What's the difference?

[Blue30]

I have tried to research this answer with no joy. Perhaps someone on here can help me and clarify why they differ.
What is the difference when testing a 'Plasma glucose level' and 'Fasting plasma glucose level'?
I know FGL is blood after fasting for at least 8 hours, but are they the same?

 

[Rachox]

Hi Blue and welcome to the forum
In answer to your question yes fasting glucose is after fasting, whereas the plasma glucose level isn’t and is sometimes called a random plasma glucose level.
BTW I don’t know how far you are into your diabetic journey but I’ll tag in @daisy1 ’s useful info post. It’s helpful for newbies and also a good reminder for those further along in their diagnosis.

 

[Bluetit1802]

It depends on the context. On lab reports, for example, it may say plasma glucose when it was actually a fasting test.

 

[daisy1]

@Blue30
Hello and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it both interesting and helpful.

BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 600,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.

 

[Blue30]

Hi Blue and welcome to the forum
In answer to your question yes fasting glucose is after fasting, whereas the plasma glucose level isn’t and is sometimes called a random plasma glucose level.
BTW I don’t know how far you are into your diabetic journey but I’ll tag in @daisy1 ’s useful info post. It’s helpful for newbies and also a good reminder for those further along in their diagnosis.

Thank you Rachox.
I was diagnosed Feb 2018 and tested again June 2018. Just had my annual check.
The reason I ask is that on my first 2 HbA1c test last year, I notice I had a Plasma Glucose level check ( 1st 12.8mmol/l and the 2nd 7.4mmol/l), but not on my this year's annual check up. I just wondered why. Were they to diagnose?
On all tests I had eaten breakfast and on the 1st, I'd also just had had a stinking cold and had just finished a normal throat lozenger.
My HbA1c and Plasma Glucose:
Feb 18 - 7.2% 55 mmol/lol . PGL 12.8mmol/l
June 18 - 5.7% 38.8 mmol/mol. PGL 7.4 mmol/l . On LCHF diet
April 19 - 6% 42.1 mmol/mol . No plasma glucose tested.
My latest HbA1c Apr 19, was a test for me personally. I had deliberately introduced a small amount of carbs from bread and potatoes in the last 3 months b4 my test, just to prove to the Diabetic nurse she should not advice people that they can eat this and eat that (carbs). I also wanted to check the accuracy of MySugar app.
So Plasma Glucose level is my blood glucose at the time of test and not my fasting level, which I have always led to believe is necessary for a diagnosis along with HbA1c.
Sorry for long reply!

 

[Blue30]

It depends on the context. On lab reports, for example, it may say plasma glucose when it was actually a fasting test.

Hi Blutit802
It actually says on my results Plasma glucose level. If it was as you suggest above, surely this would an incorrect result as I had eaten etc. Is there any way I can get this checked. I thought it was strange last year as my GP was delighted with my June 18 result of HbA1c, but mentioned the diabetic nurse insisted I was coded due to these Plasma levels! Maybe I should get this clarified with the GP.
Don't get me wrong, I don't t believe I have been misdiagnosed as I know I have sugar issues with carbs.
Please excuse me if I'm doing this wrong... I'm new to posting on here.

 

[bulkbiker]

I have tried to research this answer with no joy. Perhaps someone on here can help me and clarify why they differ.
What is the difference when testing a 'Plasma glucose level' and 'Fasting plasma glucose level'?
I know FGL is blood after fasting for at least 8 hours, but are they the same?

Well it depends..
The plasma glucose level is a snapshot of your blood glucose at that exact point in time.
If you haven't eaten anything beforehand then it will definitely have been "fasting".
If it's taken in the early morning and your blood taker believes you haven't eaten anything then it still may be called fasting glucose even though you have eaten beforehand and if say its taken in the afternoon then they will assume you have eaten something so will just call it plasma glucose.
So its semantics.. they are all "plasma glucose levels" a record of your blood sugars at that point in time whereas HbA1c is an "average" of the past 2-3 months levels.
Hope that helps?

 

[Squire Fulwood]

Plasma is the liquid part of your blood. If the red bits are left there it is whole blood and this gives a lower blood glucose reading. Plasma glucose gives a higher reading.

https://www.wisegeek.com/what-is-plasma-glucose.htm

Fasting blood or blood taken any other time can be tested by either method. Some meters are calibrated to test as if the blood sample was plasma resulting in people complaining that their meter reads high.

 

[Bluetit1802]

Hi again @Blue30

The HbA1c is used for diagnostic tests. The plasma glucose is not used in the UK although some doctors still ask for it, alongside the HbA1c. Most surgeries these days don't bother with it at all after the initial test. My surgery abandoned them a few years ago even for the initial test. It looks like your surgery is no longer interested in it, and this is perfectly normal. There is no reason for you to be concerned about it. Only the HbA1c counts.

Well done indeed on your reductions

 

[Blue30]

Thank you everyone...this is one area where I have become confused because I felt if I was thinking the same as yourselves. So, my tests would not be true reflection of my fasting levels as I'd eaten prior to the tests. All tests have to be done in the morning after I'd eaten, but I was never asked if I'd eaten or never told not to.
There seems a lot of difference of opinion in my surgery. I have had a battle on my hands with the D/N...now insist on a different nurse. My GP is great...he didn't want to put me straight on meds even though the nurse disagreed. He told me from the offset to cut carbs bread, potatoes, pasta, rice and to check every label!
I need very little carbs to raise my HbA1c but I needed to do this to prove to myself that I am "carb intolerant" and to inform the nurse her advice is wrong for me and many others I suspect!
Things like chocolate, berries had little effect on b/g if eaten with d/cream or icecream. I think fat slows down absorbsion which avoids a spike!? I do check prior, 1,2,3 hours after food, especially me food or eating out. I seem to peak at 2-2.5 hrs.

 

[bulkbiker]

I think fat slows down absorbsion which avoids a spike!?

It can be seen to lower the intensity of the spike but possibly prolong the period for which blood sugars are elevated. So you may a bigger spike without the fat but shorter whereas with the fat a longer lasting although less intense spike.
That's the main reason I try to avoid carbs altogether.. then no spike (for me).

 

[Bluetit1802]

Things like chocolate, berries had little effect on b/g if eaten with d/cream or icecream. I think fat slows down absorbsion which avoids a spike!? I do check prior, 1,2,3 hours after food, especially me food or eating out. I seem to peak at 2-2.5 hrs.

Yes, fats slow absorption so the spike is less, but the raised levels last longer. Not peaking until 2 to 2 and a half hours shows you have quite a bit of insulin resistance as it is taking your insulin much longer than it should to have an effect.

 

[Bluetit1802]

It can be seen to lower the intensity of the spike but possibly prolong the period for which blood sugars are elevated. So you may a bigger spike without the fat but shorter whereas with the fat a longer lasting although less intense spike.
That's the main reason I try to avoid carbs altogether.. then no spike (for me).

Snap, again. Team Des and Daf!

 

[bulkbiker]

Yes, fats slow absorption so the spike is less, but the raised levels last longer. Not peaking until 2 to 2 and a half hours shows you have quite a bit of insulin resistance as it is taking your insulin much longer than it should to have an effect.

Daf and Des strike again!

 

[bulkbiker]

This is getting silly!

 

[Dark Horse]

There are different ways of diagnosing diabetes. Nowadays the emphasis is on HbA1c levels but diagnosis has also been made using either fasting or random (non-fasting) plasma glucose, taking into account the different normal ranges. Diabetes UK have this info:-
Methods and criteria for diagnosing diabetes

1. Diabetes symptoms (e.g. polyuria, polydipsia and unexplained weight loss for Type 1) plus:
   • a random venous plasma glucose concentration ≥ 11.1 mmol/l or
   • a fasting plasma glucose concentration ≥ 7.0 mmol/l (whole blood ≥ 6.1 mmol/l) or
   • two hour plasma glucose concentration ≥ 11.1 mmol/l two hours after 75g anhydrous glucose in an oral glucose tolerance test (OGTT).
2. With no symptoms diagnosis should not be based on a single glucose determination but requires confirmatory plasma venous determination. At least one additional glucose test result on another day with a value in the diabetic range is essential, either fasting, from a random sample or from the two hour post glucose load. If the fasting random values are not diagnostic the two hour value should be used. https://www.diabetes.org.uk/profess...nitoring/new_diagnostic_criteria_for_diabetes

Note that a random venous plasma glucose of 11.1 mmol/l or greater is at a diabetic level so your original level of 12.8 mmol/l would be sufficient to diagnose diabetes if symptoms were present. (If there are no symptoms, 2 tests at diabetic levels are required)

 

[Squire Fulwood]

Thank you everyone...this is one area where I have become confused because I felt if I was thinking the same as yourselves. So, my tests would not be true reflection of my fasting levels as I'd eaten prior to the tests. All tests have to be done in the morning after I'd eaten, but I was never asked if I'd eaten or never told not to.
There seems a lot of difference of opinion in my surgery. I have had a battle on my hands with the D/N...now insist on a different nurse. My GP is great...he didn't want to put me straight on meds even though the nurse disagreed. He told me from the offset to cut carbs bread, potatoes, pasta, rice and to check every label!
I need very little carbs to raise my HbA1c but I needed to do this to prove to myself that I am "carb intolerant" and to inform the nurse her advice is wrong for me and many others I suspect!
Things like chocolate, berries had little effect on b/g if eaten with d/cream or icecream. I think fat slows down absorbsion which avoids a spike!? I do check prior, 1,2,3 hours after food, especially me food or eating out. I seem to peak at 2-2.5 hrs.

A fasting test is classed as fasting since you are required to fast for 8 hours or more before the test. If the result is 7 or close to it then the doctor will be interested.

If you have eaten before the test then it is classed as a random test and will only gain the interest of the doctor if the figure is 11 or above. It is as well to know which test it is since you could get diagnosed in error.

For what it's worth I would take the doctors advice over that of the nurse in your particular case. This is not the recommended path for everyone since some doctors are not as up to date as yours seems to be.

 

[Blue30]

Hi again @Blue30

The HbA1c is used for diagnostic tests. The plasma glucose is not used in the UK although some doctors still ask for it, alongside the HbA1c. Most surgeries these days don't bother with it at all after the initial test. My surgery abandoned them a few years ago even for the initial test. It looks like your surgery is no longer interested in it, and this is perfectly normal. There is no reason for you to be concerned about it. Only the HbA1c counts.

Well done indeed on your reductions

Thank you Bluetit1802.
It's taken a lot of research (thank you so much to all have contributed on this forum), willpower and change of buying what I now know is wrong food products. Used to think my shopping trolley was full of healthly balanced foods, very little fat. Never did I ever think high carb foods would create a problem for me. I grew up believing carbs were essential for energy!
It was hard getting the nurse to give me a general blood test as I had gained weight around the middle and was very concerned about developing diabetes. I started getting mood swings and getting up in the night for a toilet visit. Diabetes is rather prevelant in my family, type 1 and 2. Her answer, was "just because it's in your family, it doesn't mean you will develop it...you're propably going through the change"! Anyhow, I insisted on getting tested. I now hate to think how much I could have damaged my body if I'd gone away and continued eating the way I was and and accepted her opinion. My GP however, is a breath of fresh air.
Again apologies for my lengthy reply.

 

[Blue30]

A fasting test is classed as fasting since you are required to fast for 8 hours or more before the test. If the result is 7 or close to it then the doctor will be interested.

If you have eaten before the test then it is classed as a random test and will only gain the interest of the doctor if the figure is 11 or above. It is as well to know which test it is since you could get diagnosed in error.

For what it's worth I would take the doctors advice over that of the nurse in your particular case. This is not the recommended path for everyone since some doctors are not as up to date as yours seems to be.

Thank you Squire Fulwood.

I agree with you fully. The fact that no-one asked me to fast or if I'd eaten just makes me wonder how they were interpreted. I will certainly question it. Having said that, my GP did say that once someone is coded diabetic, it cannot be removed at all. They can put a note to say a patient is in remission, but never remove the diagnosis. His view was one can control with lifestyle changes and avoid meds. There exceptions when even this does not work and meds are eventually prescribed. So really there is nothing I can do other than perhaps make a point of informing them that I have eaten or not.

I believe I do have a problem and however one wants to call it, diabetes or carb intolerance, as some prefer to call it. Either way, it is at presently incurable, but can be controlled. However, if one continues to eat a high carb diet, then one will cause damage to the body in time from the diabetes.

Yes, my GP is a breath of fresh air. Another Dr in my surgery has the view of the D/N and believes I should be on meds even with a HbA1c of 6%?

I am very thankful for my GP's support and it has strangely given me the confidence to actually listen and learn from my own body.


Mentally, this has been something I have had to except and for the rest of my life.

 

[Blue30]

It can be seen to lower the intensity of the spike but possibly prolong the period for which blood sugars are elevated. So you may a bigger spike without the fat but shorter whereas with the fat a longer lasting although less intense spike.
That's the main reason I try to avoid carbs altogether.. then no spike (for me).

I agree and we are all different, as I have found with myself. Some can eat things I can't, and vice versa. I personally don't get get a spike whatever the length of time. Nothing is straightforward with diabetes though, as I have found out by continually monitoring!