Diabetes Screening in Pokhara: Blood Sugar Tests Explained

Nepal’s urban diabetes rate is estimated at 10–15% of adults, with a large proportion undiagnosed. In Pokhara, routine screening at A&B International Hospital identifies prediabetes and diabetes before complications develop. This article explains who should be screened, which test to use, how to interpret the numbers, and what comes next after a positive result.

Who Should Be Screened for Diabetes in Nepal?

Anyone over 40 should be screened for diabetes, but earlier testing is recommended if risk factors are present. Screening should begin at age 30 if any of the following apply: overweight or obese (BMI above 23 kg/m² in South Asian populations), family history of diabetes in a first-degree relative, history of gestational diabetes, polycystic ovary syndrome (PCOS), previously identified prediabetes, physical inactivity, or known hypertension or dyslipidaemia.

South Asians — including Nepalis — develop diabetes at lower BMI thresholds than Western populations. The cut-off for overweight in Nepal is BMI 23 kg/m², not the standard 25 kg/m² used in Western guidelines.

What Are the Different Blood Sugar Tests, and Which One Should You Use?

Three tests are used to diagnose diabetes and prediabetes. Each has different strengths:

Fasting Blood Glucose (FBG)

What it is: Blood drawn after an 8–12 hour fast, typically first thing in the morning.

Preparation: No food, no sweetened drinks after midnight. Water and essential medications are acceptable.

Results:

• Normal: below 100 mg/dL (5.6 mmol/L)
• Prediabetes: 100–125 mg/dL (5.6–6.9 mmol/L) — called impaired fasting glucose
• Diabetes: 126 mg/dL (7.0 mmol/L) or above on two separate occasions

FBG is the standard first-line screening test at A&B. It is simple, reproducible, and inexpensive.

Oral Glucose Tolerance Test (OGTT)

What it is: Fasting glucose is measured, then the patient drinks 75 g of glucose dissolved in water, and a second blood sample is taken exactly two hours later.

Best for: Diagnosing gestational diabetes (using different thresholds), identifying postprandial glucose intolerance in patients with normal fasting glucose, confirming borderline fasting results.

Results (2-hour post-glucose):

• Normal: below 140 mg/dL (7.8 mmol/L)
• Prediabetes: 140–199 mg/dL (7.8–11.0 mmol/L) — called impaired glucose tolerance
• Diabetes: 200 mg/dL (11.1 mmol/L) or above

OGTT is more sensitive than FBG alone — it detects cases where fasting glucose is normal but the body cannot handle a glucose load efficiently. It is the required test for gestational diabetes screening at 24–28 weeks of pregnancy.

HbA1c (Glycated Haemoglobin)

What it is: A blood test reflecting average blood glucose over the past 2–3 months. No fasting required.

Results:

• Normal: below 5.7%
• Prediabetes: 5.7–6.4%
• Diabetes: 6.5% or above on two occasions

Advantages: No fasting needed; reflects long-term control rather than a single point in time; the preferred test for monitoring treatment response.

Limitations: Not valid in haemolytic anaemia or iron deficiency (which affect red cell lifespan and falsely alter the result). Can be mildly elevated at altitude due to longer red cell survival — interpret cautiously in residents of high-altitude zones.

What Are the Diagnostic Criteria for Diabetes?

The American Diabetes Association and International Diabetes Federation criteria — adopted in Nepal — require:

• FBG 126 mg/dL or above on two separate fasting occasions, or
• 2-hour OGTT 200 mg/dL or above, or
• HbA1c 6.5% or above on two occasions, or
• Random glucose 200 mg/dL or above with classic symptoms (polyuria, polydipsia, unexplained weight loss)

A single abnormal result in an asymptomatic person requires a second confirmatory test on a different day (except random glucose with symptoms, which is diagnostic alone).

What Does a Prediabetes Diagnosis Mean?

Prediabetes is not diabetes — but it is a serious warning. Without intervention, approximately 30–50% of people with prediabetes progress to type 2 diabetes within five years. With lifestyle modification, this progression can be substantially reduced or prevented.

The Diabetes Prevention Program trial demonstrated that structured lifestyle changes — achieving 7% weight loss and 150 minutes per week of moderate-intensity physical activity — reduced progression from prediabetes to diabetes by 58% over three years. This is significantly more effective than metformin alone (31% reduction) in terms of prevention.

At A&B, patients diagnosed with prediabetes receive dietary counselling specific to the Nepali diet (addressing white rice portions, refined flour, and saturated fat from ghee), a physical activity plan, and a follow-up schedule for repeat testing every 6–12 months.

What Happens After a Diabetes Diagnosis at A&B?

A new diabetes diagnosis at A&B initiates a structured management pathway:

1. Confirmation and baseline assessment: Second confirmatory blood test if not already done. Baseline HbA1c, renal function, lipid profile, urine albumin-creatinine ratio, ECG, and fundus examination referral.
2. Education: Understanding what blood glucose means, how to use a glucometer at home, dietary changes, exercise prescription.
3. Treatment initiation: Lifestyle modification is first-line for all patients with type 2 diabetes. Metformin is added if HbA1c is 7.5% or above or if lifestyle changes alone fail over three months. Patients with very high HbA1c (above 10%) or symptoms of hyperglycaemia may require earlier medication.
4. Monitoring schedule: HbA1c every 3 months until stable, then every 6 months. Annual kidney function, eye examination, foot examination.

How Often Should You Repeat Diabetes Testing?

Is Diabetes Testing Covered Under ECHS at A&B?

Fasting blood glucose and HbA1c are listed investigations under the ECHS schedule. ECHS cardholders receive cashless diabetes testing at A&B. Annual diabetes monitoring tests including renal function and lipid profile are also covered.

Book Your Diabetes Screening at A&B International Hospital

A&B International Hospital

Pokhara-02, Bindhyaabasini Way to Sarangkot

Phone: +977 061-412512

Fasting blood glucose, OGTT, and HbA1c available with same-day results. Walk-in blood tests accepted during OPD hours. ECHS cashless diagnostics for entitled beneficiaries.