Diabetes & Blood Sugar

Diabetes & Blood Sugar, Women's Health

The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women be screened for gestational diabetes mellitus (GDM)—whether by patient history, clinical risk factors, or with a 50-gram, one-hour loading test at 24 to 28 weeks of gestation to determine blood glucose levels—and suggests relying on the result of the 100-gram, three-hour oral glucose tolerance test for diagnosis (often referred to as a "two-step" method).2The American Diabetes Association (ADA)3released standards that vary from the ACOG recommendations. The ADA recommends a simplified "one-step" approach to the screen and diagnosis of gestational diabetes mellitus with a 75-gram, two-hour glucose tolerance test. The LabCorp test according to the ADA recommendations isGestational Glucose Tolerance Screening and Diagnostics Test (Two-hour, ADA Recommendations) [101000]. A glucose tolerance screen glucose threshold >139 mg/dL after a 50-gram load identifies approximately 80% of women with gestational diabetes mellitus, while the sensitivity is further increased to approximately 90% by a threshold >129 mg/dL. Perform a diagnostic 100-gram oral glucose tolerance test(102004)on a separate day on women who exceed the chosen threshold on 50-gram screening.

Diabetes & Blood Sugar, General Health & Wellness

According to the ADA, a fasting glucose >125 mg/dL on more than one occasion is adequate for the diagnosis of diabetes mellitus.The ADA further classifies an intermediate group of individuals whose glucose levels do not meet criteria for diabetes yet are higher than those considered normal. These individuals were defined as having impaired fasting glucose (IFG) in plasma between 100-125 mg/dL.1The ADA defines three levels of hypoglycemia, with Level 1 cut-point being the most sensitive for detection.2Level 1 hypoglycemia is defined as a measurable glucose concentration <70 mg/dL but >53 mg/dL. A blood glucose concentration of 70 mg/dL has been recognized as a threshold for neuroendocrine responses to failing glucose in people with diabetes. Because many people with diabetes demonstrate impaired counterregulatory responses to hypoglycemia and/or experience hypoglycemia unawareness, a measured glucose level <70 mg/dL is considered clinically important.Criteria for diagnosis of diabetes include2:A1C >6.4% (utilizing NGSP certified and standardized to the DCCT assay);* orFasting glucose level >125 mg/dL;* orA two-hour plasma glucose >199 mg/dL during an OGTT;* orClassic symptoms of hyperglycemia or hyperglycemic crisis, with random plasma glucose >199 mg/dL.*In the absence of unequivocal hyperglycemia, criteria 1-3 should be confirmed by repeat testing.Recent evidence revealed a diurnal variation in FPG, with mean FPG higher in the morning than in the afternoon, indicating that many cases of undiagnosed diabetes would be missed in patients seen in the afternoon. Glucose concentrations decreaseex vivowith time in whole blood because of glycolysis. The rate of glycolysis, reported to average 5% to 7% [~0.6 mmol/L (10 mg/dL)] per hour, varies with the glucose concentration, temperature, white blood cell count and other factors. Glycolysis can be attenuated by inhibition of enolase with sodium fluoride (2.5 mg fluoride/mL of blood) or, less commonly, lithium iodacetate (0.5 mg/mL of blood). These reagents can be used alone or, more commonly, with anticoagulants such as potassium oxalate, EDTA, citrate or lithium heparin. Although fluoride maintains long-term glucose stability, the rate of decline of glucose in the first hour after sample collection in tubes with and without fluoride is virtually identical. (Note that leukocytosis will increase glycolysis even in the presence of fluoride if the white cell count is very high). After four hours, the glucose concentration is stable in whole blood for 72 hours at room temperature in the presence of fluoride. In separated, nonhemolyzed, sterile serum without fluoride, the glucose concentration is stable for 14 days at 25°C and 4°C.

Diabetes & Blood Sugar

According to the ADA, a fasting glucose >125 mg/dL on more than one occasion is adequate for the diagnosis of diabetes mellitus.The ADA further classifies an intermediate group of individuals whose glucose levels do not meet criteria for diabetes yet are higher than those considered normal. These individuals were defined as having impaired fasting glucose (IFG) in plasma between 100-125 mg/dL.1The ADA defines three levels of hypoglycemia, with Level 1 cut-point being the most sensitive for detection.2Level 1 hypoglycemia is defined as a measurable glucose concentration <70 mg/dL but >53 mg/dL. A blood glucose concentration of 70 mg/dL has been recognized as a threshold for neuroendocrine responses to failing glucose in people with diabetes. Because many people with diabetes demonstrate impaired counterregulatory responses to hypoglycemia and/or experience hypoglycemia unawareness, a measured glucose level <70 mg/dL is considered clinically important.Criteria for diagnosis of diabetes include2:A1C >6.4% (utilizing NGSP certified and standardized to the DCCT assay);* orFasting glucose level >125 mg/dL;* orA two-hour plasma glucose >199 mg/dL during an OGTT;* orClassic symptoms of hyperglycemia or hyperglycemic crisis, with random plasma glucose >199 mg/dL.*In the absence of unequivocal hyperglycemia, criteria 1-3 should be confirmed by repeat testing.Recent evidence revealed a diurnal variation in FPG, with mean FPG higher in the morning than in the afternoon, indicating that many cases of undiagnosed diabetes would be missed in patients seen in the afternoon. Glucose concentrations decreaseex vivowith time in whole blood because of glycolysis. The rate of glycolysis, reported to average 5% to 7% [~0.6 mmol/L (10 mg/dL)] per hour, varies with the glucose concentration, temperature, white blood cell count and other factors. Glycolysis can be attenuated by inhibition of enolase with sodium fluoride (2.5 mg fluoride/mL of blood) or, less commonly, lithium iodacetate (0.5 mg/mL of blood). These reagents can be used alone or, more commonly, with anticoagulants such as potassium oxalate, EDTA, citrate or lithium heparin. Although fluoride maintains long-term glucose stability, the rate of decline of glucose in the first hour after sample collection in tubes with and without fluoride is virtually identical. (Note that leukocytosis will increase glycolysis even in the presence of fluoride if the white cell count is very high). After four hours, the glucose concentration is stable in whole blood for 72 hours at room temperature in the presence of fluoride. In separated, nonhemolyzed, sterile serum without fluoride, the glucose concentration is stable for 14 days at 25°C and 4°C.

Diabetes & Blood Sugar, General Health & Wellness

Hemoglobin A1c results from the non-enzymatic glycation of the amino (N)-terminal valine residue of hemoglobin A. This process is dependent on average glucose concentrations and occurs throughout the 120-day lifespan of the RBC. Therefore, HbA1c reflects glycemic control over the previous three months.4-6HbA1c represents a weighted average, with approximately 50% of the value due to the mean blood glucose (BG) concentrations in the 30 days prior to sampling; BG concentrations from the previous 90 to 120 days make up about 10% of the final total HbA1c value.5The ADAG (A1c-Derived Average Glucose) study found a strong correlation between the HbA1c and estimated average glucose concentrations.7A change (either positive or negative) in HbA1c percentage of 0.5% is considered clinically significant.8,9The American Diabetes Association’s Standards of Medical Care in Diabetes, published in 2018, addressed the utilization of HbA1c in the diagnosis and management of Diabetes Mellitus (DM).1The diagnosis of DM is made when the HbA1c values are >6.5% based on an NGSP-certified test. Prediabetes is defined by an HbA1c of 5.7% to 6.4%. Patients with prediabetes should be tested yearly in order to determine whether they have converted to diabetic status. Plasma glucose concentrations are recommended over HbA1c testing for diagnosing Type 1 DM patients who have overt symptoms of hyperglycemia, most of whom are pediatric patients. HbA1c, fasting plasma glucose and 2-hour plasma glucose values obtained during oral glucose tolerance testing are equally beneficial in diagnosing Type 2 DM in both younger and older patients.1The ADA guidelines recommend that HbA1c testing be performed at least twice yearly in diabetic patients who have achieved stable glycemic control.2For those patients who are not at goal or for whom therapy recently changed, quarterly HbA1c testing is recommended. The guidelines also caution that HbA1c does not measure glycemic variability or hypoglycemic risk, although hypoglycemia is less common among patients with HbA1c values of <7.0% to 7.5%.2The ADA offers guidelines for initiating and escalating therapy based on HbA1c concentrations.

Diabetes & Blood Sugar

Offered as part of multiple lab tests

General Health & Wellness, Diabetes & Blood Sugar

Offered as part of multiple lab tests

Heart Health & Cardiovascular, Diabetes & Blood Sugar

Investigation of serum lipids is indicated in those with coronary and other arterial disease, especially when it is premature, and in those with family history of atherosclerosis or of hyperlipidemia. In this sense, the expression “premature” is mostly used to include those younger than 40 years of age. Patients with xanthomas should be worked up with lipid panels but not those with xanthelasmas or xanthofibromas in the sense of dermatofibromas. Those whose fasting serum is lipemic should have a lipid panel, but the serum of a subject with high cholesterol (but normal triglyceride) is not milky in appearance. The patient with high cholesterol (>240 mg/dL) should have a lipid panel. Patients with cholesterol levels between 200−240 mg/dL plus two other coronary heart disease risk factors should also have a lipid panel.1In addition to application in screening programs for evaluation of risk factors for coronary arterial disease, lipid profiling may lead to detection of some cases of hypothyroidism.Primary hyperlipoproteinemiaincludes hypercholesterolemia, a direct risk factor for coronary heart disease.Secondary hyperlipoproteinemiaincludes increases of lipoproteins secondary to hypothyroidism, nephrosis, renal failure, obesity, diabetes mellitus, alcoholism, primary biliary cirrhosis, and other types of cholestasis.Decreasedlipids are found with some cases of malabsorption, malnutrition, and advanced liver disease. In abetalipoproteinemia, cholesterol is <70 mg/dL.

Diabetes & Blood Sugar

In 2013,2the American College of Obstetricians and Gynecologists (ACOG) recommended that all pregnant women be screened for gestational diabetes mellitus (GDM)—whether by patient history, clinical risk factors, or with a 50-gram, one-hour loading test at 24 to 28 weeks of gestation to determine blood glucose levels—and suggested relying on the result of the 100-gram, three-hour oral glucose tolerance test for diagnosis (often referred to as a "two-step" method).The American Diabetes Association (ADA)1released standards that vary from the ACOG recommendations. The ADA standards recommend a simplified "one-step" approach to the screen and diagnosis of gestational diabetes mellitus with a 75-gram, two-hour glucose tolerance test. The Labcorp test according to the ADA recommendations isGestational Glucose Tolerance Screening and Diagnostics Test (Two-hour, ADA Recommendations) [101000].

Diabetes & Blood Sugar

Offered as part of multiple lab tests

Diabetes & Blood Sugar, General Health & Wellness

Diagnosis of diabetes mellitus and evaluation of carbohydrate metabolism.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

This test measures the serum concentration of triglycerides and provides a calculated value for serum very low-density lipoprotein cholesterol (VLDL-C), which may be used to help assess cardiovascular disease (CVD)-related risk. VLDL is a carrier of serum cholesterol and the main carrier of triglycerides. Often, the VLDL-C test is ordered as part of a lipid profile to provide insight into overall CVD-related risk [1,2].Triglyceride testing is useful in classification of various lipoprotein disorders and aids in the assessment of risk factors for atherosclerosis, coronary heart disease, and metabolic syndrome. VLDL-C consists of triglyceride-rich lipoprotein particles. Upon entering the circulation, these particles are metabolized to intermediate-density lipoprotein cholesterol (IDL-C) and subsequently low-density lipoprotein cholesterol (LDL-C), a key factor in the pathogenesis of atherosclerosis and coronary heart disease [1,2].The results of this test should be interpreted in the context of pertinent clinical and family history as well as physical examination findings.References1. Grundy SM, et al.Circulation. 2019;139(25):e1082-e1143.2. Hilbert T, et al. Lipids and dyslipoproteinemia. In: McPherson RA, et al, eds.Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. Saunders Elsevier; 2017:226-248.

Diabetes & Blood Sugar, Hormone Testing

Insulin is a peptide hormone with a molecular weight of approximately 6000 daltons. Serum insulin determinations may be performed on patients with symptoms of hypoglycemia4,5where insulinoma is a possible etiology. Patterns of secretion by insulinomas may be sporadic or constant. Insulinoma is a rare functional tumor of pancreatic origin that secretes insulin inappropriately, causing hypoglycemia. Whipple originally described the tumor and classic diagnostic criteria called "Whipple's Triad". The criteria included:1) neurologic symptoms of hypoglycemia2) low glucose (<50 mg/dL) which are corrected immediately by giving glucose or carbohydrate.Today, as described above, we would add inappropriately elevated insulin levels during an episode of hypoglycemia. Usually hypoglycemia is induced with a fast or exercise, and the diagnostic criteria may include a 48 to 72 hour fast with insulin levels greater than 5 μU/mL during a hypoglycemic episode.4Hypoglycemia can, however, also be facilitated intentionally or unintentionally (factitious hypoglycemia),4,5C-peptide levels along with insulin levels may be helpful in ruling out factitious insulin use, however note the limited reactivity of various insulin analogs. Accordingly, one use of the insulin test is to screen patients with low glucose for insulinoma if other factors such as glucose-lowering drugs or reactive hypoglycemia are excluded.Insulin levels can be also useful in predicting susceptibility to the development of type II diabetes.4However, the American Diabetes Association recommendations for the diagnosis of diabetes do not include the measurement of insulin levels.6Insulin levels may also be measured to estimate the patient's capacity for insulin secretion (eg, glucagon test) or in the evaluation of insulin sensitivity (eg, oral glucose tolerance test). Although the adequacy of pancreatic insulin synthesis is frequently assessed via the determination of C-peptide, fasting insulin is also measured to assess insulin resistance.In treated patients therapeutic administration of insulin can lead to the formation of insulin binding antibodies. Insulin binding antibodies invariably interfere with insulin measurement methods and results are unreliable. For patients with known autoantibodies to insulin should measure free and total insulin to assess biologically active fraction of insulin (free insulin) and total insulin. Measurements of free and total insulin, C-peptide, insulin antibodies and hemoglobin A1C are often tested in conjunction to clarify the contribution of endogenous and exogenous insulin to overall diabetic management. See Test501561for Free and Total Insulin.

Diabetes & Blood Sugar

Fructosamine is found in the plasma of both normal and diabetic individuals. “Fructosamine” is the term used to describe proteins that have been glycated (ie, are derivatives of the nonenzymatic reaction product of glucose and albumin). It has been advocated as an alternative test to hemoglobin A1cfor the monitoring of long-term diabetic control. Fructosamine and hemoglobin A1cdo not measure exactly the same thing, since fructosamine has a shorter half-life and appears to be more sensitive to short-term variations in glucose levels; however, this is not necessarily a disadvantage. Fructosamine is clearly superior in patients with abnormal hemoglobins because of the interference of abnormal hemoglobins in the anion-exchange chromatography methods for Hb A1c. Published reference interval for apparently healthy subjects between age 20 and 60 is 205−285 μmol/L and in a poorly-controlled diabetic population is 228−563 μmol/L with a mean of 396 μmol/L.

Liver & Kidney Health, Diabetes & Blood Sugar

Albumin accounts for approximately 50% of the protein in plasma.2The kidney works to prevent the loss of albumin into the urine through active resorption, but a small amount of albumin can be measured in urine of individuals with normal renal function.The prognostic value of consistently elevated albumin levels is particularly well established in diabetic patients.1Renal disease is a common microvascular complication of diabetes. Without specific interventions, 80% of type I diabetics with repeatedly elevated albumin levels will go on to end-stage renal disease. Twenty percent to 40% of type II diabetics with sustained albuminuria will progress to overt nephropathy.The American Diabetes Association (ADA) recommends that routine urinalysis should be performed annually on adults with diabetes.1If the urinalysis is negative for protein, albumin measurement is recommended. The ADA also recommends annual screening of children beginning at puberty or after five years disease duration. The reference intervals stated above reflect the diagnostic criteria prescribed by the ADA.1

Diabetes & Blood Sugar

This immunoassay is intended for the in vitro quantitative determination of C-peptide in human serum, plasma, and urine. The assay is intended for use as an aid in the diagnosis and treatment of patients with abnormal insulin secretion.C-peptide is a single chain 31-amino acid (AA 33-63) connecting (C) polypeptide with a molecular weight of approximately 3021 daltons.2,3In the process of biosynthesis of insulin, the C-peptide is formed as a byproduct together with insulin by the proteolytic cleavage of the precursor molecule proinsulin, stored in secretory granules in the Golgi complex of the pancreatic β-cells. Proinsulin, in turn, was cleaved from preproinsulin.3,4C-peptide fulfills an important function in the assembly of the two-chain insulin (α- and β-chain) structure and the formation of the two disulfide bonds within the proinsulin molecule. Insulin and C-peptide are secreted in equimolar amounts and released into circulation via the portal vein.5As half of the insulin, but almost none of the C-peptide, is extracted in the liver, C-peptide has a longer half-life (about 35 minutes) than insulin; 5 to 10 times higher concentration of C-peptide persist in the peripheral circulation, and these levels fluctuate less than insulin.3-5The liver does not extract C-peptide, which is removed from the circulation by the kidneys and degraded, with a fraction excreted unchanged in the urine. The concentration in urine is about 20- to 50-fold higher than in serum. C-peptide concentrations are, therefore, elevated in renal disease.2-4In the past, C-peptide has been considered biologically inactive; however, recent studies have demonstrated that it is capable of eliciting molecular and physiological effects suggesting that C-peptide is in fact a bioactive peptide. There is evidence that C-peptide replacement, together with insulin administration, may prevent the development or retard the progression of long-term complications in type 1 diabetes.6-11Measurements of C-peptide, insulin, and glucose are used as an aid in the differential diagnosis of hypoglycemia (factitious hypoglycemia and hypoglycemia caused by hyperinsulinism) to ensure an appropriate management and therapy of the patients. To quantify the endogenous insulin secretion, C-peptide is measured basally, after fasting and after stimulation and suppression tests. Due to high prevalence of endogenous anti-insulin antibodies, C-peptide concentrations reflect the endogenous pancreatic insulin secretion more reliably in insulin-treated diabetics than the levels of insulin itself. Measurements of C-peptide may, therefore, be an aid in the assessment of a residual β-cell function in the early stages of type-1 diabetes mellitus and for the differential diagnosis of latent autoimmune diabetes of adults (LADA) and type-2 diabetes.3,4,12-15C-peptide measurements are also used to assess the success of islet transplantation and for monitoring after pancreatectomy.3,4Urine C-peptide is measured when a continuous assessment of β-cell function is desired or frequent blood sampling is not practical (eg, in children).3C-peptide excretion in urine has been used to assess pancreatic function in gestational diabetes, and in patients with unstable glycemic control in insulin-dependent diabetes mellitus (IDDM).16,17Although testing for C-peptide is not requested for the routine monitoring of diabetes, it is a valuable tool for the individual therapeutic decisions which are essential for an optimal long-term metabolic control.18,19Elevated C-peptide levels may result from increased β-cell activity observed in hyperinsulinism, from renal insufficiency, and obesity.2Correlation was also found between higher C-peptide levels and increasing hyperlipoproteinemia and hypertension.20Decreased C-peptide levels are observed in starvation, factitious hypoglycemia, hypoinsulinism (NIDDM, IDDM), Addison disease, and after radical pancreatectomy.

Diabetes & Blood Sugar, Hormone Testing

For diagnosis and monitoring of diabetes and insulin-secreting tumors.

Liver & Kidney Health, Diabetes & Blood Sugar

This test is used to detect albuminuria by measuring albumin and creatine concentrations in a random (spot) urine sample and calculating the albumin-creatinine ratio (ACR). This test is useful for assessing kidney damage, especially at an early stage, and informing management and prognosis of chronic kidney disease (CKD) [1].Albuminuria, as a marker of kidney damage, provides a more specific and sensitive measurement of glomerular permeability than does proteinuria. An ACR measured from a spot urine sample acquired in the early morning is preferred for initial evaluation of albuminuria. This test can also be used to confirm a positive reagent strip urinalysis result. A moderately increased ACR (≥30 mg/g) for more than 3 months is diagnostic of CKD. The severity of albuminuria is also used for staging and prognosis of CKD [1,2].Albuminuria generally appears before the reduction of glomerular filtration rate in people with diabetic glomerulosclerosis but may appear later in people with hypertensive nephrosclerosis. Albuminuria is independently associated with an increased risk of cardiovascular events and mortality. In individuals with diabetes and/or hypertension, early identification of albuminuria that prompts blood pressure and glycemic control may subsequently reduce the risk of cardiovascular events and CKD progressing to end-stage renal disease. Referral to specialist kidney care services is recommended in individuals with a consistent finding of severely increased ACR (≥300 mg/g) [1-4].Factors that affect urinary ACR include menstrual blood contamination, symptomatic urinary tract infections, exercise, upright posture (orthostatic proteinuria), and other conditions that increase vascular permeability (eg, septicemia). Given the pathological and physiological causes of transient albuminuria, repeating ACR tests twice with early morning urine samples in the next 2 months is recommended. ACR from a timed urine sample can provide a more accurate estimate of albuminuria [1].The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.References1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Int Suppl. 2013;3(1):1-150.2. Inker LA, et al.Am J Kidney Dis. 2014;63(5):713-735.3. American Diabetes Association. Standards of medical care in diabetes-2020.Diabetes Care. 2020;43(suppl 1):S135-S151.4. Shin JI, et al.Hypertension. 2021;78(4):1042-1052.

Diabetes & Blood Sugar, General Health & Wellness

Serum glucose levels may be abnormally high (hyperglycemia) or abnormally low (hypoglycemia). Glucose measurements are used in the diagnosis and treatment of carbohydrate metabolic disorders including diabetes mellitus, idiopathic hypoglycemia, and pancreatic islet cell neoplasm.

Diabetes & Blood Sugar

Plasma glucose levels may be abnormally high (hyperglycemia) or abnormally low (hypoglycemia). Glucose measurements are used in the diagnosis and treatment of carbohydrate metabolic disorders including diabetes mellitus, idiopathic hypoglycemia, and pancreatic islet cell neoplasm.

Diabetes & Blood Sugar

To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretative ranges are based on ADA guidelines.

General Health & Wellness, Diabetes & Blood Sugar

This panel comprises a group of tests that provide information on an individual's blood levels of electrolytes, calcium, and glucose as well as renal function, hepatic function, and acid-base balance. The panel is usually ordered as part of a health examination to detect a range of disorders, especially those that may affect the liver or kidneys [1].The results of the panel components are usually evaluated jointly for patterns. The section below outlines the roles of the analytes assessed with this panel [1].Sodium: An electrolyte that plays a central role in maintaining the normal distribution of water and appropriate pressure to assure that substances do not leak from cells and organs. Sodium measurements are useful in the diagnosis and treatment of diseases involving electrolyte imbalance.Potassium: An electrolyte that is essential for proper muscle and nerve function and helps keep the balance of fluids. Potassium measurements are useful in assessing electrolyte balance in the diagnosis and treatment of conditions characterized by low or high blood potassium levels.Chloride: An electrolyte that helps maintain volume, acidity, and electrical neutrality of the body fluids. Chloride measurements are useful in the diagnosis and treatment of electrolyte and metabolic disorders, such as cystic fibrosis and diabetic acidosis.Carbon dioxide (bicarbonate): A type of blood gas used to evaluate the total carbonate buffering system and acid-base balance. Carbon dioxide is generally evaluated with other common electrolytes; the measurements are useful in the diagnosis and treatment of numerous potentially serious disorders associated with changes in body acid-base balance.Glucose: A type of sugar that serves as the body's main energy source. Glucose measurements are useful in the diagnosis of diabetes and low blood sugar.Calcium: A mineral in the body that is essential for nerve, muscle, and heart functions and bone formation. Calcium measurements are useful in the diagnosis of parathyroid disease, some bone disorders, and chronic kidney disease.Blood urea nitrogen (BUN): The principal waste product of protein catabolism. BUN measurements are useful in the diagnosis and treatment of certain kidney and metabolic diseases.Creatinine: A waste product of the muscles. Creatinine measurements are useful in the evaluation of kidney function and in monitoring renal dialysis.Creatinine-based estimated glomerular filtration rate (eGFR): A value calculated using serum creatinine measurements and the patient's age and sex to reflect kidney function. eGFR is useful in detecting and monitoring chronic kidney disease in adults.Albumin: A protein that keeps fluid from leaking out of the blood and carries hormones, vitamins, and enzymes in the body. Albumin measurements are useful in the monitoring and treatment of numerous diseases involving primarily the liver and kidneys.Total bilirubin: A waste product generated when old red blood cells break down. Bilirubin measurements are useful in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gallbladder obstructive disease.Total protein: A sum of albumin and globulins. Protein measurements are useful in the diagnosis of disorders involving the liver, kidneys, or bone marrow.Alkaline phosphatase: An enzyme found mainly in the liver, bones, kidneys, and digestive system. Alkaline phosphatase measurements are useful in the diagnosis of hepatobiliary disorders and bone diseases associated with increased bone formation.Aspartate aminotransferase (AST): An enzyme widely distributed throughout the tissues, with significant amounts present in the heart and liver. AST measurements are useful in the evaluation of liver and heart damage.Alanine aminotransferase (ALT): An enzyme found in highest concentrations in the liver and often measured in conjunction with AST. ALT measurements are useful in the diagnosis and management of certain liver diseases (eg, viral hepatitis and cirrhosis). Very high values may be associated with hepatitis, though some people with hepatitis have ALT values within the reference interval.References1. Rao LV, et al. Laboratory tests. In: Rao LV, eds.Wallach's Interpretation of Diagnostic Tests. Pathways to Arriving at a Clinical Diagnosis.11th ed. Wolters Kluwer; 2020.

Diabetes & Blood Sugar, General Health & Wellness

To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretative ranges are based on ADA guidelines.

Diabetes & Blood Sugar, Heart Health & Cardiovascular

Insulin is useful in diagnosing hyperinsulinemia in hypoglycemic patients. Hyperinsulinemia may be due to an insulin-producing tumor (insulinoma), syndrome of insulin resistance, or persistent hyperinsulinemic hypoglycemia of infancy.

Diabetes & Blood Sugar, General Health & Wellness

To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretative ranges are based on ADA guidelines.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

Offered as part of multiple lab tests

Diabetes & Blood Sugar

The BUN/Creatinine ratio is useful in the differential diagnosis of acute or chronic renal disease. Reduced renal perfusion, e.g., congestive heart failure, or recent onset of urinary tract obstruction will result in an increase in BUN/Creatinine ratio. Increased urea formation also results in an increase in the ratio, e.g., gastrointestinal bleeding, trauma, etc. When there is decreased formation of urea as seen in liver disease, there is a decrease in the BUN/Creatinine ratio. In most cases of chronic renal disease the ratio remains relatively normal.

Diabetes & Blood Sugar

Offered as part of multiple lab tests

Diabetes & Blood Sugar

Total protein is useful in evaluating patients for nutritional status, liver disease, protein-losing renal and gastrointestinal diseases, and many other medical conditions. Elevated concentrations may be observed in patients with monoclonal gammopathies, autoimmune hepatitis, inflammation, and other medical conditions.

Diabetes & Blood Sugar

Offered as part of multiple lab tests

Heart Health & Cardiovascular, Diabetes & Blood Sugar

LDL cholesterol is a key factor in the pathogenesis of atherosclerosis and Coronary Artery Disease (CAD), while HDL cholesterol has often been observed to have a protective effect. Even within the normal range of total cholesterol concentrations, an increase in LDL cholesterol can produce an associated increased risk for CAD. LDL cholesterol binds to receptor sites on macrophages in blood vessel walls inciting several changes to the blood wall which enhance atherosclerotic plaque development.

Diabetes & Blood Sugar, Women's Health

A value of 140 mg/dL or greater indicates the need for a full diagnostic, gestational glucose tolerance performed in the fasting state to determine if the patient has gestational diabetes.

Liver & Kidney Health, Diabetes & Blood Sugar

Proteinuria, mainly glomerular, is often a manifestation of primary renal disease although transient proteinuria may occur with fevers, thyroid disorders, and in heart disease. In the absence of renal disease, the degree of proteinuria is slight, usually amounting to less than 2 grams per day. In chronic glomerulonephritis and in the nephrotic syndrome including lipoid nephrosis and in some forms of hypertensive vascular disease, protein loss may vary from a few grams to as much as 30 g/day.

Diabetes & Blood Sugar

Postprandial glucose levels may be abnormally high in patients with gestational diabetes. If results are positive, and the patient is pregnant, a 3-hour oral glucose tolerance test should be performed for confirmation of gestational diabetes.

Diabetes & Blood Sugar, Hormone Testing

Offered as part of multiple lab tests

Diabetes & Blood Sugar

Urine chloride excretion approximates the dietary intake. The chloride content of most foods parallel that of sodium. An increase in urine chloride may result from water deficient dehydration, diabetic acidosis, Addison's disease, and salt-losing renal disease. Decreased urine levels are seen in congestive heart failure, severe diaphoresis and in hypochloremic metabolic alkalosis due to prolonged vomiting.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

LP-IR is a marker of insulin resistance, and as such the LP-IR score predicts a patient's likelihood of future development of T2D.1-4LP-IR is a multimarker index (values 0-100) based on the concentrations of particular lipoprotein subclasses [very large and large triglyceride-rich lipoprotein particles (VLL-TRLP), small low density lipoprotein particles (S-LDLP), large high density lipoprotein particles (L-HDLP), and mean TRL, LDL, and HDL particle sizes (TRLZ, LDLZ, HDLZ)]. The medical decision limits established for LPIR are <50 (low), 50-80 (intermediate), and >80 (high) with these cutpoints corresponding to the 25th and 75th percentiles in a normal population. DRI builds on the effective insulin resistance assessment by LP-IR and adds the measurement of BCAA. Similar to LP-IR, BCAA have also been shown to predict incident T2DM.5,6The analytes contributing to DRI are measured by mathematical deconvolution of the methyl signal region of the plasma/serum NMR spectrum. This algorithm is different from the NMR LipoProfile test in that the methyl region is extended downfield to include signals from the BCAA (valine and leucine).

Diabetes & Blood Sugar, General Health & Wellness

To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretative ranges are based on ADA guidelines.

Diabetes & Blood Sugar, Hormone Testing

Offered as part of multiple lab tests

Heart Health & Cardiovascular, Diabetes & Blood Sugar

This is the most common Lipid Panel. Components include those useful in the detection, classification, and monitoring of patients with hyperlipidemia.

Liver & Kidney Health, Diabetes & Blood Sugar

Proteinuria is characteristic of renal disease and concentrations may be increased with diabetes, hypertension, nephritic syndrome, and drug nephrotoxicity.

Diabetes & Blood Sugar

Albumin excreted in the urine (Microalbumin) is a sensitive marker of Nephropathy. It is used to screen for early renal disease in diabetic patients.

Diabetes & Blood Sugar, Women's Health

Plasma glucose levels may be abnormally high (hyperglycemia) or abnormally low (hypoglycemia). Glucose measurements are used in the diagnosis and treatment of carbohydrate metabolic disorders.

Diabetes & Blood Sugar, Hormone Testing

Insulin is a key hormone involved in the control of blood glucose and regulation of fatty acid metabolism. Insulin measurement is primarily used to evaluate the cause of hypoglycemia. Inappropriately elevated insulin in blood (hyperinsulinemia) is associated with hypoglycemia(1) or in disorders linked to hyperglycemia, such as metabolic syndrome(2). Causes of hyperinsulinemia include insulinoma, insulin resistance, noninsulinoma pancreatogenous hypoglycemia syndrome, insulin antibodies, surreptitious insulin administration or other drug-induced hyperinsulinism (e.g., sulfonyl urea), incretin effects after bariatric surgery, and congenital hyperinsulinism. Insulin (test code 561) immunoassay can be used to evaluate the etiology of hypo- or hyperglycemia but is not equivalent to the LC/MS/MS test. Combined with LC/MS/MS measurement of C-peptide in the Cardio IQ Insulin Resistance Panel with Score (test code 36509), the assay can also help evaluate the likelihood that an individual has clinically significant insulin resistance or help in differential diagnosis (e.g., insulinoma versus exogenous insulin administration(3). The results of this test should be interpreted in the context of pertinent clinical history and physical examination findings.References1. Cryer PE, Axelrod L, Grossman AB, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009;94(3):709-728. doi:10.1210/jc.2008-14102. Kelly CT, Mansoor J, Dohm GL, et al. Hyperinsulinemic syndrome: the metabolic syndrome is broader than you think. Surgery. 2014;156(2):405-411. doi:10.1016/j.surg.2014.04.0283. Abbasi F, Shiffman D, Tong CH, et al. Insulin resistance probability scores for apparently healthy individuals. J Endocr Soc. 2018;2(9):1050-1057. doi:10.1210/js.2018-00107

Diabetes & Blood Sugar

The fructosamine assay is useful in monitoring the degree of glycemia over short-to-intermediate time frames (1-3 weeks). A fructosamine concentration greater than the established normal range is an indication of prolonged hyperglycemia of 1-3 weeks or longer. The higher the fructosamine value, the poorer the degree of glycemia control.

Diabetes & Blood Sugar

Offered as part of multiple lab tests

Diabetes & Blood Sugar, Hormone Testing

Offered as part of multiple lab tests

Diabetes & Blood Sugar

This test is used for the routine diagnosis of diabetes in children and the non-pregnant adult. For pregnant females see test "Glucose Tolerance Test, Gestational, 4 Specimens (100 g)". For appropriate interpretation of this test, the patient must fast overnight and ingest a 75 g load of glucose, immediately after, a fasting specimen is obtained. For children, the glucose load is 1.75 g/Kg of ideal body weight, up to 75 g glucose. The diagnosis of diabetes is made if the fasting glucose is ≥126 mg/dL or if the 2-hour specimen is ≥200 mg/dL.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommend matching the intensity of statin treatment with the absolute risk of cardiovascular events. However, the standard lipid panel alone does not provide a complete assessment of absolute risk of CVD. Adding advanced CVD markers (ion mobility, apob, lp(a), hs crp and lppla2) in addition to the lipid panel will improve assessment of the CVD risk.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

The Lipid Panel with Reflex to Direct LDL panel includes evaluation of total cholesterol, HDL-cholesterol, triglyceride (TG), LDL-cholesterol (calculated), cholesterol/HDL ratio (calculated), and non-HDL cholesterol; direct LDL-C measurement will be performed at additional cost if the TG level is >400 mg/dL. This panel is useful in the detection, classification, and monitoring of hyperlipidemia, especially those expected to have highly elevated TG levels.LDL-C is widely accepted as a key factor for assessing the risk of coronary artery disease (CAD) [1]. The American Heart Association recommends lipid testing for adults over the age of 20 every 4 to 6 years [2]. Direct LDL-C measurement is more accurate than calculated LDL-C for patients with TG levels >400 mg/dL, and patients with hyperlipoproteinemia type III (dysbetalipoproteinemia). Thus, as indicated above, this panel is especially useful for individuals likely to have highly elevated TG and provides a basis for more realistic assessment of CAD risk in this group. It may also help track treatment progress by allowing healthcare practitioners to evaluate overall lipid levels, as well as direct LDL-C [3].In addition to genetic causes that lead to highly elevated TG levels, certain medical conditions can also increase TG, including diabetes, thyroid disease, liver and kidney diseases, and obesity [4].Calculated LDL values have a variance of 11% to 26%, whereas direct LDL-C values have a variance of less than 4% [5].In rare cases, gammopathy, especially monoclonal IgM (Waldenstrom’s macroglobulinemia), may cause unreliable results.References1. Grundy SM, et al.Circulation. 2019;139:e1082-e1143.2. Stone NJ, et al.Circulation. 2014;129 (suppl 2):S1-S45.3. Armbruster DA, Lambert PA.Lab Med. 1996;9:613-617.4. NHLBI. High blood triglycerides.https://www.nhlbi.nih.gov/health-topics/high-blood-triglycerides.5. Schectman G, et al.Clin Chem. 1994;39:1495-1503.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

This is the most common Lipid Panel. Components include those useful in the detection, classification, and monitoring of patients with hyperlipidemia.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

The advanced lipid profile provides a more comprehensive assessment of dyslipidemia and cardiovascular risk than standard lipid panel measurements.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

The NMR LipoProfile® test is a blood test that directly measures the amount of LDL circulating in the body. “LDL” is low-density lipoprotein and has long been recognized as a major causal factor in the development of heart disease. Although the relationship of increased LDL particle number and plaque buildup in the artery wall has been known since the 1950s, a diagnostic test did not exist to measure LDL particle number (LDL-P). Historically, LDL cholesterol, or LDL-C, has been used to estimate LDL levels to assess a patient’s LDL-related cardiovascular risk and judge an individual’s response to LDL-lowering therapy. The NMR LipoProfile® test reports results for LDL-P, a more reliable measure of LDL that directly counts the number of LDL particles a patient has using NMR technology.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

The NMR LipoProfile® test is a blood test that directly measures the amount of LDL circulating in the body. “LDL” is low-density lipoprotein and has long been recognized as a major causal factor in the development of heart disease. Although the relationship of increased LDL particle number and plaque buildup in the artery wall has been known since the 1950s, a diagnostic test did not exist to measure LDL particle number (LDL-P). Historically, LDL cholesterol, or LDL-C, has been used to estimate LDL levels to assess a patient’s LDL-related cardiovascular risk and judge an individual’s response to LDL-lowering therapy. The NMR LipoProfile® test reports results for LDL-P, a more reliable measure of LDL that directly counts the number of LDL particles a patient has using NMR technology.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

The NMR LipoProfile® test is a blood test that directly measures the amount of LDL circulating in the body. “LDL” is low-density lipoprotein and has long been recognized as a major causal factor in the development of heart disease. Although the relationship of increased LDL particle number and plaque buildup in the artery wall has been known since the 1950s, a diagnostic test did not exist to measure LDL particle number (LDL-P). Historically, LDL cholesterol, or LDL-C, has been used to estimate LDL levels to assess a patient’s LDL-related cardiovascular risk and judge an individual’s response to LDL-lowering therapy. The NMR LipoProfile® test reports results for LDL-P, a more reliable measure of LDL that directly counts the number of LDL particles a patient has using NMR technology.

Diabetes & Blood Sugar

C-Peptide is useful in the evaluation of pancreatic beta cell function (e.g., helping distinguish type 1 from type 2 diabetes mellitus, or monitoring patients who have received islet cell or pancreatic transplants) and for determining the source of insulin in patients with hyperinsulinemic hypoglycemia (e.g., distinguishing insulin-secreting tumors from exogenous insulin administration). It is also sometimes measured as an additional means (more resistant to hemolysis than is insulin itself) for evaluating glucose tolerance tests.

Liver & Kidney Health, Diabetes & Blood Sugar

The estimated glomerular filtration (GFR) provides an assessment of the filtering capacity of the kidney. The eGFR is calculated from a serum cystatin C using the CKD-EPI equation, 2012.3

Diabetes & Blood Sugar

A value of 135 mg/dL or greater indicates the need for a full diagnostic, gestational glucose tolerance performed in the fasting state to determine if the patient has gestational diabetes.

Diabetes & Blood Sugar

The insulin response to glucose infusion is useful in evaluating patients with hypoglycemia and suspected insulin-resistance.

Diabetes & Blood Sugar

This test is used for the routine diagnosis of diabetes in children and the non-pregnant adult. For pregnant females see test "Glucose Tolerance Test, Gestational, 4 Specimens (100 g)". For appropriate interpretation of this test, the patient must fast overnight and ingest a 75 g load of glucose. Immediately after, a fasting specimen is obtained. For children, the glucose load is 1.75 g/Kg of body weight, up to 75. The diagnosis of diabetes is made if the fasting glucose is ≥126 mg/dL or if the 2-hour specimen is ≥200 mg/dL.

Diabetes & Blood Sugar

This test allows for the detection of the presence of antibodies to glutamic acid decarboxylase, which provides early evidence of autoimmune disease activity; its measurement has been shown to be useful in assisting the physician in the prediction, diagnosis, and management of patients with diabetes.2-6Glutamic acid decarboxylase (GAD65) is an enzyme that is produced primarily by pancreatic islet cells. A number of recent studies indicate that patients with insulin-dependent diabetes mellitus (IDDM) often have antibodies to GAD65and several other islet cell antigens.7This is consistent with the hypothesis that IDDM is an autoimmune disease and that autoantibody production is an early step in the development of IDDM.8Autoantibodies can be detected in many cases prior to the onset of glucose intolerance. The presence of GAD65 autoantibodies can be detected in many cases prior to the onset of glucose intolerance. The presence of GAD65autoantibodies has been shown to be a strong predictive marker for the eventual onset of IDDM. Measurement of GAD65antibody can also be of use in distinguishing insulin-dependent from non−insulin-dependent diabetics when the clinical history is ambiguous. GAD65autoantibodies are often markedly elevated in patients with the stiff-person syndrome (also referred to as stiff-man syndrome), a condition that is associated with fluctuating stiffness and paroxysmal spasms of the trunk and legs.9,10

Nutrition & Vitamins, Diabetes & Blood Sugar

Plasma or serum NEFA is the portion of the total fatty acid pool that circulates in immediate readiness for metabolic needs. NEFA can be absorbed readily by muscle, heart, brain, and other organs as an energy source whenever insufficient quantities of glucose limit the usual carbohydrate energy source. In all probability, both glucose and NEFA are simultaneously taken up from the blood, even under normal conditions. When blood glucose levels are high, the NEFA level falls, and vice versa, emphasizing the reciprocal withdrawal of stored energy, under the simultaneous control of insulin and epinephrine. In acute starvation, the NEFA level may rise as much as three times the normal values.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

Offered as part of multiple lab tests

Diabetes & Blood Sugar

In diabetics, the measurement of B-hydroxybutyrate as well as blood glucose is needed for the assessment of the severity of diabetic coma and is essential for the exclusion of hyperosmolar non-ketotic diabetic coma. A specific enzymatic assay for Beta-hydroxybutyrate is extremely important in the assessment of ketosis.

Heart Health & Cardiovascular, Diabetes & Blood Sugar

Offered as part of multiple lab tests

Diabetes & Blood Sugar, Heart Health & Cardiovascular

The MVX test produces a multimarker score (MVX values 1-100) that is proportional to a patient's relative risk of all-cause death occurring in the approximate near term (within about 10 years), independent of age and other mortality risk factors. The MVX score is calculated from measured concentrations of six serum metabolites that are combined into two "sub-index" scores considered to reflect mainly the inflammatory and malnutrition elements of the intertwined metabolic malnutrition-inflammation syndrome. These "sub-index scores" are the Inflammation Vulnerability Index (IVX), derived from levels of GlycA and small HDL particles, and Metabolic Malnutrition Index (MMX), derived from levels of the three branched-chain amino acids (valine, leucine, isoleucine) and citrate.MVX scores were associated with one-year and five-year mortality.1,2MVX scores are related to mortality risk irrespective of cause (e.g., CV death and non-CV death). Associations of MVX with all-cause mortality were similar in men and women and are independent of risk factors (e.g., BMI or age) that may affect five-year survival rates.1Clinical utility in high CVD-risk patients could be stratification of those who have the highest likelihood of survival vs. those who may need aggressive intervention.1Varying levels of IVX and MMX scores in different patients may help physicians choose personalized treatments (e.g., treatment of a patient with high IVX with an anti-inflammatory agent).Extending lifespan is among the overarching objectives of modern healthcare, which is organized around therapeutic areas that target the diseases and chronic conditions (including old age) that are the primary causes of death. Mitigating disease risk will unquestionably lower mortality risk, but a new concept is emerging that near-term survival, independent of disease status, is strongly influenced by previously unrecognized metabolic factors that make individual patients either relatively resilient or vulnerable. Described initially in the context of chronic kidney disease, and later in heart failure, liver disease, rheumatoid arthritis and cancer, excess mortality risk was attributed to a syndrome of combined muscle wasting, metabolic malnutrition and inflammation.3,4The reason there is so little awareness of the impact this malnutrition-inflammation syndrome has on mortality risk, and the therapeutic opportunities it offers to extend survival in those at high risk, is a lack of simple quantitative clinical assessment tools.5The new MVX biomarker is intended to meet this need, both for prognostic purposes and to aid investigation of the efficacy and safety of potential therapeutic interventions. MVX is related to metabolic determinants of survival that are "downstream" of risk factors for the development of various diseases.1

Diabetes & Blood Sugar

For appropriate interpretation of this test, the patient must fast overnight and ingest a 75 g load of glucose, immediately after a fasting specimen is obtained. (for children, the glucose load is 1.75 g/kg of body weight, up to 75). The diagnosis of diabetes is made if glucose exceeds 200 mg/dL in the 2 hour specimen and in any preceding specimen.

Diabetes & Blood Sugar

The insulin response to glucose infusion is useful in evaluating patients with hypoglycemia and suspected insulin-resistance.

Diabetes & Blood Sugar

Type 1 diabetes, commonly referred to as insulin-dependent diabetes (IDDM), is caused by pancreatic beta-cell destruction that leads to an absolute insulin deficiency.1The clinical onset of diabetes does not occur until 80% to 90% of these cells have been destroyed. Prior to clinical onset, type 1 diabetes is often characterized by circulating autoantibodies against a variety of islet cell antigens, including glutamic acid decarboxylase (GAD), tyrosine phosphatase (IA2), and insulin.2-5The autoimmune destruction of the insulin-producing pancreatic beta cells is thought to be the primary cause of type 1 diabetes. The presence of these autoantibodies provides early evidence of autoimmune disease activity, and their measurement can be useful in assisting the physician with the prediction, diagnosis, and management of patients with diabetes. Insulin is the only beta-cell specific autoantigen thus far identified.4-6Antibodies to insulin are found predominantly, though not exclusively, in young children developing type 1 diabetes. In insulin-naive (untreated) patients, the prevalence of antibodies to insulin is almost 100% in very young individuals and almost absent in adult onset of type 1 diabetes. Because the risk of diabetes is increased with the presence of each additional autoantibody marker, the positive predictive value of insulin antibody measurement is increased when measured in conjunction with antibodies to GAD and IA-2.2-4

Diabetes & Blood Sugar, Autoimmune & Inflammation

Type 1 diabetes, commonly referred to as insulin-dependent diabetes (IDDM), is caused by pancreatic beta-cell destruction that leads to an absolute insulin deficiency.1The clinical onset of diabetes does not occur until 80% to 90% of these cells have been destroyed. Prior to clinical onset, type 1 diabetes is often characterized by circulating autoantibodies against a variety of islet cell antigens, including glutamic acid decarboxylase (GAD), tyrosine phosphatase (IA2), and insulin.2-5The autoimmune destruction of the insulin-producing pancreatic beta cells is thought to be the primary cause of type 1 diabetes. The presence of these autoantibodies provides early evidence of autoimmune disease activity, and their measurement can be useful in assisting the physician with the prediction, diagnosis, and management of patients with diabetes. Insulin is the only beta-cell specific autoantigen thus far identified.4-6Antibodies to insulin are found predominantly, though not exclusively, in young children developing type 1 diabetes. In insulin-naive (untreated) patients, the prevalence of antibodies to insulin is almost 100% in very young individuals and almost absent in adult onset of type 1 diabetes. Because the risk of diabetes is increased with the presence of each additional autoantibody marker, the positive predictive value of insulin antibody measurement is increased when measured in conjunction with antibodies to GAD and IA-2.2-4

Diabetes & Blood Sugar

1,5 Anhydroglucitol (1,5-AG) is a naturally occurring monosaccharide found in nearly all foods. Individuals without diabetes and those with diabetes but have well-controlled blood glucose levels <180 mg/dL have detectably high levels of 1,5-AG. When an individual's glucose levels are in a normal range, 1,5-AG is naturally processed by the kidneys and nearly all of it is reabsorbed back into the blood stream by the renal proximal tubules. Individuals with diabetes who have blood glucose level excursion in excess >180 mg/dL can be expected to have low levels of 1,5-AG. In these individuals, excess glucose in the body is reabsorbed first by the kidneys, blocking 1,5-AG reabsorption. The body is unable to maintain a high steady state level of 1,5-AG in blood and tissues.• Normal or high GlycoMark® values = Normal blood glucose levels• Low GlycoMark® values = Elevated blood glucose levels or high blood glucose spikes

Diabetes & Blood Sugar

The relationship between diabetes, cardiovascular disease, and chronic kidney disease is widely recognized. Among individuals with type 2 diabetes, cardiovascular disease is the leading cause of morbidity and mortality. Chronic kidney disease occurs in 20% to 40% of patients with diabetes and may be present at the time of diagnosis.While not considered to be a clinical entity itself, individuals with prediabetes are at increased risk for diabetes and cardiovascular disease. Additionally, observational evidence has linked prediabetes with early nephropathy, chronic kidney disease, small fiber neuropathy, diabetic retinopathy, and increased risk of macrovascular disease.

Liver & Kidney Health, Diabetes & Blood Sugar

Cystatin C is a non-glycosylated, low molecular weight (13,250 kD) cysteine proteinase inhibitor that is produced by all nucleated cells and found in body fluids, including serum. Since it is formed at a constant rate and freely filtered by the kidneys, its serum concentration is inversely correlated with the glomerular filtration rate (GFR); that is,high values indicate low GFRs while lower values indicate higher GFRs, similar to creatinine. The renal handling of cystatin C differs from creatinine. While both are freely filtered by glomeruli, once it is filtered, cystatin C, unlike creatinine, is reabsorbed and metabolized by the proximal renal tubules. Thus, under normal conditions, cystatin C does not enter the final excreted urine to any significant degree. The serum concentration of cystatin C remains unchanged with infections, inflammatory or neoplastic states, and is not affected by body mass, diet, or drugs. Thus, cystatin C may be a more reliable marker of renal function (GFR) than creatinine.GFR can be estimated (eGFR) from serum cystatin C utilizing an equation which includes the age and gender of the patient. The CKD-EPI cystatin C equation was developed by Inker et al, and demonstrated good correlation with measured iothalamate clearance in patients with all common causes of kidney disease, including kidney transplant recipients. Cystatin C eGFR may have advantages over creatinine eGFR in certain patient groups in whom muscle mass is abnormally high or low (for example quadriplegics, very elderly, or malnourished individuals). Blood levels of cystatin C also equilibrate more quickly than creatinine, and therefore, serum cystatin C may be more accurate than serum creatinine when kidney function is rapidly changing (for example amongst hospitalized individuals).

Diabetes & Blood Sugar, Hormone Testing

Offered as part of multiple lab tests

Liver & Kidney Health, Diabetes & Blood Sugar

Offered as part of multiple lab tests

Diabetes & Blood Sugar, Autoimmune & Inflammation

Offered as part of multiple lab tests

Diabetes & Blood Sugar, Autoimmune & Inflammation

Offered as part of multiple lab tests

Diabetes & Blood Sugar

Glucagon is produced by the alpha cells of the islets of Langerhans of the pancreas in response to a decrease in plasma glucose concentrations and in response to increased concentrations of specific amino acids.2The glucagon precursor protein undergoes tissue-specific post-translation processing.2Glucagon secretion is controlled by a number of factors. In nondiabetic individuals, secretion is stimulated by protein-rich meals, but inhibited by carbohydrate-rich meals. Hypoglycemia activates the autonomic nervous system which stimulates glucagon release into the portal circulation.3-5Glucagon release is also regulated in a paracine manner by insulin, zinc and other factors secreted from neighboring β- and δ-cells within the islet of Langerhans.5In healthy individuals, glucagon released is inhibited by hyperglycemia, mixed nutrient meals, and oral intravenously administered amino acids.Glucagon is a counter-regulatory hormone opposing the actions of insulin in glucose homoeostasis. The intravenous administration of glucagon raises blood glucose substantially in nondiabetic individuals.6Glucagon is thought to play an important role in the maintenance of fasting and postprandial glucose homeostasis.6,7By stimulating hepatic glucose output, glucagon counterbalances the action of insulin and serves to maintain circulating glucose and prevent insulin mediated hypoglycemia.2,5Blockade of endogenous glucagon secretion with somatostatin causes glucose concentrations to decrease.6A highly specific glucagon receptor is abundantly expressed on hepatocytes.6Glucagon binding to this receptor leads to increased hepatic glucose production, fatty acid oxidation and ketogenesis.6,7Glucagon stimulates glycogenolysis and gluconeogenesis, changing the liver from an organ of glucose release.2,3Glucagon secretion inhibits gastric emptying, increases gastric output, increases bile flow and increases cardiac muscle contraction. Glucagon also has lipolytic effects.2Insulin treatment of diabetic patients can cause acute hypoglycemia which is often exacerbated by a deficient glucagon response.3,4,6,8,9The exact pathophysiologic mechanisms for this dysregulation is not fully defined but has been attributed, in part, to a lack of intra-islet insulin effect.5,10Alternatively, some patients with controlled type 1 diabetes experience inappropriately elevated plasma glucagon levels in the context of hyperglycemia.6Both type 1 and type 2 diabetes frequently exhibit an inappropriately high glucagon response to a meal.10The high levels of glucagon have been shown to contribute importantly to diabetic hyperglycemia and can result in ketoacidosis.3-7,11Relative hyperglucagonemia, in the setting of deficient insulin secretion may contribute to the development of fasting and postprandial hyperglycemia in the patients.6-8Increased plasma glucagon levels have been demonstrated in many forms of physiological stress that are not typically associated with hypoglycemia.9Hyperglucagonemia has been documented in patients with trauma, burns, surgery, sepsis, hemorrhage, acute myocardial infarction, cardiac arrest and neonatal hypoxia.9A glucagonoma is a rare tumor of the alpha cells of the pancreas that results in up to a 1000-fold overproduction of glucagon.12,13Serum glucagon concentrations in excess of 500 pg/mL are strongly suggestive of glucagonoma.12These tumors are associated with glucagonoma syndrome. The raised glucagon concentrations produce hyperglycemia, diabetes mellitus and glucose intolerance. Excessive glucagon action produces a catabolic state resulting in weight loss.2,14Glucagonomas frequently present with a specific dermatitis referred to as necrolytic migratory erythema (NME).15Patients with NME develop erythematous blisters and swelling in areas subject to greater friction and pressure, including the lower abdomen, buttocks, perineum, and groin.1,13In addition, these patients are prone to deep venous thrombosis that may be a significant cause of death. Other common symptoms of glucagonoma include depression,diarrhea and anemia.2,12,14Because the symptoms of early disease are nonspecific, patients often present at a later stage with extensive metastatic disease.2

Diabetes & Blood Sugar, Hormone Testing

The glucagon assay is useful primarily when considering a glucagon-secreting tumor of the pancreas. Glucagonomas cause an unusual but characteristic syndrome consisting of a rash, mild diabetes, weight loss and hypoamninoacidemia. Measurement of plasma glucagon confirms the diagnosis; glucagon levels are very high in the setting of glucagonoma.

Diabetes & Blood Sugar

Adiponectin is the most abundant peptide hormone secreted by adipocytes.1-3Other cell types such as skeletal and cardiac myocytes and endothelial cells can produce lesser amounts of this protein. Adiponectin has a short half-life of 45-75 minutes despite its minimal degradation during circulation. Its clearance is predominantly by the liver but can also bind pancreatic beta cells and certain heart and kidney cell types.1Adiponectin participates in glucose regulation but also exerts anti-inflammatory, anti-atherogenic and cardioprotective effects as well as effects on lipid metabolism and fatty acid oxidation.1,4Adiponectin directly acts on the liver, skeletal muscle, and vasculature through insulin sensitization and anti-inflammatory/anti-atherogenic effects.1Adiponectin increases insulin secretion from the pancreas and mediates insulin sensitivity in skeletal muscle.1,3,5Adiponectin enhances basal glucose and insulin-stimulated glucose uptake in adipose tissues.1,3,4Adiponectin increases insulin sensitivity and down-regulates gluconeogenesis in the liver while activating fatty acid oxidation.1,3Studies have shown that adiponectin decreases inflammation in macrophages, endothelial tissue, muscle, and epithelial cells.3There is evidence that adiponectin prevents the production of reactive oxidative species and promotes down-regulation of inflammation.3Moreover, it has been shown to inhibit CRP secretion and suppression of pathways involving NF-kB signaling and TNF-Alpha.3Obese patients tend to have decreased serum levels of adiponectin. Various cross-sectional studies have established an inverse relationship between adiponectin serum levels and BMI and fat mass.6-8Adiponectin levels are increased in extremely lean patients suffering from conditions such as anorexia nervosa.7Weight loss through means such as diet and exercise and bariatric surgery have resulted in increased plasma levels of adiponectin in patients.7Diminished serum adiponectin levels is a feature in pathologies such as gestational diabetes.7,9Strong genetic associations between adiponectin levels and insulin resistance have also been established5and low levels of it predict future onset of insulin resistance.7,10Adiponectin levels demonstrate an inverse correlation with adiposity and proinflammatory cytokines in patients suffering from metabolic syndrome.11-14Low levels of adiponectin predict a higher incidence of adverse cardiovascular events such as myocardial infarctions and atherosclerosis.14,15Recently, adiponectin has shown to exhibit activity in functions of cell proliferation, where it has been shown to counter cell growth and induce apoptosis.14It is also noteworthy, however, that several recent studies have also demonstrated adiponectin to have anti apoptotic and proliferative roles.14Accumulating evidence suggest that adiponectin is implicated in the pathogenesis of several malignancies.13,16,17Several observational studies showed that low adiponectin levels are associated with higher risk for breast, cervical, endometrial, ovarian and prostate cancer.13,16,17A relationship between adiponectin and the aggressiveness of some of these tumors has also been reported.13,16-18

Diabetes & Blood Sugar

Adipocytes (fat cells) express a variety of proteins that function in the homeostatic control of glucose and lipid metabolism. Insulin regulates the translocation and secretion of many of these proteins in response to changes in energy balance. Adiponectin is a protein whose secretion from adipocytes is enhanced by insulin stimulation. It has been suggested that the development of non-insulin dependent (Type II) diabetes may involve dysregulation of adiponectin secretion. In support of the link between obesity and Type II diabetes, it has been shown that decreased expression of adiponectin correlates with insulin resistance, and that adiponectin appears to be a potent insulin enhancer linking adipose tissue and whole-body glucose metabolism.• Individuals with low adiponectin levels have a 3X greater risk of developing metabolic syndrome [1].• Men with two or more risk factors for metabolic syndrome and high adiponectin levels are half as likely to develop metabolic syndrome as men with low adiponectin levels [2].• Individuals with low levels of adiponectin are up to 9X as likely to develop type 2 diabetes [3].• Individuals with low adiponectin levels have a 2X increase in the prevalence of CAD [4].• Adiponectin levels in the blood can be increased by thiazolidinediones, such as pioglitazone [5].References:1. Chen SJ et al.PLoS ONE. 2012; 7: e45693.2. Kotooka N et al.Int J Cardiol. 2012 Nov 26. pii: S0167-5273(12)01441-6. doi:10.1016/j.ijcard.2012.10.066. [Epub ahead of print].3. Daimon M et al.Diabetes Care. 2003; 26: 2015-2020.4. Kumada M et al.Arterioscler Thromb Vasc Biol. 2003; 23: 35-39.5. McCoy RG et al.Mayo Clin Proc. 2012; 87: 561-570.

Diabetes & Blood Sugar

The assay is useful in making the diagnosis of primary hyperparathyroidism, secondary hyperparathyroidism, and a differential diagnosis of hypercalcemia. The assay helps in distinguishing hypercalcemia cause by either primary hyperparathyroidism or malignant disease.

Diabetes & Blood Sugar

Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gall bladder obstruction. The assessment of direct bilirubin is helpful in the differentiation of hepatic disorders. The increase in total bilirubin associated with obstructive jaundice is primarily due to the direct (conjugated) fraction. Both direct and indirect bilirubin are increased in the serum with hepatitis.

Diabetes & Blood Sugar

Glutamic acid decarboxylase (GAD-65) antibody is useful to diagnose insulin dependent diabetes mellitus [Type I diabetes (autoimmune-mediated diabetes)] to assess risk for development of Type I diabetes, to predict onset of Type I diabetes, and risk of development of related endocrine disorders, e.g., thyroiditis. Before clinical onset, Type I diabetes is characterized by lymphocytic infiltration of the islet cells, and by circulating autoantibodies against a variety of islet cell antigens, including GAD-65, IA-2 (a tyrosine phosphatase-like protein), and insulin (IAA).

Diabetes & Blood Sugar

Proinsulin is synthesized in the pancreatic beta cells as a 9390 mw polypeptide of 86 amino acids.1-3Proinsulin is subsequently cleaved enzymatically, releasing insulin into the circulation along with a residual 3000 mw fragment called C-peptide, so-named because it connects the A and B chains of insulin within the proinsulin molecule.Proinsulin, which has relatively low biological activity (approximately 10% of insulin potency), is the major storage form of insulin. Normally, only small amounts (∼3% of the amount of insulin, on a molar basis) of proinsulin enter the circulation. Because the hepatic clearance of proinsulin is only 25% of insulin clearance, the half-life of proinsulin is two- to threefold longer and concentrations in the fasting state are approximately 10% to 15% of insulin concentrations.High proinsulin concentrations have been associated with benign or malignant β-cell tumors of the pancreas4and endocrine pancreatic tumors associated with MEN-1.5Elevated proinsulin levels have been observed in individuals with impaired glucose tolerance even in the absence of abnormal glucose or C-peptide levels.6Elevated proinsulin levels have been found to be a positive risk factor for the development on NIDDM.7,8Most patients with β-cell tumors have increased insulin, C-peptide, and proinsulin concentrations, but occasionally only proinsulin is elevated. Despite its low biological activity, proinsulin may be increased sufficiently to produce hypoglycemia.9In addition, a rare form of familial hyperproinsulinemia, due to impaired conversion to insulin, has been described. Increased proinsulin concentrations may also be detected in patients with chronic renal failure, cirrhosis, or hyperthyroidism.

Nutrition & Vitamins, Diabetes & Blood Sugar

Offered as part of multiple lab tests

Diabetes & Blood Sugar, General Health & Wellness

1,5 Anhydroglucitol (1,5-AG) is a naturally occurring monosaccharide found in nearly all foods. Individuals without diabetes and those with diabetes but have well-controlled blood glucose levels <180 mg/dL have detectably high levels of 1,5-AG. When a individual's glucose levels are in a normal range, 1,5-AG is naturally processed by the kidneys and nearly all of it is reabsorbed back into the blood stream by the renal proximal tubules. Individuals with diabetes that have blood glucose level excursion in excess >180 mg/dL can be expected to have low levels of 1,5-AG. In these individuals, excess glucose in the body is reabsorbed first by the kidneys, blocking 1,5-AG reabsorption. The body is unable to maintain a high steady state level of 1,5-AG in blood and tissues.• Normal or high GlycoMark® values = Normal blood glucose levels• Low GlycoMark® values = Elevated blood glucose levels or high blood glucose spikes• Normal levels of glucose produce a normal amount of Hb A1c. As the average amount of plasma glucose increases, the fraction of Hb A1cincreases in a predictable way. This test serves as an indicator for average blood glucose levels over the previous two to three months prior to the measurement.• Normal Hb A1cvalues = Normal blood glucose• Higher Hb A1cvalues = Elevated blood glucose levels

Diabetes & Blood Sugar, General Health & Wellness

1,5 Anhydroglucitol (1,5-AG) is a naturally occurring monosaccharide found in nearly all foods. Individuals without diabetes and those with diabetes but have well-controlled blood glucose levels <180 mg/dL have detectably high levels of 1,5-AG. When a individual's glucose levels are in a normal range, 1,5-AG is naturally processed by the kidneys and nearly all of it is reabsorbed back into the blood stream by the renal proximal tubules. Individuals with diabetes that have blood glucose level excursion in excess >180 mg/dL can be expected to have low levels of 1,5-AG. In these individuals, excess glucose in the body is reabsorbed first by the kidneys, blocking 1,5-AG reabsorption. The body is unable to maintain a high steady state level of 1,5-AG in blood and tissues.• Normal or high GlycoMark® values = Normal blood glucose levels• Low GlycoMark® values = Elevated blood glucose levels or high blood glucose spikes• Normal levels of glucose produce a normal amount of Hb A1c. As the average amount of plasma glucose increases, the fraction of Hb A1cincreases in a predictable way. This test serves as an indicator for average blood glucose levels over the previous two to three months prior to the measurement.• Normal Hb A1cvalues = Normal blood glucose• Higher Hb A1cvalues = Elevated blood glucose levels

Diabetes & Blood Sugar

Type 1 diabetes, commonly referred to as insulin-dependent diabetes (IDDM), is caused by pancreatic beta-cell destruction that leads to an absolute insulin deficiency.1The clinical onset of diabetes does not occur until 80% to 90% of these cells have been destroyed. Prior to clinical onset, type 1 diabetes is often characterized by circulating autoantibodies against a variety of islet cell antigens, including glutamic acid decarboxylase (GAD), tyrosine phosphatase (IA2), and insulin.2-7The autoimmune destruction of the insulin-producing pancreatic beta cells is thought to be the primary cause of type 1 diabetes. The presence of these autoantibodies provides early evidence of autoimmune disease activity, and their measurement can be useful in assisting the physician with the prediction, diagnosis, and management of patients with diabetes. Autoantibodies to IA2, a tyrosine phosphatase-like protein, are found in 50% to 75% of type 1 diabetics at and prior to disease onset. These autoantibodies are generally more prevalent in younger onset patients. Because the risk of diabetes is increased with the presence of each additional autoantibody, the positive predictive value of the IA2antibody test is enhanced when measured in conjunction with antibodies to GAD and insulin.

Diabetes & Blood Sugar, Autoimmune & Inflammation

Type 1 diabetes, commonly referred to as insulin-dependent diabetes (IDDM), is caused by pancreatic beta-cell destruction that leads to an absolute insulin deficiency.1The clinical onset of diabetes does not occur until 80% to 90% of these cells have been destroyed. Prior to clinical onset, type 1 diabetes is often characterized by circulating autoantibodies against a variety of islet cell antigens, including glutamic acid decarboxylase (GAD), tyrosine phosphatase (IA2), and insulin.2-7The autoimmune destruction of the insulin-producing pancreatic beta cells is thought to be the primary cause of type 1 diabetes. The presence of these autoantibodies provides early evidence of autoimmune disease activity, and their measurement can be useful in assisting the physician with the prediction, diagnosis, and management of patients with diabetes. Autoantibodies to IA2, a tyrosine phosphatase-like protein, are found in 50% to 75% of type 1 diabetics at and prior to disease onset. These autoantibodies are generally more prevalent in younger onset patients. Because the risk of diabetes is increased with the presence of each additional autoantibody, the positive predictive value of the IA2antibody test is enhanced when measured in conjunction with antibodies to GAD and insulin.

Diabetes & Blood Sugar

Patient population is primarily children and adolescents to confirm a diagnosis of type 1 diabetes.

Diabetes & Blood Sugar, Heart Health & Cardiovascular

The determination of insulin in serum is primarily used for the diagnosis of glycemic disorders in diabetic and pre-diabetic patients in the assessment of insulin resistant syndromes. Insulin is synthesized by the pancreatic beta cell as a precursor, proinsulin. Proinsulin is processed to insulin and C-peptide, a contiguous peptide between the insulin A and B chains, as it passes through the cell. The C-peptide in the proinsulin ensures correct folding and processing of proinsulin as it passes through the cell. Both insulin and C-peptide are released together from the beta cells in response to increased glucose levels. Because of differences in half-life and hepatic clearance, peripheral blood levels of C-peptide and insulin are no longer equimolar but remain highly correlated. A steady-state plasma glucose test in individuals undergoing an insulin suppression test to assess insulin resistance found that the combination of insulin and C-peptide was a better indicator of insulin resistance than either one individually.

Diabetes & Blood Sugar

Copeptin is a peptide derived from the cleavage of the precursor of arginine vasopressin (AVP).7-10AVP, also known as antidiuretic hormone (ADH), is a neuropeptide that is secreted from the hypothalamus in response to hypovolemia and elevated plasma osmolality.10-12AVP has two primary functions: to retain water in the body and to constrict blood vessels.11The measurement of AVP has been employed in the differential diagnosis of a variety of disorders related to the physiologic response to changes in plasma osmolality and non-osmotic stress.13-15Unlike AVP, copeptin is a stable molecule and can be readily measured using an automated immunoassay.6Because copeptin and AVP are produced simultaneously through a common proteolytic process, they are secreted into the circulation in an equimolar ratio.16 Serum copeptin concentrations correlate significantly with AVP levels17and the levels of the two molecules respond equally to changes in blood volume.9,18The assessment of circulating AVP levels is challenging because it is released in a pulsatile pattern and is rapidly cleared from plasma. Measurement of AVP is further complicated by the highex vivoinstability of the peptide.13,19Copeptin levels tend to be relatively constant in plasma and this peptide is much more stableex vivo,making sample handling more straight forward.9As a consequence, copeptin can serve as a superior, surrogate marker of physiological AVP release in the assessment of patients with water balance disorders. The correlation of plasma copeptin with plasma osmolality has been shown to be stronger than the correlation of AVP with plasma osmolality,4in great part due to the complexity and methodological drawbacks of the AVP assay. Copeptin is a stable surrogate marker of AVP and its measurement has proved to be convenient and sensitive diagnostic in a number of clinical applications.13,19Diabetes insipidus (DI) is a rare disorder of water homeostasis characterized by the excretion of abnormally large volumes of hypotonic urine due to the inability to appropriately concentrate urine in response to volume and osmolar stimuli.7,20The primary causes for DI are decreased AVP production (central DI) or decreased renal response to AVP (nephrogenic DI), both of which lead to hypotonic polyuria which is usually accompanied by polydipsia. Along with these etiologies, the differential diagnosis of hypotonic polyuria includes primary polydipsia.8In primary polydipsia, there is no initial compromise in AVP secretion or renal action and instead, excessive fluid intake leads to a drop in plasma osmolality and a suppression of AVP synthesis. Primary polydipsia can be caused by an abnormality in the thirst center (dipsogenic polydipsia) or, more commonly, as the result of one of a number of psychiatric disorders (psychogenic polydipsia).7Historically, the primary diagnostic test for the evaluation of polyuria-polydipsia syndrome has been the standard water deprivation test.14,21,22In healthy subjects, water deprivation causes the plasma osmolality to rise, leading to the release of AVP (and copeptin) into the circulation. In this test, insufficient AVP secretion or effect is revealed by insufficient concentration capacity of the kidneys on osmotic stimulation which is achieved by a prolonged period of thirsting and followed by assessment of the response to exogenous AVP administration (Desmopressin). Recent studies aimed at validating the classical water deprivation revealed a diagnostic accuracy of only around 70%, with an even lower diagnostic accuracy in patients with primary polydipsia.21,22Direct measurement of arginine vasopressin (AVP) upon osmotic stimulation has been proposed as an alternative to measuring 24-hour urine osmolality,23but this method failed to enter clinical practice in large part due to technical limitations of AVP testing.13,22The utility of copeptin measurement in assessing polyuria and water balance disorders has been evaluated.14,15,24A baseline copeptin concentration of 21.4 pmol/L or greater (consistent with pathogenic overproduction of AVP) has been shown to accurately differentiate nephrogenic DI from other causes of polyuria, with a sensitivity and specificity of 100%.14,16The distinction between central diabetes insipidus and primary polydipsia is not as straightforward because of the considerable overlap in baseline copeptin levels. In particular, distinguishing partial central diabetes insipidus from primary polydipsia is very challenging.22Two copeptin-based test procedures have been proposed to overcome these difficulties: the hypertonic saline stimulation test21and the arginine stimulation test.25Katan and coworkers found that the measurement of copeptin after insulin induced hypoglycemia could be used to assess posterior pituitary function in patients after pituitary surgery.3They found that a significant induction of copeptin levels was seen in patients with normal posterior pituitary function, but copeptin levels remained low in patients with postsurgical DI.3This same group went on to demonstrate, in a prospective multicenter study, that a copeptin concentration of less 2.5 pmol/L after trans- sphenoidal surgery (without the need for induction of hypoglycemia) had a predictive value of 81% for central DI, with a specificity of 97%.25

Diabetes & Blood Sugar

The Copeptin test is used in the diagnosis of central diabetes insipidus and in the differential diagnosis of central or nephrogenic diabetes insipidus. It is a reliable surrogate marker for arginine vasopressin (AVP).

Diabetes & Blood Sugar

Offered as part of multiple lab tests

Diabetes & Blood Sugar

Proinsulin is used to diagnose insulinomas and to monitor therapy in patients with insulinomas.

Diabetes & Blood Sugar, Hormone Testing

Offered as part of multiple lab tests

Diabetes & Blood Sugar, Autoimmune & Inflammation

Offered as part of multiple lab tests

Diabetes & Blood Sugar, Autoimmune & Inflammation

Offered as part of multiple lab tests