5.3mmol/L (SI units)

Premature infant: 20-60mg/dL or 1.1-3.3mmol/L

Neonate: 30-60mg/dL or 1.7-3.3mmol/L

Infant: 40-90mg/dL or 2.2-5.0mmol/L

Child <2 years: 60-100mg/dL or 3.3-5.5mmol/L

Child >2 years to adult:

Fasting: 70-110mg/dL or <6.1mmol/L (Fasting is defined as no caloric intake for at least 8 hours.)

Casual: 200mg/dL (<11.1mmol/L) (Casual is defined as any time of day regardless of food intake.)

Adult: 74-106mg/dL or 4.1-5.9mmol/L

Elderly: 60-90 years: 82-115mg/dL or 4.6-6.4mmol/L>90 years: 75-121mg/dL or 4.2-6.7mmol/L

Possible critical values

Adult male: <50 and >400mg/dL

Adult female: <40 and >400mg/dL

Infant: <40mg/dL

Newborn: <30 and >300mg/dL1

Test explanation and related physiology

Through an elaborate feedback mechanism, glucose levels are controlled by insulin and glucagon. In the
fasting state, glucose levels are low. In response, glucagon is secreted. Glucagon causes glucose levels to
rise.

After eating, glucose levels are elevated. Insulin is secreted. Insulin drives glucose into the cells to be
metabolized to glycogen, amino acids, and fatty acids. Blood glucose levels diminish. Other hormones,
such as adrenocorticosteroids, adrenocorticotropic hormone, epinephrine, growth hormone, and
thyroxine, can also affect glucose metabolism.
Serum glucose levels must be evaluated according to the time of day they are performed. For example, a
glucose level of 135mg/dL may be abnormal if the patient is in the fasting state, but this level would be
within normal limits if the patient had eaten a meal within the previous hour.

In general, true glucose elevations indicate diabetes mellitus; however, one must be aware of many
other possible causes of 2hyperglycemia. Similarly, hypoglycemia has many causes. The most common
cause is inadvertent insulin overdose in patients with brittle diabetes. If diabetes is suspected by
elevated fasting blood levels, glycosylated hemoglobin (p. 483) or glucose tolerance tests (p. 479) can be
performed.

Glycosylated hemoglobin (page 483) is now being performed more frequently to identify diabetes
because this blood test represents blood sugar levels over the previous 120 days. That being said, the
diagnosis of diabetes should be confirmed with a repeat of the same tests initially performed but on a
different day to guard against laboratory error.

Glucose determinations must be performed frequently in new patients with diabetes to monitor closely
and adjust the insulin dosage to be administered. Fingerstick blood glucose determinations are often
performed before meals and at bedtime. Patients with diabetes can then adjust their insulin doses of
rapid-acting subcutaneous insulin.

For patients with diabetes who experience recurrent episodes of severe hypoglycemia or who require
more than three doses of insulin per day, minimally invasive glucose monitoring is available. A small,
sterile, disposable glucose-sensing device is inserted into the subcutaneous tissue (usually the arm). This
sensor measures the change in glucose in the interstitial fluid. This information is recorded in a small
beeper-sized monitor for 3 to 4 days. The monitor is taken to the doctors office, where it is connected to
a standard personal computer. Specialized software then downloads the stored information, and a more
effective insulin regimen can be developed.

Interfering factors

Many forms of stress (e.g., general anesthesia, cerebrovascular accident, myocardial infarction, shock,
strenuous exercise, burns) can cause increased serum glucose levels.

Many pregnant women experience some degree of glucose intolerance. If significant, it is called
gestational diabetes.

Most IV fluids contain dextrose, which is quickly converted to glucose. Therefore, most patients receiving
IV fluids will have increased glucose levels.

Drugs that may cause increased levels include antidepressants (tricyclics), antipsychotics, beta-
adrenergic blocking agents, corticosteroids, cyclosporine, dextrose IV infusion, dextrothyroxine,
diazoxide, diuretics, epinephrine, estrogens, glucagon, isoniazid, lithium, niacin, phenothiazines,
phenytoin, salicylates (acute toxicity), triamterene, and statins.2
Drugs that may cause decreased levels include acetaminophen, alcohol, alpha-glucosidase inhibitors,
anabolic steroids, biguanides, clofibrate, disopyramide, gemfibrozil, incretin mimetics, insulin,
meglitinides, monoamine oxidase inhibitors, pentamidine, propranolol, sulfonylureas, and
thiazolidinediones.

Procedure and patient care

See inside front cover for Routine Blood Testing.

Fasting: yes.

Blood tube commonly used: red or gray.

For FBS, instruct the patient to fast for 8 hours. Water is permitted.

To prevent starvation, which may artificially raise the glucose levels, tell the patient not to fast much
longer than 8 hours.

Withhold insulin or oral hypoglycemics until after blood is obtained.

Glucose levels also can be evaluated by performing a finger stick and using either a visually read test or
a reflectance meter. The advantage of the visually read test is that it does not require an expensive
machine. However, the patient must be able to visually interpret the color of the reagent strip. Using
reflectance meters (e.g., glucometer, Accu-Chek bG, Stat-Tek) improves the accuracy of the blood glucose
determination.

Abnormal findings

Increased levels

(hyperglycemia)

Diabetes mellitus

Acute stress response

Cushing syndrome

Pheochromocytoma

Chronic renal failure

Glucagonoma

Acute pancreatitis

Diuretic therapy

Corticosteroid therapy
Acromegaly

Decreased levels

(hypoglycemia)

Insulinoma

Hypothyroidism

Hypopituitarism

Addison disease

Extensive liver disease

Insulin overdose

Starvation4