Fasting for cholesterol and diabetes test

[ghworker2010]

Last year the wife and I were in Bangkok with kun yai (grandma) and we were out shopping for 3 hours or so. We were in a restaurant and she got up to go to the toilet and collapsed. We want to take her to a hospital and get her some blood tests. If we were to be taking her to one of the big hospitals at 5pm how long should she be fasting for to have the above tests done? I think that we should also get full blood count and protein in the urine done for good measure. Would you agree with this. She is 60 and putting on a lot of weight- fat arms. Should we also do liver and kidneys. We live in the sticks where the hospitals are no good and thus we might as well do a full check up. Do you agree?

 

thanks

[simoh1490]

Fasting for blood test purposes should be done over night, nothing by mouth after 10pm, except water, assuming the blood tests will be done around 8/9 am in the morning. Fasting during the day is not a good idea since it makes people fall over, really.

[NancyL]

Yes, it's a good idea for her to have a comprehensive health screening, with blood screening for liver and kidney function, fasting blood sugar, thyroid function and other tests that Sheryl can recommend.  Also chest xray and EKG would be recommended.  Normally this is done in the morning after someone has stopped all food and drink after 8 pm the night before.  Normally health screenings aren't done in the evening.  

 

[Sheryl]

As mentioned, check-ups aren't done at 5 PM.

 

As she has had a fainting episode it might make more sense to see a doctor about that in the course of which basic ;abs would usually be done. Where exactly in the sticks are you?

 

 

[ghworker2010]

We took old khun yai to a big hospital in bkk and she had some anomalies on the blood results:

WBC was normal but Neutrophil was low at 38.5

 

T4 was normal at 1.12 but TSH was 0.078. Dr put her on 25mg of hormone tablet. 

 

All the liver results were normal except Globulin which was H at 3.8   The dr didn't mention anything about this. 

 

In the Metabolic profile the BUN was high at 21.6. The dr didn't mention anything about this as the range is 7 to 21

 

The chloride (blood) was H at 109

 

Cholesterol was H at 223

Triglycerides was N at 106

HDL-C was L at 43

CHDL/HDL C was H at 5.2

LDL-C was H at 157

LDL-C/HDL-C was H at 3.7

 

The dr did nothing about the cholesterol results and said re test after 3 months. What should we recommend her to do from now on improve the C readings?

 

thanks

Edited May 27, 2017 by ghworker2010

[Sheryl]

First of all, the WBC differential (neutrophils, lymphocytes etc) is of no importance if the overall WBC is normal, so forget about that.

 

The slight BUN elevation, assuming the creatnine was normal, suggests she was dehydrated when the test was done.

 

The cholesterol profile could likely be improved through changes to diet, whether you can get her to do that is another matter. (More fish, vegetables; less fatty meats, less white rice or switch to brown rice, avoid sweets and junk food etc).

 

Most important however is that the tests done are not relevant to her fainting episode  and the reason for that remains unknown. as I said before, it makes more sense to have her evaluated for that than to undergo a general physical exam.  A cardiologist would be the place to start.

 

[NancyL]

Is Khun Yai drinking enough water?  Many elderly people don't, esp if they have mobility problems and it's difficult for them to get up and around to use the toilet.   Esp if they have to ask for help and don't want to bother others. Their solution is to simply cut back on the liquids.  Also, older people often don't feel the heat the way that young people do, some even like to be in a rather warm environment.  All this can cause dehydration and they don't realize it because they don't feel thirsty.  Simple dehydration can cause dizziness.

 

 

[ghworker2010]

On 5/27/2017 at 12:48 PM, Sheryl said:

First of all, the WBC differential (neutrophils, lymphocytes etc) is of no importance if the overall WBC is normal, so forget about that.

 

The slight BUN elevation, assuming the creatnine was normal, suggests she was dehydrated when the test was done.

 

The cholesterol profile could likely be improved through changes to diet, whether you can get her to do that is another matter. (More fish, vegetables; less fatty meats, less white rice or switch to brown rice, avoid sweets and junk food etc).

 

Most important however is that the tests done are not relevant to her fainting episode  and the reason for that remains unknown. as I said before, it makes more sense to have her evaluated for that than to undergo a general physical exam.  A cardiologist would be the place to start.

 

Hi Sheryl,

 

Further to the above results Khun Yai today received a set of blood results. 

 

The anomalies are:

 

Neutrophil 32.9

Eosinophil 25.4  (normal range 0-6)

 

Urine:

Nitrite: positive

Leukocyte: 1+ negative

 

Cholesterol:  240

Triglyceride: 210

 

Creatinine  0.69

 

She forgot to test the thyroid.... despite being diagnosed with abnormal thyroid results. She took the thyroid medication for 3 months and then stopped. 

 

If she wants to see a specialist at a regional hospital tomorrow, what sort of dr should she see? 

 

Does she have to fast for a thyroid test tomorrow morning?

 

thanks for your opinion on the results. When comparing the bumrungrad results above to these new ones it seems that chelesterol is much higher. She's worried about the Eosinophil

[Sheryl]

These seem like only partial results, there must be an overall WBC count and also LDL, HDL on the cholesterol.  It is also important to know the clinical picture, i.e. how is she feeling? What prtopbnlems? Lab results don't exist in a vacuum.

 

without knowing the total WBC count I cannot comment on the neutrophils. The eosinophils are definitely high and suggestive of either parasites or an allergic condition.

 

She also appears to have a urinary tract infection.

 

Her triglyceride level is definitely high, cannot comment on the cholesterol without knowing the LDL/HDL breakdwon. Did she make any changes to her diet? (Doesn't look like it...)

 

She should indeed have a repeat thyroid panel and no, it does not require fasting. I have trouble envisioning what treatment could have been given for the earlier result, the TSH  was suggestive of hyper rather than hypo thyroid (or the effects of taking a thyroid supplement)  but the T4 was normal and apparently no free T3 done which should have been the next step before proceeding to treat.   One cannot diagnose hyperthyroid based on a low TSH with normal T4 alone and her rsults certainly did nto suggest hypothyroid.

 

In terms of whom to see - an endocrinologist can handle the thyroid and lipid issues but she also needs to see  an internist regarding the likely UTI and the eosinophilia.

 

Again, please indicate what if any symptoms she is having as other investigations/specialists might or might not be indicated. Did she ever have a cardiac workup for the fainting spell? Have there been recurrences?

[72BKK]

Hi everybody

I am struggling to find a topic about best clinics/hospitals to have blood tests.

I need diabetes blood test (blood sugar lever and glycated hemoglobin) and would love to save some money so i kindly ask you a tip about a good and affordable place where to have such test

Thank you in advance

Cheers

Andrea

[Sheryl]

Hi everybody
I am struggling to find a topic about best clinics/hospitals to have blood tests.
I need diabetes blood test (blood sugar lever and glycated hemoglobin) and would love to save some money so i kindly ask you a tip about a good and affordable place where to have such test
Thank you in advance
Cheers
Andrea

There is no best clinic or hospital. All hospitals can do this as can stand alone labs. With a few exceptions, clinics are usually best avoided and will in any case just send the specimen to a hospital or lab.

Where in Thailand are you? And do you only need the lab test or do you also need a doctor to review the results?

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[lopburi3]

These are relatively inexpensive tests - cost at Bangkok Hospital is currently 740 each and that would likely be about the most expensive place.  Expect any hospital will require a doctor consultation so if you have time for queues a government hospital might fit.  Have no knowledge on clinics as would not trust many of them - but know there are some good labs.  Perhaps be a help if you advise in what area of Bangkok you wish to use.

[72BKK]

Thank you both Sheryl and lopburi3 for your kind and helpful replies.

I am located in On Nut bangkok.

I had cholesterol, kidney functions, diabetes tests a couple of time in the past years in a clinic in On Nut Road (it's close to the srinakarin intersection). Both times I paid just 900 baht for that package (it was a promotion) and the doctor on duty at that time commented those results with me. I thought it was really a cheap price. 

Then i have been in Vipharam hospital and was told that blood tests were costing 6000 baht as promotion (normal price was 9000 baht).

So the clinic offers partial tests at 900 baht. The hospital full tests at 9000 baht. 

Since my italian doctor recommends me to keep doing such tests on regularly basis (annualy i d say)  i am now wondering: cheap clinic or expensive hospital?

This is why i am asking for tips

[72BKK]

yes i also need a doctor to read the results with me

[Sheryl]

All the hospitals offer check up packages that include blood sugar usually at around 24,000 baht. If you want noth FBS and Hb1AC you would have to add on the second. Most people get one or the othet and mot noth .

76No hospital charges 9,000 bahtfor basic check up. That must have been the price of a higher end package that would also have included a lot of other things that you may not have needed.

I am not entirely clear if what your home doctor advised doing yearly eas just the blood sugar/Hb1ACor a basic set of labs including creatnine, cholesyeroletc. Also not clear why both a fasting sugar and an Hb1AC would be advised, most unusual.

If you need the larger set of labs then a check up package at a hospital eould be best. Sikarin Hospital is close to On Nut and packages start at 2,000 baht. This will include a fasting blood sugar but not also an Hb1Ac (again, very odd to get both). You can add on the Hb1Ac for under 1000 baht.

If all you need is the diabetes screening I suggest you go to MedConsult Asia on Sukhumvit Soi 49, have the bloods drawn and make appointment with Dr. Donna (British GP) for the next day to review redults. . A fasting sugar there is 250 baht, not sure the cost of Hb1Ac but will be more.

The thing you need to be wary of in private clinics in Bangkok is that they sometimes just make up the results without really sending the blood to a lab to test.

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[72BKK]

5 hours ago, Sheryl said:

All the hospitals offer check up packages that include blood sugar usually at around 24,000 baht. If you want noth FBS and Hb1AC you would have to add on the second. Most people get one or the othet and mot noth .

76No hospital charges 9,000 bahtfor basic check up. That must have been the price of a higher end package that would also have included a lot of other things that you may not have needed.

I am not entirely clear if what your home doctor advised doing yearly eas just the blood sugar/Hb1ACor a basic set of labs including creatnine, cholesyeroletc. Also not clear why both a fasting sugar and an Hb1AC would be advised, most unusual.

If you need the larger set of labs then a check up package at a hospital eould be best. Sikarin Hospital is close to On Nut and packages start at 2,000 baht. This will include a fasting blood sugar but not also an Hb1Ac (again, very odd to get both). You can add on the Hb1Ac for under 1000 baht.

If all you need is the diabetes screening I suggest you go to MedConsult Asia on Sukhumvit Soi 49, have the bloods drawn and make appointment with Dr. Donna (British GP) for the next day to review redults. . A fasting sugar there is 250 baht, not sure the cost of Hb1Ac but will be more.

The thing you need to be wary of in private clinics in Bangkok is that they sometimes just make up the results without really sending the blood to a lab to test.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

Thank you very much Sheryl

I don't need a complete check up now and yes i have seen myself that it's very expensive. I just need blood test and specifically that one for diabetes. 

That offer from Vipharam was a special one that was proposed to me once I was there for a totally different matter and it was a 6000 baht package for only blood tests. 

I will follow your advise and give it a try to this lab in soi 49. 

Wow!! Make up the results without really sending the blood to the lab...i can't believe it! Really?? It's crazy!!

 

Thanks again Sheryl

[ghworker2010]

On 11/29/2017 at 7:21 PM, Sheryl said:

These seem like only partial results, there must be an overall WBC count and also LDL, HDL on the cholesterol.  It is also important to know the clinical picture, i.e. how is she feeling? What prtopbnlems? Lab results don't exist in a vacuum.

 

without knowing the total WBC count I cannot comment on the neutrophils. The eosinophils are definitely high and suggestive of either parasites or an allergic condition.

 

She also appears to have a urinary tract infection.

 

Her triglyceride level is definitely high, cannot comment on the cholesterol without knowing the LDL/HDL breakdwon. Did she make any changes to her diet? (Doesn't look like it...)

 

She should indeed have a repeat thyroid panel and no, it does not require fasting. I have trouble envisioning what treatment could have been given for the earlier result, the TSH  was suggestive of hyper rather than hypo thyroid (or the effects of taking a thyroid supplement)  but the T4 was normal and apparently no free T3 done which should have been the next step before proceeding to treat.   One cannot diagnose hyperthyroid based on a low TSH with normal T4 alone and her rsults certainly did nto suggest hypothyroid.

 

In terms of whom to see - an endocrinologist can handle the thyroid and lipid issues but she also needs to see  an internist regarding the likely UTI and the eosinophilia.

 

Again, please indicate what if any symptoms she is having as other investigations/specialists might or might not be indicated. Did she ever have a cardiac workup for the fainting spell? Have there been recurrences?

I took khun yai for another check up and thyroid was normal this time which is good. They did another urine analysis (see attached photo). Once again there was bacteria in the urine and I suggested maybe she has Urinary tract infection. No he said 'its normal'. Before being moved on I said what about the Blood in the urine etc. Ok he said 'she should do a pap smear'. I couldn't wait around for the result for that and her son took her back to the dr to get that result. From what I understand the dr said its all ok and that she should go back in 3 weeks for another test/ checkup. The hospital that we visited was in the sticks and at xmas time we will be in a city that has the 'bangkok hospital' chain. Do you think we should go and see a real dr and do another urine test there? What does Blood +1 mean? RBC 1-2 and WBC 2-3. Epi Sq 0-1. What does all that mean?

 

Do you think we should go to the pharmacist and get a course of antibiotics to treat the urinary tract? The urine result from 1 month ago also indicated Bacteria = 'found'. If so what antibiotics do you think?

 

thanks Sheryl. Sorry to bother you on this day of rest

[Sheryl]

Do not self prescribe antibiotics, may do more harm than good. especially since it is nto certain she has a UTI. ("Few" bacteria can often just indicate a slightly contaminated sample, ditto the very small amount of WBC found).

 

It might be a good idea to get an actual urine culture.

 

Is she symptomatic? Fever? Elevated WBCs?

 

Upcountry private hospitals are usually best avoided, and yes, with exception of ChiangMai that includes those in the chain mentioned. As I think I said before, in Issan KKU Hospital is best.

 

I am somewhat at a loss over all these labs in the absence of any information on the clinical picture. Why are all these labs being done? What are her symptoms?  Lab results cannot be treated in a vacuum.