AK’s the 4.3mg/dL cut-off for dialysis in diabetic

AK’s lab results are indicative of type 2 diabetes. Blood tests are important for monitoring and preventing further complications from type 2 diabetes. Unmanaged diabetes causes short-term consequences such as diabetic ketoacidosis and hyperglycemia. Long-term consequences include cardiovascular diseases, retinopathy, nephropathy, and neuropathy.1

            Fasting blood glucose (FBG) or plasma glucose (FPG) is widely-used in the diagnosis of type 2 diabetes. FPG measurements greater than 126mg/dL are indicative of diabetes. AK’s FPG is 150mg/dL, suggesting hyperglycemia caused by his diabetic conditions.2 Another diagnostic test for hyperglycemia in types 2 diabetes is HgbA1c. HgbA1c is the glycated form of hemoglobin in the blood caused by high plasma glucose levels. Readings of 5.7-6.4% indicate increased risk for diabetes, and the diagnostic cut-off for diabetes is ?6.5%.3 Chronic hyperglycaemia is indicated by AK’s HgbA1c reading of 9%.

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High plasma glucose in type 2 diabetes also increases blood filtration load on the kidneys. Blood pressure also elevates in response to increased blood filtration volume. Excessive load damages glomerular filters in which useful protein leaks through and is lost in urine. As follows, diabetes is the major cause of end-stage renal disease. Therefore, monitoring kidney function in diabetic patients is critical to reducing the risks of diabetic nephropathy.4

Blood creatinine is a simple way to evaluate kidney function because creatinine is normally metabolized and 100% excreted by the kidneys. Creatinine is produced after the breakdown of creatine in skeletal muscles. Thus, serum creatinine evaluates skeletal muscle mass, which is a primary site action for insulin. Low serum creatinine indicates decreased skeletal muscle mass and could mark insulin resistance in diabetic patients. High serum creatinine indicates impaired kidney function to filter and clear creatinine from the body. Normal serum creatinine falls within 0.8-1.4mg/dL. AK’s blood creatinine is 1.6mg/dL, higher than the ideal parameter. AK has not reached the 4.3mg/dL cut-off for dialysis in diabetic patients.

The risk of liver complications is also higher in patients with type 2 diabetes. Blood glucose is regulated by the liver responding to insulin and absorbing glucose to make glycogen in liver cells. Insulin resistance can result in glycogenolysis and increased hepatic glucose output. Liver function tests (LFT) measure substances including albumin, bilirubin, AST, ALT, AP, and GGT. Mild AST and ALT abnormalities are potential factors behind insulin resistance.5 AK’s LFTs show readings within normal limits.

BMI calculations measure weight and height to assess the health risk of an individual. Obesity and increased body weight in adults are major risk factors for type 2 diabetes. High BMI has been shown to be a strong predictor of type 2 diabetes. Normal BMI lies between 18.5 and 25kg/m2. AK’s BMI of 30.2kg/m2 classifies him as obese, quantified by BMI?30kg/m2.6

Overall, AK’s lab results lie outside of ideal parameters and suggest the need for combination drug therapy beyond diet and exercise to manage his type 2 diabetes.


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