Glucose, 2HR Challenge

Laboratory : Chemistry

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

TESTS REQUESTED
Test Name:	ICD9 Code: (required)
1. Glucose, 2HR Challenge
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

GL2HR MACH3

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

1.5 mL

Storage:

Shipping: Send Refrigerated; Storage: Room Temp: 8 hours; Refrigerated: 72 hours; Frozen: 3 days

Availability:

Mon-Fri, call for appointment

Methodology:

Roche UV test

Special Instructions:

Prior to drawing patient, see Specimen Collection Procedure - Glucose Tolerance Testing. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Mahoning Valley).

Lab/Phone:

330-746-9623

TAT:

1 hour/draw

Additional Info:

Criteria for Diagnosis of Diabetes (2HR Challenge):
Fasting specimen (no caloric intake for at least 8 hours):
<100 mg/dl	Normal
100-125 mg/dl	Increased Risk for Diabetes
>125 mg/dl	Diagnostic for Diabetes
2 Hour Specimen (post glucose administration):
<=139 mg/dl	Normal
140-199 mg/dl	Increased Risk for Diabetes
>200 mg/dl	Diagnostic for Diabetes