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This leads to false results that are difficult to interpret or rely on, as the result of this fasting begins to produce additional amounts of glucose through the process of (gluconeogenesis) as a result of increased hormonal secretion (glucagon and epinephrine).Note (Fasting during the day and performing the analysis of the fasting person after that is considered an inaccurate procedure and should not be relied upon, for example fasting from 10 am to 7 pm and then doing the analysis)Plasma glucose values ​​have a diurnal variation with the mean FBG higher in the morning than in the afternoon. Diabetes in patients tested in the afternoon may be missed because of this variationAs for innate sugar: it must also be preceded by fasting from 8 to 10 hours, then the patient eats (the normal daily food for him with treatment, if any) for a maximum period of 10 to 15 minutes, then completes the rest of the two hours without eating or drinking, taking into account that he is in the laboratory before an appointment Take the sample in 10 minutesNote (if the patient continues to eat for a long time, the analysis here is considered inaccurate, because you are actually measuring sugar after a period of less than two hours)Note (if the patient is late so that the period has become more than two hours, the analysis in this case is inaccurate and must be repeated)Second: The very important point before entering into the interpretation of the result is to make sure first of the accuracy of the laboratory test.In other words, I was sure of my chemicals, my equipment, and the necessary control factor, and I separated the samples immediately after the withdrawal, or worked directly so that the glucose would not drop by leaving it in the blood.Of course, you must take a urine sample along with the samples of the fasting person and the fasting person (this is a very very important control for your work).Third: If all laboratory matters are complete and you verify them, the first thing you will do is to ask the patient about the nature of breakfast.... Did he really eat???Because some patients eat something very simple, or drink only, or even smoke a cigarette in the belief that this is the breaking of the fast. Of course, this is realistic as if it is a supplement to fasting, and in fact the person who is fasting may appear less than the fasting person.Ok if I eat normalHere we divide the case into two parts*** Either he is diabeticHere, the most likely possibility is that the dose of the treatment that is taken with food in the analysis of the fungus is higher than necessary and must be changed so as not to cause (hypoglycemia) to the patient, and that is why the doctor must know the result in this form.*** Either he is a person who is not a diabetic, and here I have several possibilities1- There is a need called the “Dawn effect” or the effect of dawn, and here the body, between 4 and 5 am, begins to secretly secrete the growth hormones, cortisol, glucagon and epinephrine, and these are all catabolic hormones, allowing the liver to make and It secretes a large amount of glucose in the blood (of course, the aim is to prepare the person to wake up) and also glucagon temporarily stops the effect of insulin, as this can lead to some cases of a significant rise in fasting sugar.............. Then with breakfast it decreases These hormones and insulin are released naturally, so the sugar decreases and appears below the fasting level in this case2- In some people they have a condition called (reactive hypoglycemia), and this happens when food moves from the stomach to the intestines faster than the normal rate (rapid gastric emptying), and of course it will not be well digested and entering the intestines quickly, this causes (release excessive amounts). of insulin into the bloodstream), and this reduces the sugar in the blood after breakfast and makes it appear like this. And this situation we find in people who have gastric surgeries for obesity or people who have stomach ulcers (about 15% of cases).3- This issue, too, they found that it happens in some patients with hypothyroidism, especially when the level of thyroid hormones is very low, because this affects the absorption of glucose from the intestines after eating, so the result of breakfast is very close to fasting or less (even when the sugar curve is made For these cases, almost all results appear from the first sample to the last sample, the same as some, and therefore the curve is straight and is called the (Flattened OGTT curve))Fourth: How do you see the result?It is very important that you avoid the following disaster((((((((((((Reverse the result))))))))))))))))Certainly, of course, some colleagues saw this issue in some laboratories. They believe that the doctor will not accept the result or will not understand it.And here is the questionAre you doing the analysis in order to comfort the doctor???? And not to give the patient and the doctor the realistic results of the case???In these cases and after making sure of the accuracy of the work in the laboratoryWrite the result as it is with the addition of a comment explaining to the doctor that you intend to write the result in this wayPostprandial can be less than fast due to normal transient decline, diabetes therapy or suspected reactive hypoglycemiaThis is how the doctor will understand what you mean and can deal correctly with the caseDr. Khaled Magdy

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