GLYCOSILATED HEMOGLOBIN LEVEL (HBA1C)  

Glycosilated hemoglobin level (HBA1C) is the one of best measure to check the plasma glucose level in past three month of time. glucose in the plasma bound to the hemoglobin in the red blood cells and remain until the rbc is destroyed.
this is important test to check the control of diabetic mellitus patient

serum amylase / amylase level elevation

Amylase

Test Overview

An amylase test measures the amount of this enzyme in a sample of blood taken from a vein or in a sample of urine.

Normally, only low levels of amylase are found in the blood or urine. But if the pancreas or salivary glands become damaged or blocked, more amylase is usually released into the blood and urine. In the blood, amylase levels rise for only a short time. In the urine, amylase may remain high for several days.

Why It Is Done

A test for amylase is done to:

• Find pancreatitis and other pancreatic diseases.
• See if the treatment for pancreatitis and other pancreatic diseases is working.
• Check swelling and inflammation of the salivary glands.

How To Prepare

To prepare for an amylase test:

• Do not drink alcohol for 24 hours before the test.
• For a blood test for amylase, do not eat or drink anything except water for at least 2 hours before having the test.
• For a 24-hour urine test for amylase, be sure to drink enough fluids during the test to prevent dehydration .

Many medicines may affect the results of this test. Be sure to tell your doctor about all the nonprescription and prescription medicines you take.

How It Is Done

Blood test

The health professional drawing your blood will:

• Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put the needle in the vein.
• Clean the needle site with alcohol.
• Put the needle in the vein. More than one needle stick may be needed.
• Attach a tube to the needle to fill it with blood.
• Remove the band from your arm when enough blood is collected.
• Put a gauze pad or cotton ball over the needle site as the needle is removed.
• Put pressure to the site and then put on a bandage.

Urine test

Amylase can be measured in a 24-hour or 2-hour urine sample.
A 24-hour urine sample is all of the urine you produce over a 24-hour period.

• You start collecting your urine in the morning. When you first get up, empty your bladder but do not save this urine. Write down the time that you urinated to mark the beginning of your 24-hour collection period.
• For the next 24 hours, collect all your urine. Your doctor or lab will usually provide you with a large container that holds about 1 gal (4 L). The container has a small amount of preservative in it. Urinate into a small, clean container and then pour the urine into the large container. Do not touch the inside of the container with your fingers.
• Keep the large container in the refrigerator for the 24 hours.
• Empty your bladder for the final time at or just before the end of the 24-hour period. Add this urine to the large container and record the time.
• Do not get toilet paper, pubic hair, stool (feces), menstrual blood, or other foreign matter in the urine sample.

A 2-hour urine sample is all of the urine you produce over a 2-hour period. Collect it in the same manner as the 24-hour urine sample, during the 2-hour period your health professional recommends.

How It Feels

Blood test

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch.

Urine test

There is no pain while collecting a 2-hour or 24-hour urine sample.

Risks

Blood test

There is very little chance of a problem from having a blood sample taken from a vein.

• You may get a small bruise at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes.
• In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this.
• Ongoing bleeding can be a problem for people with bleeding disorders. Aspirin, warfarin (Coumadin), and other blood-thinning medicines can make bleeding more likely. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your doctor before your blood sample is taken.

Urine test

There are no risks associated with collecting a 2-hour or 24-hour urine sample.

Results

An amylase test measures the amount of this enzyme in a sample of blood taken from a vein or in a sample of urine. Many conditions can change amylase levels. Your doctor will discuss any significant abnormal results with you in relation to your symptoms and past health.
Results are normally available within 72 hours.
The normal values listed here?called a reference range?are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what?s normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

Normal

Amylase in blood 1
Adults age 60 and younger:	25?125 units per liter (U/L) or 0.4?2.1 microkats/liter ( mckat/L )
Adults older than age 60:	24?151 U/L or 0.4?2.5 mckat/L

Amylase in urine 1
2-hour urine sample:	2?34 U or 16?283 nanokats/hour
24-hour urine sample:	24?408 U or 400?6,800 nanokats/day

Amylase/creatinine clearance ratio 1
Normal:	1%?4% or 0.01?0.04 clearance fraction

High values

Values may be high because of:

• Inflammation of the pancreas ( pancreatitis ), a pancreatic cyst, or cancer of the pancreas.
• Inflammation of the salivary glands , such as mumps .
• Blockage of or severe damage to the intestines (bowel obstruction or strangulation).
• A stomach ulcer that has caused a hole in the stomach wall.
• Gallstones that are causing pancreatitis.
• Diabetic ketoacidosis .
• A ruptured ectopic pregnancy .
• Kidney failure.
• Appendicitis or peritonitis .
• Macroamylasemia, an uncommon and harmless condition in which amylase is bound to a protein in the blood. This condition can cause amylase levels to be either high or low.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

• Medicines, including opiates such as codeine and morphine, birth control pills, diuretics , indomethacin, and blood-thinning medicines, such as warfarin and aspirin.
• Drinking a large amount of alcohol before the test.
• Saliva, which contains large amounts of amylase. Coughing, sneezing, or even talking over an uncovered urine or blood specimen can contaminate the specimen and artificially increase amylase values.
• Being pregnant.
• Having an endoscopic retrograde cholangiopancreatogram (ERCP) test before the amylase test.

What To Think About

• Pancreatitis usually causes levels of amylase in the urine to remain high for several days longer than blood amylase levels.
• Babies have little or no amylase at birth. By the end of the first year, a baby's amylase level is the same as an adult's level.
• Lipase is an enzyme produced only by the pancreas. A lipase test may be done at the same time as an amylase test when pancreatitis is suspected. For more information, see the medical test Lipase.
• Occasionally, a test that compares urine amylase with creatinine (a renal clearance ratio) may be done to help diagnose pancreatitis. For more information, see the topic Creatinine.

serum bilirubin / neonatal jaundice

Bilirubin

Test Overview

A bilirubin test measures the amount of bilirubin in a blood sample. Bilirubin is a brownish yellow substance found in bile . It is produced when the liver breaks down old red blood cells. Bilirubin is then removed from the body through the stool (feces) and gives stool its normal color.
Bilirubin circulates in the bloodstream in two forms:

• Indirect (or unconjugated) bilirubin. This form of bilirubin does not dissolve in water (it is insoluble). Indirect bilirubin travels through the bloodstream to the liver, where it is changed into a soluble form (direct or conjugated).
• Direct (or conjugated) bilirubin. Direct bilirubin dissolves in water (it is soluble) and is made by the liver from indirect bilirubin.

Total bilirubin and direct bilirubin levels are measured directly in the blood, whereas indirect bilirubin levels are derived from the total and direct bilirubin measurements.
When bilirubin levels are high, the skin and whites of the eyes may appear yellow ( jaundice ). Jaundice may be caused by liver disease ( hepatitis ), blood disorders ( hemolytic anemia ), or blockage of the tubes (bile ducts) that allow bile to pass from the liver to the small intestine .
Mild jaundice in newborns usually does not cause problems. But too much bilirubin (hyperbilirubinemia) in a newborn baby can cause brain damage ( kernicterus ) and other serious problems. So some babies who develop jaundice may need treatment to lower their bilirubin levels.

Why It Is Done

The bilirubin test is used to:

• Check liver function and watch for signs of liver disease, such as hepatitis or cirrhosis , or the effects of medicines that can damage the liver.
• Find out if something is blocking the bile ducts. This may occur if gallstones , tumors of the pancreas, or other conditions are present.
• Diagnose conditions that cause increased destruction of red blood cells , such as hemolytic anemia or hemolytic disease of the newborn .
• Help make decisions about whether newborn babies with neonatal jaundice need treatment. These babies may need treatment with special lights, called phototherapy. In rare cases, blood transfusions may be needed

How To Prepare

Adults should not eat or drink for 4 hours before a bilirubin test.
No special preparation is needed for children before having a bilirubin test.
Tell your doctor if you:

• Are taking any medicines.
• Are allergic to any medicines.
• Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin).
• Are or might be pregnant.

How It Is Done

Blood sample from a heel stick

For a heel stick blood sample, several drops of blood are collected from the heel of your baby. The skin of the heel is first cleaned with alcohol and then punctured with a small sterile lancet. Several drops of blood are collected in a small tube. When enough blood has been collected, a gauze pad or cotton ball is placed over the puncture site. Pressure is maintained on the puncture site briefly, and then a small bandage is usually applied.
Instead of the standard heel stick, some hospitals may use a device called a transcutaneous bilirubin meter to check a newborn's bilirubin level. This small handheld device measures bilirubin levels when it is placed gently against the skin. With this device, there may be no need to puncture the baby's skin. This is a screening test, and a blood sample will be needed if your baby's bilirubin level is high.

Blood sample from a vein

The health professional taking a sample of your blood will:

• Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
• Clean the needle site with alcohol.
• Put the needle into the vein. More than one needle stick may be needed.
• Attach a tube to the needle to fill it with blood.
• Remove the band from your arm when enough blood is collected.
• Put a gauze pad or cotton ball over the needle site as the needle is removed.
• Put pressure on the site and then put on a bandage.

How It Feels

Blood sample from a heel stick

A brief pain, like a sting or a pinch, is usually felt when the lancet punctures the skin. Your baby may feel a little discomfort with the skin puncture.

Blood sample from a vein

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch.

Risks

Heel stick

There is very little chance of a problem from a heel stick. A small bruise may develop at the site.

Blood test

There is very little chance of a problem from having a blood sample taken from a vein.

• You may get a small bruise at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes.
• In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this.
• Ongoing bleeding can be a problem for people with bleeding disorders. Aspirin, warfarin (Coumadin), and other blood-thinning medicines can make bleeding more likely. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your doctor before your blood sample is taken.

Results

A bilirubin test measures the amount of bilirubin in a blood sample. The results are usually available in 1 to 2 hours.

Normal values in adults

The normal values listed here?called a reference range?are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what's normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

Bilirubin levels in adults 1
Bilirubin type	Bilirubin level
Total bilirubin	0.3?1.0 mg/dL or 5.0?17.0 mmol/L
Direct bilirubin	0.0?0.2 mg/dL or 0.0?3.4 mmol/L

High values

• High levels of bilirubin in the blood may be caused by:
• Some infections, such as an infected gallbladder, or cholecystitis .
• Some inherited diseases, such as Gilbert's syndrome, a condition that affects how the liver processes bilirubin. Although jaundice may occur in some people with Gilbert's syndrome, the condition is not harmful.
• Diseases that cause liver damage, such as hepatitis , cirrhosis , or mononucleosis .
• Diseases that cause blockage of the bile ducts, such as gallstones or cancer of the pancreas .
• Rapid destruction of red blood cells in the blood, such as from sickle cell disease or an allergic reaction to blood received during a transfusion (called a transfusion reaction).
• Medicines that may increase bilirubin levels. This includes many antibiotics, some types of birth control pills, indomethacin (Indocin), phenytoin (Dilantin), diazepam (Valium), and flurazepam (Dalmane).

Low values

Low levels of bilirubin in the blood may be caused by:

• Medicines that may decrease bilirubin levels. This includes vitamin C, phenobarbital, and theophylline.

Normal values in newborns

Normal values in newborns depend on the age of the baby in hours and whether the baby was premature or full term. Normal values may vary from lab to lab.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful (except in newborns) include:

• Caffeine, which can lower bilirubin levels.
• Not eating for a long period (fasting), which normally increases indirect bilirubin levels.

What To Think About

• Bilirubin can be measured in amniotic fluid if your doctor thinks that your unborn baby may have a condition that destroys red blood cells (erythroblastosis fetalis). For more information, see the topic Amniocentesis.
• Bilirubin may also be measured in the urine in some cases. Normally, urine does not contain any bilirubin. If bilirubin is detected in urine, additional testing may be needed to determine the cause. High amounts of bilirubin in urine may indicate that the bilirubin is not being removed from the body by the liver.
• Using a transcutaneous bilirubin test, doctors can screen all newborns for jaundice. They place a device gently against the skin to check bilirubin levels before a baby goes home from the hospital. For more information, see the topic Jaundice in Newborns.

Blood Glucose /Plasma glucose/fasting blood glucose / fasting blood sugar

Blood Glucose

Test Overview

A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Glucose comes from carbohydrate foods . It is the main source of energy used by the body. Insulin is a hormone that helps your body's cells use the glucose. Insulin is produced in the pancreas and released into the blood when the amount of glucose in the blood rises.
Normally, your blood glucose levels increase slightly after you eat. This increase causes your pancreas to release insulin so that your blood glucose levels do not get too high. Blood glucose levels that remain high over time can damage your eyes, kidneys, nerves, and blood vessels.
There are several different types of blood glucose tests.

• Fasting blood sugar (FBS) measures blood glucose after you have not eaten for at least 8 hours. It is often the first test done to check for prediabetes and diabetes .
• 2-hour postprandial blood sugar measures blood glucose exactly 2 hours after you start eating a meal. This is not a test used to diagnose diabetes.
• Random blood sugar (RBS) measures blood glucose regardless of when you last ate. Several random measurements may be taken throughout the day. Random testing is useful because glucose levels in healthy people do not vary widely throughout the day. Blood glucose levels that vary widely may mean a problem. This test is also called a casual blood glucose test.
• Oral glucose tolerance test is used to diagnose prediabetes and diabetes. An oral glucose tolerance test is a series of blood glucose measurements taken after you drink a sweet liquid that contains glucose. This test is commonly used to diagnose diabetes that occurs during pregnancy ( gestational diabetes ). This test is not commonly used to diagnose diabetes in a person who is not pregnant.
• Glycohemoglobin A1c measures how much sugar (glucose) is stuck to red blood cells. This test can be used to diagnose diabetes. It also shows how well your diabetes has been controlled in the last 2 to 3 months and whether your diabetes medicine needs to be changed. The result of your A1c test can be used to estimate your average blood sugar level. This is called your estimated average glucose, or eAG.

To make a diagnosis of type 2 diabetes, your doctor will use the American Diabetes Association's criteria.

Why It Is Done

Blood glucose tests are done to:

• Check for prediabetes and diabetes.
• Monitor treatment of diabetes.
• Check for diabetes that occurs during pregnancy (gestational diabetes).
• Determine if an abnormally low blood sugar level ( hypoglycemia ) is present. A test to measure blood levels of insulin and a protein called C-peptide may be done along with a blood glucose test to determine the cause of hypoglycemia. To learn more, see the topic C-Peptide.

How To Prepare

Fasting blood sugar (FBS)

For a fasting blood sugar test, do not eat or drink anything other than water for at least 8 hours before the blood sample is taken.
If you have diabetes, you may be asked to wait until you have had your blood tested before taking your morning dose of insulin or diabetes medicine.

2-hour postprandial blood sugar

For a 2-hour postprandial test , start eating a meal exactly 2 hours before the blood sample is taken. A home blood sugar test is the most common way to check 2-hour postprandial blood sugar levels.

Random blood sugar (RBS) and glycohemoglobin A1c

No special preparation is required before having a random blood sugar or A1c test.

Oral glucose tolerance test

For an oral glucose tolerance test, you'll need to follow a special diet for 3 days before the test. And do not eat, drink, smoke, or exercise strenuously for at least 8 hours before your first blood sample is taken.
To learn more about how to prepare for this test, see Oral Glucose Tolerance Test.

How It Is Done

The health professional taking a sample of your blood will:

• Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
• Clean the needle site with alcohol.
• Put the needle into the vein. More than one needle stick may be needed.
• Attach a tube to the needle to fill it with blood.
• Remove the band from your arm when enough blood is collected.
• Apply a gauze pad or cotton ball over the needle site as the needle is removed.
• Apply pressure to the site and then a bandage.

How It Feels

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch.

Risks

There is very little risk of a problem from having blood drawn from a vein.

• You may develop a small bruise at the puncture site. You can reduce the risk of bruising by keeping pressure on the site for several minutes after the needle is withdrawn.
• In rare cases, the vein may become inflamed after the blood sample is taken. This condition is called phlebitis and is usually treated with a warm compress applied several times daily.
• Continued bleeding can be a problem for people with bleeding disorders. Aspirin, warfarin (Coumadin), and other blood-thinning medicines can also make bleeding more likely. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your health professional before your blood is drawn.

Results

Normal

A blood glucose test measures the amount of a type of sugar, called glucose, in your blood.
Results are often ready in 1 to 2 hours. Glucose levels in a blood sample taken from your vein (called a blood plasma value) may differ a little than glucose levels checked with a finger stick.
The normal values listed here?called a reference range?are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what's normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

Blood glucose
Fasting blood glucose: 1	Less than or equal to 100 milligrams per deciliter ( mg/dL ) (5.6 millimoles per liter, or mmol/L ).
2 hours after eating ( postprandial ): 2	Less than 140 mg/dL (7.8 mmol/L) for people age 50 and younger; less than 150 mg/dL (8.3 mmol/L) for people ages 50?60; less than 160 mg/dL (8.9 mmol/L) for people age 60 and older.
Random (casual): 3	Levels vary depending on when and how much you ate at your last meal. In general: 80?120 mg/dL (4.4?6.6 mmol/L) before meals or when waking up; 100?140 mg/dL (5.5?7.7 mmol/L) at bedtime.

Many conditions can change your blood glucose levels. Your doctor will discuss any significant abnormal results with you in relation to your symptoms and past health.
For more information on results from an oral glucose tolerance test or glycohemoglobin A1c test, see:

• Oral Glucose Tolerance Test.
• Glycohemoglobin A1c.

High values

You may have diabetes. To make a diagnosis of type 2 diabetes, your doctor will use the American Diabetes Association's criteria.
Other conditions that can cause high blood glucose levels include:

• Severe stress.
• Heart attack .
• Stroke .
• Cushing's syndrome .
• Medicines such as corticosteroids .
• Excess production of growth hormone ( acromegaly ).

Low values

A fasting glucose level below 40 mg/dL (2.2 mmol/L) in women or below 50 mg/dL (2.8 mmol/L) in men that is accompanied by symptoms of hypoglycemia may mean you have an insulinoma, a tumor that produces abnormally high amounts of insulin.
Low glucose levels also may be caused by:

• Addison's disease .
• Decreased thyroid hormone levels ( hypothyroidism ).
• A tumor in the pituitary gland .
• Liver disease, such as cirrhosis .
• Kidney failure.
• Malnutrition or an eating disorder, such as anorexia .
• Medicines used to treat diabetes.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

• Eating or drinking less than 8 hours before a fasting blood test or less than 2 hours before a 2-hour postprandial test.
• Drinking alcohol.
• Illness or emotional stress, smoking, and caffeine.
• Taking a medicine, such as birth control pills, medicines used to treat high blood pressure, phenytoin (Dilantin), furosemide (Lasix), triamterene (Dyrenium, Dyazide), hydrochlorothiazide (Esidrix, Oretic), niacin, propranolol (Inderal), or corticosteroids (prednisone). Some medicines can cause changes in your test results. Make sure that your doctor knows about any medicines you take and how often you take them.

What To Think About

• Glucose levels in urine can also be measured. Many people with diabetes have glucose in their urine. But the level in the blood must be very high before glucose can be detected in the urine. For this reason, tests for glucose in urine are not used to diagnose or monitor diabetes. To learn more, see Urine Test.
• If you have diabetes, you will be able to measure your blood glucose levels at home. To learn more, see Home Blood Glucose Test.