Why HbA1c?

Haemoglobin is the oxygen-carrying pigment that gives blood its red colour and is also the predominant protein in red blood cells. About 90% of haemoglobin is haemoglobin A (the "A" stands for adult type). Although one chemical component accounts for 92% of haemoglobin A, approximately 8% of haemoglobin A is made up of minor components that are chemically slightly different. These minor components include haemoglobin A1c, A1b, A1a1, and A1a2. Hemoglobin A1c (HbA1c) is a minor component of haemoglobin to which glucose is bound. HbA1c also is sometimes referred to as glycosylated or glycosylated hemoglobin or glycohaemoglobin.

In addition to random fasting blood glucose levels, HbA1c levels are routinely measured in the monitoring of people with diabetes. HbA1c levels depend on the blood glucose concentration. That is, the higher the glucose concentration in blood, the higher the level of HbA1c. Levels of HbA1c are not influenced by daily fluctuations in the blood glucose concentration but reflect the average glucose levels over the prior six to eight weeks. Therefore, HbA1c is a useful indicator of how well the blood glucose level has been controlled in the recent past (over two to three months) and may be used to monitor the effects of diet, exercise, and drug therapy on blood glucose in people with diabetes.

In healthy people the HbA1c level is less than 6% of total hemoglobin. Studies have demonstrated that the complications of diabetes can be delayed or prevented if the HbA1c level can be kept below 7%. It is recommended that treatment of diabetes be directed at keeping an individual’s HbA1c level as close to normal as possible (<6%) without episodes of hypoglycemia (low blood glucose levels).

The following are the results when A1c is being used to diagnose diabetes:

• Normal (no diabetes): Less than 5.6%
• Pre-diabetes: 5.6% to 6.4%
• Diabetes: 6.5% or higher

If you have diabetes, you and your doctor or nurse will discuss the correct range for you. For many people the goal is to keep your level below 7%.

The test result may be incorrect in people with anemia, kidney disease, or certain blood disorders (thalassemia). Talk to your doctor if you have any of these conditions. Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results. Abnormal results mean that you have had a high blood sugar level over a period of weeks to months.

• If your A1c is above 6.5% and you do not already have diabetes, you may be diagnosed with diabetes.
• If your level is above 7% and you have diabetes, it often means that your blood sugar is not well controlled. Your target A1c should be determined by you and your health care provider. 

The higher your A1c, the higher the risk that you will develop problems such as:

• Eye disease
• Heart disease
• Kidney disease
• Nerve damage
• Stroke

If your A1c stays high for a long period, the risk of these problems is even greater. Ask your doctor how often you should have your level tested. Usually, doctors recommend testing every 3 or 6 months.
Other names for this test includes: HbA1C test: Glycated hemoglobin test; Glycosylated hemoglobin test; Hemoglobin glycosylated test; Glycohemoglobin test.

GGT test for your Liver

The Gamma-Glutamyl Transpeptidase (GGT) test measures the amount of the enzyme GGT in your blood. Enzymes are molecules that are necessary for chemical reactions in your body. GGT functions in the body as a transport molecule, helping to move other molecules around the body. It plays a significant role in helping the liver metabolize drugs and other toxins. GGT is concentrated in the liver, but is also present in the gallbladder, spleen, pancreas, and kidneys. GGT blood levels are usually high when the liver is damaged.

This test is often done in conjunction with other tests that measure liver enzymes. The liver is crucial for producing proteins in the body and filtering out poisons. It also makes bile, a substance that helps the body process fats. Your doctor may order the GGT if your liver is suspected to be damaged. Often, this stems from heavy use of alcohol or other toxic substances, like drugs or poisons.

Symptoms of liver problems include:

• decreased appetite
• vomiting or nausea
• lack of energy
• abdominal pain
• jaundice (a yellowing of the skin)
• unusually dark urine or light-coloured feces
• itchy skin

If you have finished an alcohol rehab program and are trying to abstain from alcohol, your doctor might order this test to check compliance with your treatment program. The test can also monitor levels for people who have been treated for alcoholic hepatitis.Your doctor may instruct you to fast for eight hours before the test and to stop taking certain drugs. Phenobarbital, phenytoin, and alcohol can raise your GGT level. Birth control pills and clofibrate may decrease your GGT level. If you drink even a small amount of alcohol within 24 hours of the test, it can affect your results. The GGT test is somewhat equivocal, because while it can diagnose liver damage, it can’t determine the cause. If your GGT is elevated, you’ll probably have to undergo more tests.

Some of the conditions that result in increased GGT include:

• overuse of alcohol
• hepatitis
• lack of blood flow to the liver
• liver tumors
• cirrhosis (scarred liver)
• overuse of drugs or other toxins
• heart failure

GGT is often measured relative to another enzyme, alkaline phosphatase (ALP). If both are elevated, doctors will suspect problems with the liver or the bile ducts. If GGT is normal and ALP is elevated, this could indicate bone disease. Therefore, the GGT test may be used to rule out certain problems when making a diagnosis.

ESR- Erythrocyte Sedimentation Rate

An erythrocyte sedimentation rate (ESR) test does not diagnose one specific condition. Instead, it helps your doctor determine whether you are experiencing inflammation. ESR is a blood test that can reveal inflammatory activity in your body. ESR test isn't a stand-alone diagnostic tool, but it may help your doctor diagnose or monitor the progress of an inflammatory disease. When your blood is placed in a tall, thin tube, red blood cells (erythrocytes) gradually settle to the bottom. Inflammation can cause the cells to clump together. Because these clumps of cells are denser than individual cells, they settle to the bottom more quickly.


The ESR test measures the distance red blood cells fall in a test tube in one hour. The farther the red blood cells have descended, the greater the inflammatory response of your immune system. The doctor will look at ESR results along with other information or test results to help figure out a diagnosis. Which tests are ordered will depend on your symptoms. Your doctor may order an ESR test to help detect inflammation in your body. This can be useful in diagnosing conditions that cause inflammation, such as autoimmune diseases, cancers, and infections. The ESR test is rarely performed alone. Instead, it will be combined with other tests to determine the cause of your symptoms.

Tell your doctor if you are taking any medications. You will be told whether you should temporarily stop taking them before the test. All this test involves is a blood draw. The skin directly over a vein will be cleaned, and a needle will be inserted to collect your blood. After the blood has been collected, the needle will be removed, and the site of the puncture will be covered to stop any bleeding. It should take only a minute or two.

An abnormal ESR result does not diagnose any particular disease. It just identifies any inflammation in your body. This test is not always reliable or meaningful and abnormal test results don’t always mean you have a disease (HHP, 2003). Many factors, such as age or medication use, can alter your results. In addition, abnormal results don’t tell your doctor what is actually wrong. Instead, they indicate a need to look further. Your doctor will usually order follow-up tests if your ESR results are too high or low.
There are multiple causes of high ESR rates. Some common conditions associated with high rates include:

• anemia
• kidney disease
• lymphoma
• multiple myeloma
• old age
• pregnancy
• temporal arteritis
• thyroid disease

Some types of infection that cause ESR rates to become higher than normal are:

• bone infection
• heart infection
• heart valve infection
• rheumatic fever
• skin infection
• systemic infection
• tuberculosis

Low ESR rates may be caused by:

• congestive heart failure
• hypofibrinogenemia (Fibrinolysis syndrome is characterized by an acute hemorrhagic state brought about by inability of the blood to clot, with massive hemorrhages into the skin producing blackish, purplish swellings and sloughing)
• leukocytosis (an increase in the number of white cells in the blood, especially during an infection)
• low plasma protein
• polycythemia (an abnormally increased concentration of haemoglobin in the blood)
• sickle cell anemia

Some causes of abnormal ESR rates are more serious than others, but many are not a huge deal. That’s why it’s important not to worry too much just because your ESR levels are abnormal. Instead, work with your doctor to find out what’s causing your symptoms.

Ebola Virus

Ebola virus cause haemorrhagic fevers — illnesses marked by severe bleeding (haemorrhage), organ failure and, in many cases, death. This virus is native to Africa, where sporadic outbreaks have occurred for decades. Ebola virus lives in animal hosts, and humans can contract the viruses from infected animals. After the initial transmission, the viruses can spread from person to person through contact with body fluids or contaminated needles.

No drug has been approved to treat the virus. People diagnosed with Ebola virus receive supportive care and treatment for complications. Scientists are coming closer to developing vaccines for these deadly diseases. Signs and symptoms typically begin abruptly within five to 10 days of infection with Ebola virus. Early signs and symptoms include:

• Fever
• Severe headache
• Joint and muscle aches
• Chills
• Weakness

And overtime, increased condition may include symptoms like:

• Nausea and vomiting
• Diarrhoea (may be bloody)
• Red eyes
• Raised rash
• Chest pain and cough
• Stomach pain
• Severe weight loss
• Bleeding, usually from the eyes, and bruising (people near death may bleed from other orifices, such as ears, nose and rectum)
• Internal bleeding

Experts suspect that it is transmitted to humans through an infected animal's bodily fluids. Examples include:
1. Blood: Butchering or eating infected animals can spread the viruses. Scientists who have operated on infected animals as part of their research have also contracted the virus.
2. Waste products: Tourists in certain African caves and some underground mine workers have been infected with the Ebola virus, possibly through contact with infected bats.

Infected people typically don't become contagious until they develop symptoms. Family members are often infected as they care for sick relatives or prepare the dead for burial. Medical personnel can be infected if they don't use protective gear, such as surgical masks and gloves. Medical centres in Africa are often so poor that they must reuse needles and syringes. Some of the worst Ebola epidemics have occurred because contaminated injection equipment wasn't sterilized between uses.

Culture & Sensitivity Test

A culture is done to find out what kind of organism (usually bacteria) is causing an illness or infection. A sensitivity test checks to see what kind of medicine, such as an antibiotic, will work best to treat the illness or infection. A culture is done by collecting a sample of body fluid or tissue and then adding it to a substance that helps promote the growth of bacteria or other disease-causing organisms. If there are bacteria (or other organisms) in the sample, they will grow in the culture. Bacteria usually grow quickly in a culture (2 days), while other types of organisms, such as a fungus, can take longer.


Sensitivity analysis, also called susceptibility testing, helps find the right antibiotic to kill an infecting microorganism. This test determines the “sensitivity” of a colony of bacteria to an antibiotic. It also determines the ability of the drug to kill the bacteria. Unfortunately, many bacteria are resistant to common antibiotics. Resistant means that the drug can’t kill the bacteria. Sensitivity analysis is a useful tool to help quickly determine if bacteria are resistant to certain drugs. It may also be used if you have a fungal infection. Sensitivity analysis starts with a bacterial sample. Your doctor will obtain this sample by swabbing the infected area or secretions of the infected area. Your doctor can sample any area that has an infection.
Cultures may be taken from:

• Blood
• Urine
• Sputum (“spit”)
• Inside the cervix
• A wound

Your doctor will send the specimen to a laboratory, where it will be spread on a special growing surface or culture. Bacteria in the culture will grow and multiply. The bacteria will form colonies (large groups of bacteria) that will each be exposed to different antibiotics. The colonies show up as susceptible, resistant, or intermediate.

• Susceptible means they can’t grow if the drug is present. This indicates an effective antibiotic.
• Resistant means they can grow even if the drug is present. This indicates an ineffective antibiotic.
• Intermediate means a higher dose of the antibiotic is needed to prevent growth.

Your doctor can use the results to determine the best antibiotic to treat your infection.Few risks are associated with this test. Blood collection comes with small risks. For example, you may feel slight pain or a mild pinching sensation during the blood draw. You may feel throbbing after the needle is withdrawn. An antibiotic that bacteria, fungus, or another micro-organism shows resistance to shouldn't be used to treat your infection. Your doctor will decide which drug is best if several antibiotics are shown to be effective in killing the micro-organism causing your infection.

Glucose Tolerance Test

The glucose tolerance test, also known as the oral glucose tolerance test, measures your body's response to sugar (glucose). The glucose tolerance test can be used to screen for type 2 diabetes. More commonly, a modified version of the glucose tolerance test is used to diagnose gestational diabetes — a type of diabetes that develops only during pregnancy. The glucose tolerance test identifies abnormalities in the way your body handles glucose after a meal — often before your fasting blood glucose level becomes abnormal. 

A glucose tolerance test measures how well your body is able to break down glucose, or sugar. Those who suffer from diabetes (type 1) have trouble processing glucose because the body is not able to make an adequate supply of insulin. This test is also used to diagnose the presence of gestational diabetes and type-2 diabetes. Type-2 diabetes develops during adulthood, unlike type 1 diabetes, which occurs during childhood. Type 2 diabetes is the most common form of diabetes. In this type, your body either doesn't produce enough insulin, the hormone in the body that metabolize sugar, or the cells in your body are resistant to insulin.

Gestational diabetes is when a pregnant woman who is not a diabetic, has high blood sugar levels as a result of the pregnancy. Generally most healthcare providers recommend that all pregnant women be screened for gestational diabetes. Experts recommend this test to pregnant women who are between 24 and 28 weeks of pregnancy. This test is also recommended for anyone suspected of developing adult diabetes.

If your test shows that your glucose levels are higher than normal, you may be asked to test again on a different day. Higher-than-normal levels of glucose may mean you have pre-diabetes, diabetes, or gestational diabetes

Liver Care

Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood. Many tests can be performed on the liver, but most of them do not measure the overall function of the liver. The most widely used tests to check liver function are the albumin test and the bilirubin test. These tests measure how well the liver creates albumin, a protein, and disposes of bilirubin, a waste product of the blood.

Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Other liver function tests measure enzymes that liver cells release in response to damage or disease. Conditions other than liver disease or damage can lead to abnormal liver function test results. Test results can be normal in people who have liver disease or damage. Albumin is the main protein made by the liver. It performs many important bodily functions. For instance, albumin:

• stops fluid from leaking out of blood vessels
• Nourishes tissues
• Transports hormones, vitamins and other substances throughout the body.

An albumin test measures how well the liver is making this particular protein. A low result on this test indicates that the liver is not functioning properly. Bilirubin, on the other hand, is a waste product ordinarily processed by the liver. This waste product is caused by the breakdown of red blood cells. It passes through the liver before being excreted through your stool. If your liver is damaged, it cannot properly process bilirubin. This will lead to an abnormally high level of bilirubin in the blood. Thus, a high result on the bilirubin test indicates that the liver is not functioning properly.

Liver tests are performed to determine if the liver is working correctly. The liver performs a number of vital bodily functions, such as:

• removing contaminants from the blood
• converting the nutrients from the food you eat
• storing minerals and vitamins
• regulating blood clotting
• producing proteins, enzymes, and bile
• making factors that fight infection
• removing bacteria from the blood
• processing substances that could harm the body
• maintaining hormone balances

Problems with the liver can make a person very sick and can lead to death. Symptoms of a liver disorder include:

• weakness
• fatigue or loss of energy
• weight loss
• jaundice (yellow skin and eyes)
• symptoms of nephritic syndrome (swelling around the eyes, belly, and legs)
• discoloured bodily discharge (dark urine or light stools)
• nausea
• vomiting
• diarrhoea
• abdominal pain

The different liver function tests can check for infection, monitor the progression or treatment of a disease, and test for the side effects of certain medications.