What is the significance of a patient having a non-fasting (random) blood glucose level of 98 mg/dL and a non-fasting insulin level of 2.1 uU/mL?

From the Guidelines

The patient's non-fasting blood sugar of 98 mg/dL and insulin level of 2.1 μIU/mL are within normal ranges, indicating normal glucose metabolism, and no medication or intervention is needed at this time. According to the American Diabetes Association standards of medical care in diabetes-2021 1, a non-fasting blood glucose level below 100 mg/dL is considered normal. Additionally, the patient's insulin level is within the normal range, suggesting that their pancreas is producing appropriate amounts of insulin and their body is responding properly to maintain blood glucose within healthy limits.

Key Points to Consider

• A normal non-fasting blood glucose typically ranges from 70-140 mg/dL, while normal random insulin levels generally fall between 2-25 μIU/mL.
• The patient's results should be considered alongside other clinical factors such as symptoms, medical history, and other laboratory values.
• Regular health maintenance is recommended, including annual check-ups with standard screenings appropriate for the patient's age and risk factors.
• If the patient has symptoms suggesting metabolic issues despite these normal values, further testing such as an oral glucose tolerance test or glycated hemoglobin (HbA1c) might be warranted, as suggested by the American Family Physician recommendation statement 1.

Next Steps

• Monitor the patient's blood glucose and insulin levels over time to ensure that they remain within normal ranges.
• Encourage the patient to maintain a healthy lifestyle, including a balanced diet and regular physical activity, to reduce the risk of developing insulin resistance and type 2 diabetes.
• Consider screening for other cardiovascular risk factors, such as hypertension and hyperlipidemia, as recommended by the American Family Physician 1.

From the Research

Patient's Blood Sugar and Insulin Levels

• The patient's non-fasting blood sugar level is 98, which is within the normal range for non-fasting blood glucose levels.
• The patient's non-fasting insulin level is 2.1, which is a relatively low level of insulin.

Treatment Options for Type 2 Diabetes

• According to 2, metformin is the first choice of glucose-lowering medicines for most patients with type 2 diabetes.
• Sulphonylureas have proven benefits in long-term trials, as stated in 2 and 3.
• Insulin is required in patients with symptoms of insulin deficiency, as mentioned in 2.
• Glucagon-like peptide 1 agonists and sodium-glucose co-transporter 2 inhibitors provide some assistance in weight loss as well as improving blood glucose control, as stated in 2 and 4.

Management of Type 2 Diabetes

• Metformin is one of the oldest antidiabetic medications, commonly used in the management of type 2 diabetes, as stated in 4.
• The emergence of newer agents has significantly altered the way diabetes is managed, thus prompting re-evaluation of metformin as the initial therapy for all patients with diabetes, as mentioned in 4.
• Insulin glargine is a long-acting human insulin analog often administered at bedtime to patients with type 2 diabetes, as stated in 5.

Risks Associated with Treatment

• Sulfonylurea and insulin use were more relevant predictors of severe hypoglycemia and death than were glucose levels, as stated in 6.
• Elderly subjects with type 2 diabetes and low HbA1c on sulfonylurea or insulin treatment experienced a substantially higher risk of hospitalization for severe hypoglycemia, as mentioned in 6.