Diabetes, Newly Diagnosed and Monitoring Panel

Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood.

The ratio of albumin to globulin (A/G ratio) is calculated from measured albumin and calculated globulin (total protein - albumin). Normally, there is a little more albumin than globulins, giving a normal A/G ratio of slightly over 1. Because disease states affect the relative amounts of albumin and globulin, the A/G ratio may provide a clue as to the cause of the change in protein levels. A low A/G ratio may reflect overproduction of globulins, such as seen in multiple myeloma or autoimmune diseases, or underproduction of albumin, such as may occur with cirrhosis, or selective loss of albumin from the circulation, as may occur with kidney disease (nephrotic syndrome). A high A/G ratio suggests underproduction of immunoglobulins as may be seen in some genetic deficiencies and in some leukemias. More specific tests, such as liver enzyme tests and serum protein electrophoresis, must be performed to make an accurate diagnosis. With a low total protein that is due to plasma expansion (dilution of the blood), the A/G ratio will typically be normal because both albumin and globulin will be diluted to the same extent.

Alkaline phosphatase (ALP) is a protein found in all body tissues. Tissues with higher amounts of ALP include the liver, bile ducts, and bone.

Alanine transaminase (ALT) is an enzyme found in the highest amounts in the liver. Injury to the liver results in release of the substance into the blood.

AST (aspartate aminotransferase) is an enzyme found in high amounts in liver, heart, and muscle cells. It is also found in lesser amounts in other tissues.

Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. A small amount of older red blood cells are replaced by new blood cells every day. Bilirubin is left after these older blood cells are removed. The liver helps break down bilirubin so that it can be removed from the body in the stool.

A ratio between a person’s BUN and blood creatinine to help determine what is causing these concentrations to be higher than normal. The ratio of BUN to creatinine is usually between 10:1 and 20:1. An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys, such as congestive heart failure or dehydration. It may also be seen with increased protein, from gastrointestinal bleeding, or increased protein in the diet. The ratio may be decreased with liver disease (due to decrease in the formation of urea) and malnutrition.

You have more calcium in your body than any other mineral. Calcium has many important jobs. The body stores more than 99 percent of its calcium in the bones and teeth to help make and keep them strong. The rest is throughout the body in blood, muscle and the fluid between cells. Your body needs calcium to help muscles and blood vessels contract and expand, to secrete hormones and enzymes and to send messages through the nervous system.

CO2 is carbon dioxide. Measures the amount of carbon dioxide in the liquid part of your blood, called the serum. In the body, most of the CO2 is in the form of a substance called bicarbonate (HCO3-). Therefore, the CO2 blood test is really a measure of your blood bicarbonate level.

Chloride is a type of electrolyte. It works with other electrolytes such as potassium, sodium, and carbon dioxide (CO2). These substances help keep the proper balance of body fluids and maintain the body's acid-base balance. This is a measure of the amount of chloride in the fluid portion (serum) of the blood.

The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys work.

Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood.

Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood.

Globulins is the collective term for most blood proteins other than albumin. Identifying the types of globulins can help diagnose certain disorders. Globulins are roughly divided into three groups: alpha, beta, and gamma globulins. Gamma globulines include various types of antibodies such as immunoglobulins (Ig) M, G, and A.

A blood glucose test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of the body, including those in the brain. The hormones insulin and glucagon help control blood glucose levels.

Potassium is a mineral that the body needs to work normally. It helps nerves and muscles communicate. It also helps move nutrients into cells and waste products out of cells. A diet rich in potassium helps to offset some of sodium's harmful effects on blood pressure.

The total protein is the total amount of two classes of proteins, albumin and globulin that are found in the fluid portion of your blood. Proteins are important parts of all cells and tissues. Your albumin helps prevent fluid from leaking out of blood vessels and your globulins are an important part of your immune system.

Sodium is a substance that the body needs to work properly it is vital to normal body processes, including nerve and muscle function

BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down. BUN measures the amount of urea nitrogen in the blood.

The A1c test evaluates the average amount of glucose in the blood over the last 2 to 3 months. It does this by measuring the concentration of glycated (also often called glycosylated) hemoglobin A1c. Hemoglobin is an oxygen-transporting protein found inside red blood cells (RBCs). There are several types of normal hemoglobin, but the predominant form – about 95-98% – is hemoglobin A. As glucose circulates in the blood, some of it spontaneously binds to hemoglobin A. The hemoglobin molecules with attached glucose are called glycated hemoglobin. The higher the concentration of glucose in the blood, the more glycated hemoglobin is formed. Once the glucose binds to the hemoglobin, it remains there for the life of the red blood cell – normally about 120 days. The predominant form of glycated hemoglobin is referred to as HbA1c or A1c. A1c is produced on a daily basis and slowly cleared from the blood as older RBCs die and younger RBCs (with non-glycated hemoglobin) take their place. This test is used to monitor treatment in someone who has been diagnosed with diabetes. It helps to evaluate how well their glucose levels have been controlled by treatment over time. This test may be used to screen for and diagnose diabetes or risk of developing diabetes. In 2010, clinical practice guidelines from the American Diabetes Association (ADA) stated that A1c may be added to fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) as an option for diabetes screening and diagnosis. For monitoring purposes, an A1c of less than 7% indicates good glucose control and a lower risk of diabetic complications for the majority of diabetics. However, in 2012, the ADA and the European Association for the Study of Diabetes (EASD) issued a position statement recommending that the management of glucose control in type 2 diabetes be more "patient-centered." Data from recent studies have shown that low blood sugar (hypoglycemia) can cause complications and that people with risk of severe hypoglycemia, underlying health conditions, complications, and a limited life expectancy do not necessarily benefit from having a stringent goal of less than 7% for their A1c. The statement recommends that people work closely with their doctor to select a goal that reflects each person's individual health status and that balances risks and benefits.

Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body. Your body needs some cholesterol to work properly. But if you have too much in your blood, it can combine with other substances in the blood and stick to the walls of your arteries. This is called plaque. Plaque can narrow your arteries or even block them. High levels of cholesterol in the blood can increase your risk of heart disease. Your cholesterol levels tend to rise as you get older. There are usually no signs or symptoms that you have high blood cholesterol, but it can be detected with a blood test. You are likely to have high cholesterol if members of your family have it, if you are overweight or if you eat a lot of fatty foods. You can lower your cholesterol by exercising more and eating more fruits and vegetables. You also may need to take medicine to lower your cholesterol.

Triglycerides are a form of fat and a major source of energy for the body. This test measures the amount of triglycerides in the blood. Most triglycerides are found in fat (adipose) tissue, but some triglycerides circulate in the blood to provide fuel for muscles to work. After a person eats, an increased level of triglycerides is found in the blood as the body converts the energy not needed right away into fat. Triglycerides move via the blood from the gut to adipose tissue for storage. In between meals, triglycerides are released from fat tissue to be used as an energy source for the body. Most triglycerides are carried in the blood by lipoproteins called very low density lipoproteins (VLDL). High levels of triglycerides in the blood are associated with an increased risk of developing cardiovascular disease (CVD), although the reason for this is not well understood. Certain factors can contribute to high triglyceride levels and to risk of CVD, including lack of exercise, being overweight, smoking cigarettes, consuming excess alcohol, and medical conditions such as diabetes and kidney disease.