Treatment And Tests For Diabetes
Diagnostic tests for Diabetes Diagnosing diabetes enables the doctors and lab workers to detect and treat diabetes well before complications begin to occur [1]. It also helps to detect and cure prediabetes, which indicates greater risk of developing diabetes in future. Following tests are used nowadays to diagnose or detect diabetes: Oral glucose tolerance test (OGTT) A1C or the hemoglobin A1c or the glycohemoglobin test Fasting blood sugar test Oral Glucose Tolerance Test (OGTT) The OGTT can be used to diagnose diabetes, prediabetes as well as gestational diabetes. OGTT measures blood sugar after 8 hours of fasting and 2 hours after the intake of a liquid containing 75 grams of glucose dissolved in water. If the blood sugar level is 140 to 199 mg/dL, the person has prediabetes or impaired glucose tolerance (IGT). On confirmation by another test if,the glucose level is 200 mg/dL or above means that a person has diabetes. A1C Test The A1C test is used for detection of prediabetes and type 2 diabetes but does not diagnose type 1 or gestational diabetes. It is a blood test that determines the average blood glucose levels of a person over past 3 months but does not detect daily fluctuations. The A1C test can be performed at any time of the day and doesn’t require fasting which makes it convenient for patients. What is HbA1c (A1c)? The A1C test result is obtained in percentage with 5.7% or lesser as normal value. A value of 5.7- 6.4% indicates prediabetes. A1C level above 6.0% is considered as very high risk of developing diabetes. A1C level of 6.5% or above indicates that a person has diabetes. Fasting Plasma Glucose Test (FPG) The Fasting blood glucose test detects both diabetes and prediabetes. It is the most common test used for the diagnosis of diabetes as it is more Continue reading >>
Understanding Your Hba1c
You’ve heard about a diabetes test called a hemoglobin A1C. It’s sometimes shortened to HgbA1c or HbA1c or just A1C. Hopefully, you know what yours is. But do you know what it means and what to do with the information? Hemoglobin is what makes red blood cells red. It consists of several proteins wrapped around an iron-based molecule called heme. Heme attaches to oxygen and carries it to the cells. That’s why iron is important in our diets. We need iron to make heme to carry oxygen, so our cells can breathe. Glucose (sugar) molecules are also floating along in our blood. Glucose attaches itself to all kinds of proteins, including the hemoglobin in red blood cells (RBCs). When glucose levels are high, many more of them will attach. Hemoglobin coated with glucose is called “glycated” or “glycosylated” hemoglobin. Glycation (“sugar-coating”) may not harm an RBC, but it does tell us if the cell has encountered much glucose during its lifetime. The more glucose has been in the blood, the more RBCs will be glycated. This is what an HbA1c test measures. A1C isn’t measuring what your blood glucose level is at the moment. It measures how high glucose has been over the last two months or so. RBCs only live about 100–120 days in the bloodstream. Once they become glycated, they stay glycated for life, so the number of glycated RBCs (HbA1c) gives a good picture of how much glucose has been in the blood recently. The A1C test has several advantages over other tests such as a fasting blood sugar (FBS). You don’t have to fast for an A1C. It can be taken at any time of day. It doesn’t matter what you ate the day before or on the day of the test, because it’s not measuring your current sugar. Normally, between 4.2% and 5.6% of RBCs will be glycated. The America Continue reading >>
Comparative Study Of The Effects Of A 1-year Dietary Intervention Of A Low-carbohydrate Diet Versus A Low-fat Diet On Weight And Glycemic Control In Type 2 Diabetes
OBJECTIVE To compare the effects of a 1-year intervention with a low-carbohydrate and a low-fat diet on weight loss and glycemic control in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS This study is a randomized clinical trial of 105 overweight adults with type 2 diabetes. Primary outcomes were weight and A1C. Secondary outcomes included blood pressure and lipids. Outcome measures were obtained at 3, 6, and 12 months. RESULTS The greatest reduction in weight and A1C occurred within the first 3 months. Weight loss occurred faster in the low-carbohydrate group than in the low-fat group (P = 0.005), but at 1 year a similar 3.4% weight reduction was seen in both dietary groups. There was no significant change in A1C in either group at 1 year. There was no change in blood pressure, but a greater increase in HDL was observed in the low-carbohydrate group (P = 0.002). CONCLUSIONS Among patients with type 2 diabetes, after 1 year a low-carbohydrate diet had effects on weight and A1C similar to those seen with a low-fat diet. There was no significant effect on blood pressure, but the low-carbohydrate diet produced a greater increase in HDL cholesterol. Type 2 diabetes affects >20 million people in the U.S. (1). Optimal weight loss strategies in patients with type 2 diabetes continue to be debated, and the best dietary strategy to achieve both weight loss and glycemic control in type 2 diabetes is unclear. Prior studies, done primarily in patients without diabetes, demonstrated weight loss outcomes with low-carbohydrate diets comparable to that with other diets (2–6). Based on the effectiveness of low-carbohydrate diets for weight loss, recent guidelines from the American Diabetes Association state that for short-term weight loss either a low-carbohydrate or low-f Continue reading >>
- The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
- Early Glycemic Control and Magnitude of HbA1c Reduction Predict Cardiovascular Events and Mortality: Population-Based Cohort Study of 24,752 Metformin Initiators
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
What’s The Right Hba1c Target?
In my most recent post I mentioned the matter of an on-going debate over the proper target for HbA1c values. I went back and listened again to the debate at this year’s EASD conference on the “right” A1c target. (You can find it by starting at the EASD webcast page and searching for “Berger”.) The talks by Drs. Irl B. Hirsch and Andrea Siebenhofer-Kroitzsch are chock full of information, and I’ll summarize them here. I’ve also taken the liberty of including some of their slides. Any mistakes in recapping these presentation are entirely due to my limited knowledge of epidemiology and shouldn’t reflect on the good doctors arguments. Also, there’s a lot of statistics in these presentations; and while I studied mathematics as an undergraduate, I went the abstract math route and am rubbish with statistical jargon. First, Dr. Hirsch advocated for a target of 6.5%. An A1c of 6.5% works out to an average of 144 mg/dL or 7.8 mmol. But 6.5% actually has a fairly large overlap with 7.0% if you use the 95% confidence intervals of each. So, there’s not that much of a difference between 6.5 and 7.0%. 6.5% is protective. There’s a small but significant reduction in the risk of complications with an A1c below 7.0%. And there’s an “exaggerated increased risk of hypoglycemia” below 7.0% for type 1. The DCCT (which suggested that there was increased risk of severe hypoglycemia with better A1c) was reported in 1993. It’s a different time now. JDRF continuous glucose monitor (CGM) studies show that risk is way down at all levels of A1c to the same as very high A1c. Lower A1c values are protective for type 2 as well, but treatment is a “moving target.” No matter what you target, the actual is going to be higher (often by as much as 0.5%). — So why not aim Continue reading >>
The Two-digit A1c Number That Finally Got Her To Lose Weight
Liz Peralta is a medical technician. So when her doctor told her that her A1C had gone over 10, she knew what that meant. “I said, ‘Oh my God, I’m going to die,’” Peralta remembers. “I know the damage diabetes can do.” A1C is a measure of blood sugar over time. For years, Peralta’s A1C had fallen between 5.6 and 6.4, considered prediabetes. But above 10, she was no longer “pre.” She had full-blown type 2 diabetes. And she wasn’t in the yellow “caution” zone (6.5 - 10). She had shot straight up to the red “danger” zone. An A1C above 10 is considered high risk for all the complications that go along with diabetes, including stroke, heart attack, blindness, and amputation. For all the years she had prediabetes, Peralta brushed off her doctor’s warnings about her weight. “I’m like, ‘Yeah, yeah, yeah,’ ” she jokes. “You don’t get scared until the time comes.” For Peralta, that “10” was the wake-up call. And she listened. She started with her diet. “I never knew when to stop,” she says. “My plate had to be full to the top.” She says she was eating more than 5,000 calories per day, more than twice what she needed. She started the day with a couple of donuts before breakfast and finished with a liter of Pepsi before bed. “So that stopped. I put a brake on my life the next day,” she says. Her ally was a nutritionist and a certified diabetes educator named Maria Rodriguez at The Diabetes Alliance at Mount Sinai Hospital. Rodriguez says most patients need more than warnings from doctors, they need knowledge. “There’s no guidance, they don’t know where to start,” she says. “The key… is to make small achievable change goals, behavioral changes that are able to be sustained long term.” “They educated me,� Continue reading >>
What’s In A Number? Measuring Blood Pressure, Diabetes Readings & Cholesterol
by: The My Medicare Matters Team What’s in a number? Only calendar pages, if we’re talking about your age. But if we’re talking about your blood pressure, cholesterol level, or blood glucose reading, then it’s a whole other matter. All of these things are measured at your Medicare Annual Wellness visit, which is covered by Medicare Part B at no cost. The Annual Wellness visit is a one-on-one assessment of your current health status, family/medical history and disease risk factors. It allows your doctor to develop a personalized plan for preventive screenings, so you can avoid diseases and chronic conditions before they develop. So let’s make sure that when your doctor starts throwing these numbers at you, you’re ready to understand their meaning and ask informed questions! Check out our guide below. Ideal blood pressure: What is it and what do I need to know? Ah, yes. That’s the one with two numbers. “Number X over Number Y.” Number X is actually called systolic pressure. Number Y is diastolic pressure. According to the American Heart Association, the top number, (systolic) should be under 120. The bottom number (diastolic) should be under 80. A reading of 120/80 (“one twenty over eighty”) is considered pre-hypertensive, which means you are already in the danger zone of having overly high blood pressure. If the top number reaches 140, you officially have high blood pressure. And anything higher than that is a serious problem–if you get to 180, you’re officially in crisis and need to call 911. However, it’s important to keep in mind that these readings can vary depending on time and circumstance. If you show readings of 140 on a regular basis, speak to your primary care provider about taking your blood pressure at home to monitor the situation Continue reading >>
Deluding Yourself About The A1c
I went to the lab this morning in preparation for my visit to the endo in two weeks. As usual, she wanted an A1c and cholesterol test, though this time she also did a microalbumin and the cheap thyroid check (TSH). That got me thinking about what a worthless test the A1c is and how it sucks that the A1c is the only test a lot of docs pay attention to. The A1c is a very rough, indirect measure of average blood sugar over the recent months. What's actually being measured is how much glucose is stuck to your hemoglobin molecules. If you are anemic and have few of these hemoglobin molecules, your A1c may be deceptively low while high blood sugars are devastating your body. Many general practitioners don't know this. If your hemoglobin cells for some reason live longer or shorter lives than most people, you'll also end up with an A1c value that is misleading. But even if the A1c is an accurate reflection of your blood sugar control, it isn't average blood sugars that cause complications--unless your control is so bad that your very lowest blood sugar level is well into the damage danger zone (over 140 mg/dl or 7.7 mmol/l). If your average is attained by going high for a few hours and then going low, you may easily end up with an A1c in the range that the lab flags as "excellent control", while elevated blood sugars during each of your spikes isflooding into your nerves, capillaries and retinas, setting you up for the classic, and very ugly, diabetic complications. Relying on the A1c might have made sense 20 years ago when people with diabetes didn't own blood sugar meters, but now, when home testing is accurate and easy, it's another of the old fashioned medical practices that keeps people with diabetes getting old fashioned complications. Continue reading >>
Zone Tool Diabetes
All Clear Zone...This is the safety zone if you have: • A1c under 7 percent • Fasting blood sugar 90–130 • Blood sugar less than 180 (one to two hours after eating) • Blood pressure less than 130/80 • LDL cholesterol target less than 100mg/dL if no cardiovascular disease • LDL less than 70mg/dL for those with a history of cardiovascular disease (e.g., ischemia, angina, stroke, heart attack) Green Zone Means: • Your blood sugars are under control. • Continue taking your medications as ordered. • Continue routine blood glucose monitoring. • Follow healthy eating habits. • Keep all physician appointments. Warning Zone ... This is the watch zone if you have: • A1c between 7 and 8 percent • Blood sugar of less than 60 or 70, or if you are having signs/symptoms of low blood sugar • Average blood sugar is 150–210 • Most fasting blood sugars under 200 • Blood pressure greater than 140/90 Work closely with your health care team if you are going into the YELLOW zone. Yellow Zone Means: • Your blood sugar may indicate that you need an adjustment of your medications. • Improve your eating habits. • Increase your activity level. Call your doctor, nurse or diabetes educator if changes in your activity level or eating habits don’t decrease your fasting blood sugar levels. Medical Alert Zone… This is the danger zone if you have: • A1c greater than 9 percent • Blood sugar less than 50 • Average blood sugars are over 210 • Most fasting blood sugars are well over 200 Call your physician if you are in the RED ZONE. Red Zone Means: • You need to be evaluated by a doctor. • If you have a blood glucose over____________ Continue reading >>
- Pre-diabetes goes into remission on higher protein, lower carbohydrate diet (Zone diet balance)
- It’s horrible, deadly — and insanely easy to fix. But America’s troubles with food insecurity means millions are closer to the scurvy zone than we admit.
- An unlikely tool to combat diabetes: chocolate, say researchers
Monitoring At Home
Disclaimer - This content has been created for information purposes only, please consult your doctor before taking any decision on diabetes management. Although great care has been taken in compiling and checking the information, Johnson and Johnson Ltd., and its associates shall not be responsible, or in any way liable for any errors, omissions or inaccuracies in this publication whether arising from negligence or otherwise however, or for any consequence arising there from. What is good control? Ask your doctor to write down your glycemic goals. The American Diabetes Association suggests the following targets for most nonpregnant adults with diabetes. More or less stringent glycemic goals may be appropriate for each individual. Always test according to the glycemic goals recommended by your doctor. A1C: 7% A1C may also be reported as eAG: 154 mg/dl Before a meal (pre-prandial plasma glucose): 70–130 mg/dl 1-2 hours after beginning of the meal (Postprandial plasma glucose): Less than 180 mg/dl Achieving long-term control During your regular visits with your doctor, he may have you get an HbA1C test. The HbA1C test measures the proportion of red blood cells that have sugar attached to them. The American Association of Clinical Endocrinologists recommends targeting an A1C goal of ≤6.5% for patients in general. When your blood glucose is too high, the sugar attaches itself irreversibly to your red blood cells. Because red blood cells live for 2 to 3 months, this test shows the average blood glucose levels over the lifetime of the red blood cells. *When blood glucose levels are too high or too low, you are in the Diabetes Danger Zone. Your doctor will identify the glucose levels that define your Diabetes Safe Zone to help you stay healthy. Continue reading >>
Understanding Diabetes
This information describes diabetes, the complications related to the disease, and how you can prevent these complications. Blood Sugar Control Diabetes is a disease where the blood sugar runs too high, usually due to not enough insulin. It can cause terrible long-term complications if it is not treated properly. The most common serious complications are blindness ("retinopathy"), kidney failure requiring dependence on a dialysis machine to stay alive ("nephropathy"), and foot and leg amputations. The good news is that these complications can almost always be prevented if you keep your blood sugar near the normal range. The best way to keep blood sugar low is to eat a healthy diet and do regular exercise. Just 20 minutes of walking 4 or 5 times a week can do wonders for lowering blood sugar. Eating a healthy diet is also very important. Do your best to limit the number of calories you eat each day. Put smaller portions of food on your plate and eat more slowly so that your body has a chance to let you know when it's had enough to eat. It is also very important to limit saturated fats in your diet. Read food labels carefully to see which foods are high in saturated fats. Particular foods to cut down on are: whole milk and 2% milk, cheese, ice cream, fast foods, butter, bacon, sausage, beef, chicken with the skin on (skinless chicken is fine), doughnuts, cookies, chocolate, and nuts. Often, diet and exercise alone are not enough to control blood sugar. In this case, medicine is needed to bring the blood sugar down further. Often pills are enough, but sometimes insulin injections are needed. If medicines to lower blood sugar are started, it is still very important to keep doing regular exercise and eating a healthy diet. Keeping Track of Blood Sugar Checking blood sugar wi Continue reading >>
How Low Can You Go?
Being that I talk to endocrinologists all day for work, I’ve certainly discussed my own care and issues with them. And a few of them I’m close enough with to share my latest A1c of 6.0%. I’ve been getting the expected high fives and “good work” comments, but I’m also getting a reaction that I didn’t expect: concern. Many of the endos I’ve spoken to have first congratulated me on the low number, and then given me that knowing look down the bridge of their nose and said “Now don’t go too low, you hear me?” Too low? I didn’t know there was such a thing for a person with diabetes. All our lives we’re told to keep the A1c as close to normal as possible, and that some guidlines indicate keeping an A1c below 6.5% is the best bet for staving off complications. And if 6.0% is close to a functioning pancreas percentage, then what’s the problem? My endo buds explained: low A1cs mean aggressive diabetes management. And being aggressive with insulin therapy means you’re bound for low blood sugars more often than your average diabetic bear. Turns out a low A1c is not only a great predicter of avoiding complications, but also means the patient is often dealing with frequent and possibly dangerous lows. Hypoglycemia is more dangerous in the short run than running high, because it happens quickly and must be treated quickly. Insulin is one of the most powerful – and dangerous- drugs in the world, and anyone who has diabetes knows that sometimes even the smallest errors or miscalculations can mean big consequences. I don’t personally feel that I suffered more frequent or scarier lows while getting to an A1c of 6%, but have any of you dealt with this issue? Did you keep going or decide to go up a few points to feel safer? And have any of you ever had this Continue reading >>
Hemoglobin A1c Test (hba1c, A1c, Hb1c)
Hemoglobin A1c definition and facts Hemoglobin A1c is a protein on the surface of red blood cells that sugar molecules stick to, usually for the life of the red blood cell (about three months). The higher the level of glucose in the blood, the higher the level of hemoglobin A1c is detectable on red blood cells. Hemoglobin A1c levels correlate with average levels of glucose in the blood over an approximately three-month time period. Normal ranges for hemoglobin A1c in people without diabetes is about 4% to 5.9%. People with diabetes with poor glucose control have hemoglobin A1c levels above 7%. Hemoglobin A1c levels are routinely used to determine blood sugar control over time in people with diabetes. Decreasing hemoglobin A1c levels by 1% may decrease the risk of microvascular complications (for example, diabetic eye, nerve, or kidney disease) by 10%. Hemoglobin A1c levels should be checked, according to the American Diabetic Association, every six months in individuals with stable blood sugar control, and every three months if the person is trying to establish stable blood sugar control. Hemoglobin A1c has many other names such as glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin, and HbA1c. To explain what hemoglobin A1c is, think in simple terms. Sugar sticks to things, and when it has been stuck to something for a long time it's harder to the get sugar (glucose) off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die. When sugar (glucose) sticks to these red blood cells by binding to hemoglobin A1c, it gives us an idea of how much glucose has been around in the blood for the preceding three months. Hemoglobin A1c is a minor component of hemoglobin to which gl Continue reading >>
In Search Of: The Highest Diabetes A1c In History
My most recent A1C was nothing to be proud of, but I consoled myself with the thought that it was hardly the worst in history. That got me wondering: What was the all-time worst A1C? Who holds this dubious record, and how high is it possible to go? I decided to pound the pavement and try to find out. So where to start when looking for a diabetes record? Well, with the Guinness Book of World Records, of course. But oddly, the Guinness people don’t seem to have any listings related to A1Cs. They do, however, report that Michael Patrick Buonocore survived a blood sugar of 2,656 mg/dL upon admittance to the ER in East Stroudsburg, PA, on March 23, 2008. Michael was a T1 kiddo at the time, and that record-high sugar level was part of his diagnosis experience. So does Michael also hold the record for top A1C? No. Because while he’s living (thankfully) proof that stratospheric blood sugar levels are possible, a sky-scraping A1C requires both altitude and time. Remember that A1Cs provide a three-month average of our blood sugars. Individual high BG readings, even crazy-high ones, don’t alter the test as much as you’d think if they last only a short time. Because type 1 in kids Michael's age hit so quickly, I figured his A1C would have been rather middle of the road. It takes a slow burn to make an A1C boil. But just to be sure, I reached out to his parents, who tell me his A1C was 11.9 at diagnosis. Higher than I expected, but not too high given the four-digit BG reading. (If his 2,656 had been his average blood sugar for three months, his A1C would have been roughly 95! Yes, that’s 95.0, not 9.5). The highest A1C turns out to be a tricky piece of data to ferret out. If you try Google, you find a gazillion people talking about their own personal highest A1Cs, and comp Continue reading >>
Diabetes Blood Sugar Level And Charts
How to understand you have diabetes from the blood sugar level readings? What are the tests to perform for monitoring blood glucose? How are sugar levels related to risk for heart disease? Diabetes blood sugar level is obtained when you perform a blood sugar test, and it is of most value especially when diabetes symptoms are noticed. The most important thing is to learn how to correctly measure your blood glucose levels and carefully interpret the results by your own. If you find any difficulty, go and pay a visit to your doctor. How to recognize if you have diabetes? No Charge Glucose Meter - OneTouch Verio Flex® Meter Ad Compact Design to Track Your Glucose On-the-Go. Get It At No Charge. OneTouch Learn more If the results you get are > 200 mg/dl, you are in a dangerous zone. Diabetes complications, heart stroke or even death are one step from you. Be careful! I am just emphasizing the importance of your current health situation. At the same time, you can take total control of blood sugar through simple and natural steps. They include lifestyle and dietary strategies changes that can give you a hand in lowering high sugar in blood and beating diabetes naturally. There is another natural alternative which can help you stabilize your high glucose levels. Click here to see how. Another important fact is to have a good understanding of what a normal sugar level is, what the range for your case as a diabetic is, and how far you can achieve it. Diabetes blood sugar level - Understanding the tests The tests you need to perform are pretty easy. You may also try them at home through a practical home-testing kit and have the results whenever and wherever you want. However, you must also learn how to read the results by yourself correctly. Keep in mind that your testing results Continue reading >>
Understanding Glucose And A1c Numbers
Almost All Annual Physicals Measure Fasting Glucose. A1c Should Always Be Included But Is Not. More Things Should Be Measured, But Here Are The Health Implications of These Two. Glucose is the most common “simple” sugar. Fructose is the second most common one. Together they account for the bulk of sugar you consume. All the starch you eat is converted directly to glucose, and gets quickly into your bloodstream. Carbohydrates from vegetables do as well, but more slowly. Table sugar and fruit are about half glucose and half fructose. If these two are combined it is called sucrose. It will be split into the two before it gets very far into your digestive tract. Fructose is stored by the liver and converted to glucose. So for all practical purposes all starch, all sugars, end up as glucose. Glucose is energy. It is one of the four types of energy the body’s cells can run on, the other three being fat, protein, and ketones. Protein can be used for structural uses and won’t be burned for energy if other sources are available. Fat is the preferred fuel for most cells, but not the brain. The brain cannot run on most types of circulating fat. The brain has an extra layer of protection against various toxins and creatures like bacteria and viruses. It accomplishes this protection by invoking a fine mesh called the Blood Brain Barrier. Glucose can make it through, but most fats cannot . (Small fats like butter fat – butyric acid – can. Cream in your coffee? Yum!) Because of this, the body tries to maintain a circulating level of glucose equal to around 80 mg/ml. (Outside America 4.4 mmol/l). If there is more glucose, then the body will get rid of it by first storing it in the liver, then forcing the muscle to use it, then storing it as fat. If the glucose is low, the l Continue reading >>
