Uric Acid

↑ High Uric Acid Level

• Gout, renal failure, leukemia, multiple myeloma, polycythemia, lymphoma, other disseminated neoplasms, toxemia of pregnancy, psoriasis, glycogenosis type I, Lesch-Nyhan syndrome, Down syndrome, polycystic kidney disease, and chronic lead nephropathy
• A purine-rich diet (liver, kidney, sweetbread), as well as severe exercise, increases uric acid values.
• In association with hyperlipidemia, obesity, hypertension, arteriosclerosis, diabetes mellitus, ethanol consumption, hypoparathyroidism, acromegaly, sarcoidosis, and liver disease; after gross tissue destruction (increased nucleoprotein breakdown), and in excessive nucleoprotein turnover (e.g., myeloid leukemia, pernicious anemia, and strychnine poisoning).
• Acute (sometimes dangerous) elevation follows treatment of leukemia with cytotoxic drugs.

↓ Low Uric Acid Level

• Wilson’s disease, Fanconi’s syndrome, some malignancies (e.g., Hodgkin’s disease, multiple myeloma, bronchogenic carcinoma), xanthinuria, SIADH, deficiencies of adenosine deaminase, purine, and nucleoside phosphorylase; low-purine diet.

 

Glucose

↑ High Glucose Level

• Primary: Diabetes mellitus (adult and juvenile)
• Physiological: Strenuous exercise, strong emotion, increased epinenphrine from injection, shock, burns; infection (?)
• Endocrine disorders: Pheochromocytoma, thyrotoxicosis, acromegaly, gigantism, Cushing’s syndrome, glucagonoma, somatostatinoma
• Pancreatic disease: Acute and chronic pancreatitis; pancreatitis resulting from mumps, cystic fibrosis, hemochromatosis; neoplasms of pancreas
• Related to other disorders: Cerebrovascular accident, acute myocardial infarction or severe angina, chronic liver disease, chronic renal disease
• Related to insulin receptor antibodies: Acanthosis nigricans
• Vitamin B1 deficiency: Wernicke’s encephalopathy

 

↓ Low Glucose Level

• Pancreatic disorders: Islet cell tumor, glucagon deficiency
• Tumors: Carcinoma of adrenal gland, carcinoma of stomach, fibrosarcoma
• Severe hepatic disorders: Poisoning (e.g., arsenic, carbon tetrachloride, chloroform, cinchophen, phosphorus, alcohol, salicylates, phenformin, antihistamines)
• Endocrine disorders: Hypopituitarism, Addison’s disease, hypothyroidism
• Functional disorders: Postgastrectomy, gastroenterostomy, autonomic nervous system disorders
• Pediatric anomalies: Prematurity, infant of diabetic mother, ketotic hypoglycemia, Zetterstrom’s syndrome, idiopathic leucine sensitivity
• Enzyme deficiency diseases: von Gierke’s syndrome, galactosemia, maple syrup urine disease, fructose intolerance

 

Hemoglobin (Hb), Total

↑ High Total Hemoglobin (Hb) Level

• Polycythemia, after vigorous exercise or excitement, hemoconcentration (as in dehydration, burns, severe vomiting, intestinal obstruction)

↓ Low Total Hemoglobin (Hb) Level

• Anemia, recumbency; drugs that cause aplastic anemia or that cause hemolysis, either in G6PD deficiency or by an immune mechanism

 

β-Ketone

β-Hydroxybutyrate (BOHB) (the predominant ketone) is a better indicator of clinical state than acetoacetate in diabetic ketoacidosis (DKA). The BOHB/AcAc ratio is normally 3:1. This ratio will increase to 6:1 or 12:1 during ketoacidosis, particularly if there is associated decreased tissue perfusion, metabolic acidosis, and tissue catabolism. All of these will favor reductive metabolism and hence BOHB production. Acetoacetate may increase during therapy for DKA because BOHB is oxidatively metabolized to acetoacetate.

↑ High β-Ketone Level

• Diabetic ketoacidosis, prolonged excessive insulin administration in diabetics, prolonged fasting (so-called ketotic hypoglycemia, most common in children aged 1-6 yr), severe carbohydrate restriction with normal fat intake (weight-reducing diets), anorexia nervosa, persistent vomiting, glycogen storage diseases I, III, and VI, branched-chain ketonuria, methylmalonic aciduria, exercise in untrained subjects,1 pregnancy,1 stress, postanesthesia.

Blood Glucose

Tracking your blood glucose concentration through frequent tests is an important part of proper diabetes care. Your healthcare professional will help you to decide the normal target range for your glucose levels. They will also help you to determine when and how often to test your blood glucose. Some suggested times are:

• When you wake up (fasting level)
• Before breakfast
• 1 - 2 hours after breakfast
• Before lunch
• 1 - 2 hours after lunch
• Before or after exercise
• Before dinner
• 1 - 2 hours after dinner
• Before bedtime
• After a snack
• At 2 or 3 AM, if taking insulin

You may need to test more often whenever1:

• You add or adjust your diabetes medication.
• You think your blood glucose levels may be too low or too high.
• You are ill, or feeling uncomfortable over long periods of time.

Expected blood glucose levels for people without diabetes ²:

Time	Range, mg/dL	Range, mmol/L
Fasting and Before Meals	70 - 100	3.9 - 5.6
2 Hours after Meals	Less than 140	Less than 7.8

Talk to your healthcare professional to set your own daily target ranges.

Time of Day	Your Target Range
Waking up (Fasting level)
Before meals
2 hours after meals
Bedtime
2 AM to 3 AM
Other

(Note: 1 mmol/L = 18 mg/dL)

Use the logbook to record your blood glucose measurements and related information. Bring the logbook with you when you visit your doctor so that you can determine how well your blood glucose is being controlled. This can help you and your healthcare professional make the best decisions about your glucose control plan.

 

β-Ketone

Continuous high blood glucose means your body does not have enough insulin to burn glucose, instead it will start burning fat and this produces a chemical called β-Ketone. If left untreated, β-Ketones continues to rise and can result a condition called Diabetic Ketoacidosis, or DKA. This condition may lead to death therefore requires immediate medical attention. It is suggested that if your blood glucose level is above 300 mg/dL or 16.7 mmol/L for two tests in a row, a β-Ketone test needs to be applied immediately.

There are situations when you have positive β-Ketones without blood glucose being too high. Positive β-Ketones are not a problem when blood glucose levels are within range and you are trying to lose weight.

The normal adult blood β-Ketone range for person without diabetes is less than 0.6 mmol/L. Consult with your healthcare professional for the blood β-Ketone range that is appropriate for you. If your blood β-Ketone test result is between 0.6-1.5 mmol/L and glucose is higher than 300 mg/dL, this may indicate development of a medical concern. You need to contact with your healthcare professional for assistance. If your blood β-β-Ketone test result is more than 1.5 mmol/L and glucose is higher than 300 mg/dL, contact with your healthcare professional immediately. This indicates a risk of developing diabetic ketoacidosis (DKA).

 

Uric Acid

It is important to monitor your Uric Acid level because high levels of uric acid in the blood can cause solid crystals to form within joints. This causes a painful condition called gout. If gout remains untreated, these uric acid crystals can build up in the joints and nearby tissues, forming hard lumpy deposits called tophi. High levels of uric acid may also cause kidney stones or kidney failure.

Most labs that carry out uric acid test will have slightly different definitions of low, Normal and high levels of uric acid in the blood. As such, the information here and all you come across online should be interpreted as a guide only. It will be the decision of your doctor as to whether or not your levels are in the safer regions.

Men	3.4 to 7.0 mg/dL	202 to 416 µmol/L
Women	2.4 to 6.0 mg/dL	143 to 347 µmol/L
Children	2.0 to 5.5 mg/dL	119 to 327 µmol/L

Reference:

1. Jennifer Mayfield and Stephen Havas, “Self-Control: A Physician’s Guide to Blood Glucose Monitoring in the Management of Diabetes – An American Family Physician Monograph”
2. ADA Standards of Medical Care in Diabetes, 2015. Diabetes Care, 2015, Vol.38, Supplement