Routine physical examination blood sugar level

Most routine physical examinations include blood sugar testing, but usually only cover fasting venous blood sugar. Some low-priced entry-level packages may omit this item. Whether additional blood sugar-related tests are needed depends on your physical condition.

A while ago, when I was helping my cousin who had just graduated to get a physical examination package, I discovered that the current physical examination packages on the market are extremely layered: basic packages costing more than 300 yuan will basically tie fasting blood sugar into the biochemical routine, and put the results together with liver and kidney function and blood lipids.； However, many cost-effective models such as 199 and 299, which are mainly "exclusive for students and young people", will secretly delete items such as blood sugar and blood uric acid, euphemistically calling it "streamlining redundant items for healthy groups." If you don't carefully look through the item list, you will most likely realize that you missed the item after you get the report.

Regarding whether the configuration of routine physical examination of blood sugar is sufficient, there have been two different ideas in the industry. Most of the experienced doctors who have been working in public physical examination centers for 20 to 30 years believe that routine screening of fasting blood sugar for the general population is completely sufficient - after all, the test cost is low and the results are obtained quickly. It only needs to be fasted for 8 hours before the test, and no extra effort is needed. Most people with abnormal blood sugar will first show elevated fasting indicators. This is the most cost-effective way to use this as a preliminary screening. There is no need for everyone to spend two or three hours and an extra 180 yuan to check after meals or glycation, which wastes already tight medical resources.

But when I was helping out at the chronic disease management post at a community health service center last year, I really encountered a lot of people who fell into the trap of "only checking fasting". What impressed me the most was a 37-year-old Internet operator. Every year during the work physical examination, his fasting blood sugar was around 5.4mmol/L, firmly stuck in the normal range of 3.9-6.1. He never cared about it until last year, when he was thirsty every day for two or three months. Even though I couldn't quench my thirst even after drinking two liters of water, I still felt hungry at every turn. I lost almost 10 pounds before I hurriedly went to the endocrinology department to register. When I checked, my blood sugar level reached 12.9mmol/L two hours after a meal, and my glycosylated hemoglobin was also 7.2%. I was diagnosed with type 2 diabetes on the spot. The attending doctor said at the time that his situation was a typical one of "normal on an empty stomach and high after a meal." If he had checked glycation or postprandial blood sugar two or three years earlier, he could have reversed the early stage of blood sugar through diet and exercise, and would not have developed to the point where he needed to take medicine for a long time.

Nowadays, more and more young endocrinologists also hold this view: The current lifestyle is completely different from that of 20 years ago. Many young people only take out milk tea, stay up until 2 or 3 o'clock to go to bed, take the car and lie down upstairs when going out, and a lot of them have abdominal obesity. Currently, at least one-third of the pre-diabetic people in China have simple elevated blood sugar after meals, and fasting is completely normal. The missed diagnosis rate of fasting blood sugar alone is more than 30%. Especially for women who have a family history of diabetes, have a BMI over 24, have polycystic ovary syndrome, often eat high-sugar and high-fat foods, and are preparing for pregnancy or are pregnant, even if the fasting blood sugar in a routine physical examination shows normal, it is best to pay tens of dollars to check the glycosylated hemoglobin, which can reflect the average blood sugar level in the past three months and is much more reliable than the random result of a single fasting. If the fasting blood sugar has exceeded 5.6mmol/L, it is best to do an oral glucose tolerance test directly, which is often called "sugar water screening". Don't take it seriously.

By the way, by the way, don’t be nervous or reassured after checking yourself with a fingertip blood glucose meter at home. Routine physical examinations and clinical diagnosis use the results of venous plasma blood sugar. The value of fingertip blood can only be used for daily monitoring and cannot be used as a basis for diagnosis. If you prick your finger and find that the value is high, you must go to the hospital to draw venous blood for reexamination.

In fact, to put it bluntly, you don’t have to worry about checking blood sugar during routine physical examination. When choosing a package, scan the list of items and do it first if there is fasting blood sugar. If you are in a high-risk group, take the initiative to add glycation. It doesn’t cost much and the blood can be drawn in half an hour. If you wait until obvious symptoms of “three more and one less” appear before you think about checking, you will often have missed the best opportunity for intervention, right?