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Biochemistry

Insulin

Insulin

Reference Range

No associated reference range. Should be interpreted alongside with glucose and c-peptide.

Non- diabetic hypoglycaemia
Evaluation of hypoglycaemia should only be undertaken for patients in whom Whipple’s triad has been documented. Firstly, review the history and physical findings to exclude more common hypoglycaemic aetiologies such as; drugs (insulin, insulin secretagogues, alcohol ingestion), critical illness (sepsis, organ failure), cortisol deficiency and non-islet cell tumours.
Once these have been excluded, in the seemingly well individual, the differentials lie between accidental/ surreptitious hypoglycaemia and endogenous hyperinsulinaemia. Further evaluation is warranted and should involve the following concomitant tests in the event of an ongoing episode of hypoglycaemia; plasma glucose (for confirmation of hypoglycaemia), insulin, C-peptide, beta-hydroxybutyrate as well as the measurement of circulating oral hypoglycaemic agents (if there is a degree of suspicion). When spontaneous hypoglycaemia cannot be observed, a prolonged fast or mixed meal test may recreate the environment in which hypoglycaemia is likely to occur.

Table 1: Taken from the Endocrine Society Guideline in 2009

Sxs/Signs

Glucose (mmol/L)

Insulin (pmol/L) C-peptide (pmol/L) BHB (mmol/L) Circulating OHA Ab to insulin Interpretation
No <3.1 <21 <200 >2.7 No No Normal
Yes <3.1 >>21 <200 ≤2.7 No Neg (Pos) Exogenous insulin
Yes <3.1 ≥21 ≥200 ≤2.7 No Neg Insulinoma, NIPHS, PGBH
Yes <3.1 ≥21 ≥200 ≤2.7 Yes Neg Oral hypoglycaemic agent
Yes <3.1 >>21 >>200 ≤2.7 No Pos Insulin autoimmune
Yes <3.1 <21 <200 ≤2.7 No Neg IGF mediated
Yes <3.1 <21 <200 >2.7 No Neg Not insulin (or IGF) mediated

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Turnaround Time: 7 days
Cholesterol

Cholesterol

Reference Range

The optimal cholesterol concentration for men and women is <4.0 mmol/L (Joint British Societies Guidelines). The National Service Frameworks for coronary disease recommend a reduction to <5.0 mmol/L for those who are treated for secondary prevention or primary prevention where their risk for cardiovascular disease is >20% over a 10 year period. It is often recommended that diagnosis and treatment should not be based on individual measurements because of the relatively high biological variation. Age, sex, pregnancy etc may affect results and appropriate ranges are reported.

  • Turnaround Time: 1 day
Iron (Serum)

Iron (Serum)

Reference Range

Male:    11.6 - 31.3 µmol/L

Female:  9.0 - 30.4 µmol/L


The concentration of iron in serum and plasma is dependent upon diet and is subject to circadian variations. Total iron may be slightly lower in the female population.

  • Turnaround Time: 1 day
HbA1c (Glycated haemoglobin)

HbA1c (Glycated haemoglobin)

Reference Range

20-42 mmol/mol

  • Turnaround Time: 24 hours
Chylomicrons

Chylomicrons

Reference Range

 Following visual inspection, results are reported as chylomicrons being present/not present.

  • Turnaround Time: 48 hours
Testosterone

Testosterone

Reference Range

Adults (Alinity immunoassay):

Female: <1.9 nmol/L

Male aged 18-49 years: 8.3 - 30.2 nmol/L

Male aged >50 years: 7.7 - 24.8 nmol/L

 

Adults (mass spectrometry):

Female: <1.9 nmol/L

Male: 7.0-27.0 nmol/L

  

Paediatrics:

Group

Testosterone (nmol/L)

Neonates

Not reported (can be elevated during year 1)

Female Tanner 1

<0.6

Male Tanner 1

<0.7

 

Reference for mass spectrometry reference ranges: 

  • Kushnir et al (2010). Liquid Chromatography–Tandem Mass Spectrometry Assay for Androstenedione, Dehydroepiandrosterone, and Testosterone with Pediatric and Adult Reference Intervals. Clinical Chemistry 2010:56;1138–77.
  • Turnaround Time: 24 hours (immunoassay), 5 working days (mass spec)
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