Lipid Test Panel

The lipid profile is a group of tests that are often ordered together to determine risk of coronary heart disease. They are tests that have been shown to be good indicators of whether someone is likely to have a heart attack or stroke caused by blockage of blood vessels or hardening of the arteries (atherosclerois). The lipid profile typically includes:


An extended profile may also include:
• Very low density lipoprotein cholesterol (VLDL-C)

Sometimes the report will include additional calculated values such as the Cholesterol/HDL ratio or a risk score based on lipid profile results, age, sex, and other risk factors.

How is the lipid test sample collected for testing? 
A blood sample is obtained by inserting a needle into a vein in the arm. Sometimes a drop of blood is collected by puncturing the skin on a fingertip. This fingerstick sample is typically used when a lipid profile is being measured on a portable testing device, for example, at a health fair. You need to fast for 9-12 hours before having your blood drawn; only water is permitted.

How is a lipid profile used? 
The lipid profile is used to help determine your risk of heart disease and to help guide you and your health care provider in deciding what treatment may be best for you if you have borderline or high risk. The results of the lipid profile are considered along with other known risk factors of heart disease to develop a plan of treatment and follow-up. Depending on your results and other risk factors, treatment options may involve life-style changes such as diet and exercise or lipid-lowering medications such as statins.

When is a lipid profile ordered? 
It is recommended that healthy adults with no other risk factors for heart disease be tested with a fasting lipid profile once every five years. You may be screened using only a cholesterol test and not a full lipid profile. However, if the cholesterol test result is high, you may have follow-up testing with a lipid profile.

If you have other risk factors or have had a high cholesterol level in the past, you should be tested more regularly and you should have a full lipid profile.

For children and adolescents at low risk, lipid testing is usually not ordered routinely. However, screening with a lipid profile is recommended for children and youths who are at an increased risk of developing heart disease as adults. Some of the risk factors are similar to those in adults and include a family history of heart disease or health problems such as diabetes, high blood pressure (hypertension), or being overweight. High-risk children should have their first lipid profile between 2 and 10 years old, according to the American Academy of Pediatrics. Children younger than 2 years old are too young to be tested.

A lipid profile may also be ordered at regular intervals to evaluate the success of lipid-lowering lifestyle changes such as diet and exercise or to determine the effectiveness of drug therapy such as statins.

Glucose Test

The blood glucose test is ordered to measure the amount of glucose in the blood right at the time of sample collection. It is used to detect both hyperglycemia and hypoglycemia, to help diagnose diabetes, and to monitor glucose levels in persons with diabetes. Blood glucose may be measured on a fasting basis (collected after an 8 to 10 hour fast), randomly (anytime), post prandial (after a meal), and/or as part of an oral glucose tolerance test (OGTT / GTT). An OGTT is a series of blood glucose tests. A fasting glucose is collected; then the patient drinks a standard amount of a glucose solution to "challenge" their system. This is followed by one or more additional glucose tests performed at specific intervals to track glucose levels over time. The OGTT may be ordered to help diagnose diabetes and as a follow-up test to an elevated blood glucose.

The American Diabetes Association recommends either the fasting glucose or the OGTT to diagnose diabetes but says that testing should be done twice, at different times, in order to confirm a diagnosis of diabetes.

Most pregnant women are screened for gestational diabetes, a temporary form of hyperglycemia, between their 24th and 28th week of pregnancy using a version of the OGTT, a 1-hour glucose challenge. If either fasting glucose or a random glucose is above the values used to diagnose diabetes in those who are not pregnant, the woman is considered to have gestational diabetes and neither the screening nor the glucose tolerance test is needed. If the 1-hour level is higher than the defined value, a longer OGTT is performed to clarify the patient’s status.

Diabetics must monitor their own blood glucose levels, often several times a day, to determine how far above or below normal their glucose is and to determine what oral medications or insulin(s) they may need. This is usually done by placing a drop of blood from a skin prick onto a glucose strip and then inserting the strip into a glucose meter, a small machine that provides a digital readout of the blood glucose level.

In those with suspected hypoglycemia, glucose levels are used as part of the "Whipple triad" to confirm a diagnosis. (See “Is there anything else I should know?” section).

The urine glucose is seldom ordered by itself. At one time, it was used to monitor diabetics, but it has been largely replaced by the more sensitive and “real time” blood glucose. The urine glucose is, however, one of the substances measured when a urinalysis is performed. A urinalysis may be done routinely as part of a physical or prenatal checkup, when a doctor suspects that a patient may have a urinary tract infection, or for a variety of other reasons. The doctor may follow an elevated urine glucose test with blood glucose testing.

When is the Glucose Test ordered? 
Blood glucose testing can be used to screen healthy, asymptomatic individuals for diabetes and pre-diabetes because diabetes is a common disease that begins with few symptoms. Screening for glucose may occur during public health fairs or as part of workplace health programs. It may also be ordered when a patient has a routine physical exam. Screening is especially important for people at high risk of developing diabetes, such as those with a family history of diabetes, those who are overweight, and those who are more than 40 to 45 years old.

The glucose test may also be ordered to help diagnose diabetes when someone has symptoms of hyperglycemia, such as:


or symptoms of hypoglycemia, such as:


Blood glucose testing is also done in emergency settings to determine if low or high glucose is contributing to symptoms such as fainting and unconsciousness. If a patient has pre-diabetes (characterized by fasting or OGTT levels that are higher than normal but lower than those defined as diabetic), the doctor will order a glucose test at regular intervals to monitor the patient’s status. With known diabetics, doctors will order glucose levels in conjunction with other tests such as hemoglobin A1c to monitor glucose control over a period of time. Occasionally, a blood glucose level may be ordered along with insulin and C-peptide to monitor insulin production.

Diabetics may be required to self-check their glucose, once or several times a day, to monitor glucose levels and to determine treatment options as prescribed by their doctor.

Pregnant women are usually screened for gestational diabetes late in their pregnancies, unless they have early symptoms or previously have had gestational diabetes. When a woman has gestational diabetes, her doctor will usually order glucose levels throughout the rest of her pregnancy and after delivery to monitor her condition.

What does the Glucose test result mean? 
High levels of glucose most frequently indicate diabetes, but many other diseases and conditions can also cause elevated glucose. The following information summarizes the meaning of the test results. These are based on the clinical practice recommendations of the American Diabetes Association.

Fasting Blood Glucose
From 70 to 99 mg/dL (3.9 to 5.5 mmol/L)	Normal fasting glucose
From 100 to 125 mg/dL (5.6 to 6.9 mmol/L)	Impaired fasting glucose (pre-diabetes)
126 mg/dL (7.0 mmol/L) and above on more than one testing occasion	Diabetes

Oral Glucose Tolerance Test (OGTT) [except pregnancy] (2 hours after a 75-gram glucose drink)
Less than 140 mg/dL (7.8 mmol/L)	Normal glucose tolerance
From 140 to 200 mg/dL (7.8 to 11.1 mmol/L)	Impaired glucose tolerance (pre-diabetes)
Over 200 mg/dL (11.1 mmol/L) on more than one testing occasion	Diabetes

Gestational Diabetes Screening: Glucose Challenge Test (1 hour after a 50-gram glucose drink)
Less than 140* mg/dL (7.8 mmol/L)	Normal screen
140* mg/dL (7.8 mmol/L) and over	Abnormal, needs OGTT (see below)
* Some use a cutoff of >130 mg/dL (7.2 mmol/L) because that identifies 90% of women with gestational diabetes, compared to 80% identified using the threshold of >140 mg/dL (7.8 mmol/L).

Gestational Diabetes Diagnostic: OGTT (100-gram glucose drink)
Fasting*	95 mg/dL (5.3 mmol/L)
1 hour after glucose load*	180 mg/dL (10.0 mmol/L)
2 hours after glucose load*	155 mg/dL (8.6 mmol/L)
3 hours after glucose load* **	140 mg/dL (7.8 mmol/L)
* If two or more values are above the criteria, gestational diabetes is diagnosed. ** A 75-gram glucose load may be used, although this method is not as well validated as the 100-gram OGTT; the 3-hour sample is not drawn if 75 grams is used.

Some of the other diseases and conditions that can result in elevated glucose levels include:


Low to non-detectible urine glucose results are considered normal. Anything that raises blood glucose levels also has the potential to elevate urine glucose levels. Increased urine glucose levels may be seen with medications, such as estrogens and chloral hydrate, and with some forms of renal disease.

Moderately increased blood levels may be seen with pre-diabetes. This condition, if left un-addressed, often leads to type 2 diabetes.

Low blood glucose levels (hypoglycemia) are also seen with:


Is there anything else I should know? 
Hypoglycemia is characterized by a drop in blood glucose to a level where first it causes nervous system symptoms (sweating, palpitations, hunger, trembling, and anxiety), then begins to affect the brain (causing confusion, hallucinations, blurred vision, and sometimes even coma and death). An actual diagnosis of hypoglycemia requires satisfying the "Whipple triad." These three criteria include:


Primary hypoglycemia is rare and often diagnosed in infancy. People may have symptoms of hypoglycemia without really having low blood sugar. In such cases, dietary changes such as eating frequent small meals and several snacks a day and choosing complex carbohydrates over simple sugars may be enough to ease symptoms. Those with fasting hypoglycemia may require IV glucose if dietary measures are insufficient.