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Diabetes Mellitus And Sickle Cell Disease

Glucose-hba1c Link Differs In Blacks By Sickle-cell Status

Glucose-hba1c Link Differs In Blacks By Sickle-cell Status

Glucose-HbA1c Link Differs in Blacks by Sickle-Cell Status The relationship between glucose levels and HbA1c in African Americans differs from that of whites, as has been noted previously. Now research suggests blacks with the sickle-cell trait (SCT) have lower HbA1c than African Americans in general, perhaps more akin to that of whites. In a new retrospective analysis of data from two prior cohort studies, published in the February 7, 2017 issue of the Journal of the American Medical Association, epidemiologist Mary E Lacy, MPH, of Brown University, Providence, Rhode Island, and colleagues indicate that the 8% to 10% of African Americans who carry the SCT have lower levels of HbA1c at any given concentration of fasting or 2-hour glucose than do those without the trait. The phenomenon is thought to be due to the fact that red blood cells of people with the SCT contain a lower proportion of hemoglobin A and higher levels of hemoglobin S, resulting in overall shorter red blood cell life-spans and less available time for glycation, thereby throwing off the established glucose-glycated hemoglobin relationship. "As a screening tool, an HbA1c value that systematically underestimates long-term glucose levels may result in a missed opportunity for intervention," the authors write, pointing out that in the current study, using standard HbA1c cutoffs resulted in identifying 40% fewer people with prediabetes and 48% fewer with diabetes among those with the SCT, compared with those without it. At the same time, glucose-based methods resulted in similar prevalences of diabetes and prediabetes regardless of SCT status. "Because black people typically have a higher prevalence of diabetes and experience a number of diabetic complications at higher rates than white people, the cost of Continue reading >>

Fructosamine

Fructosamine

Fructosamines are compounds that result from glycation reactions between a sugar (such as fructose or glucose) and a primary amine, followed by isomerization via the Amadori rearrangement. Biologically, fructosamines are recognized by fructosamine-3-kinase, which may trigger the degradation of advanced glycation end-products (though the true clinical significance of this pathway is unclear). Fructosamine can also refer to the specific compound 1-amino-1-deoxy-D-fructose (isoglucosamine), first synthesized by Nobel laureate Hermann Emil Fischer in 1886. Most commonly, fructosamine refers to a laboratory test for diabetes management that is rarely used in clinical practice (simple blood glucose monitoring or hemoglobin A1c testing are preferred). Many direct-to-consumer lab testing companies sell fructosamine tests, but these are unnecessary and of limited clinical value. Use in medicine[edit] In diabetes, maintaining a normal blood glucose is essential to preventing many medical complications, including heart attacks, diabetic nephropathy, diabetic neuropathy and also diabetic retinopathy eventually leading to blindness. Most commonly, blood sugars are measured by either blood glucose monitoring which measures the current blood glucose level, or by Glycated hemoglobin (HbA1c) which measures average glucose levels over approximately 3 months. In a similar way to hemoglobin A1c testing (which measures the glycation of hemoglobin), fructosamine testing determines the fraction of total serum proteins that have undergone glycation (the glycated serum proteins). Since albumin is the most abundant protein in blood, fructosamine levels typically reflect albumin glycation. (Some fructosamine tests specifically quantify the glycation of albumin, or glycated serum albumin instead o Continue reading >>

Sickle Cell Trait & Other Hemoglobinopathies & Diabetes (for Providers)

Sickle Cell Trait & Other Hemoglobinopathies & Diabetes (for Providers)

The hemoglobin A1C (A1C) test can be unreliable for diagnosing or monitoring diabetes and prediabetes in people with inherited hemoglobin variants, also called hemoglobinopathies. Hemoglobins S and E are prevalent variants in people of African, Mediterranean, or Southeast Asian descent. These variants interfere with some A1C tests—both laboratory and point-of-care tests. If A1C tests are at odds with blood glucose testing results, interference should be considered. Reliable A1C tests that do not cause interference with hemoglobin variants are available. More information about appropriate assay methods to use for hemoglobin variants is available from the NGSP at www.ngsp.org . Also, alternative tests may be needed for people with any disorder that affects red blood cells or hemoglobin. When to Suspect that a Patient with Diabetes Has a Hemoglobinopathy Most people who are heterozygous—having one variant gene and one standard hemoglobin gene—for a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin. Health care providers should suspect the presence of a hemoglobinopathy when an A1C result is different than expected an A1C result is above 15 percent results of self-monitoring of blood glucose have a low correlation with A1C results a patient’s A1C result is radically different from a previous A1C result following a change in laboratory A1C methods Statistically Speaking Hemoglobins S and C African Americans have an increased risk of inheriting sickle cell trait, the condition in which people have both hemoglobin A (HbA), the usual form of hemoglobin, and hemoglobin S (HbS), a variant. African Americans are also at risk for having hemoglobin C (HbC), another variant. About one in 12 African Americans has sickle cell trait. Ab Continue reading >>

Diagnosis

Diagnosis

While symptoms may be indicative of disease, definitive diagnosis requires one or more of the following blood tests: Plasma glucose levels: The American Diabetes Association reports that the fasting plasma glucose (FPG) for normal individuals should be <100 mg/dL. Here fasting is defined as no caloric intake for at least 8 hours (usually implying overnight fasting). Approximately 2 hours after a meal plasma glucose levels should be less than 140 mg/dL. The diagnosis of diabetes requires fasting glucose levels greater than 126 mg/dl on two occasions. Test Administration Risks Blood is drawn from the vein following overnight fasting (for fasting blood glucose levels) or at any random moment during the day (to measure random glucose levels). There may be some bruising, infection, and soreness at the site of puncture for drawing blood. The subject may also feel some dizziness. Oral Glucose Tolerance Test (OGTT) is an elaboration of the blood glucose test that reveals how the body metabolizes glucose ~2 hours after ingesting glucose. For pregnant mothers with high risk of diabetes, a glucose-screening test (OGTT) is usually performed between 24-28 weeks of pregnancy (or earlier) to identify gestational diabetes and manage the blood glucose levels for the health of mother and baby. Test Administration Risks After blood is drawn, the subject is asked to drink a liquid, which contains 50, 75, or 100 grams of glucose. Normally the absorption of glucose in the body occurs rapidly, and blood glucose levels rise within 30 to 60 minutes of fluid intake. Blood work is done an hour after drinking the solution. If the blood test shows abnormal blood glucose levels, then blood work must be repeated after three hours. The blood test may cause side effects such as moderate pain, nausea, a Continue reading >>

Sickle Cell Trait Could Alter Diabetes Test Results

Sickle Cell Trait Could Alter Diabetes Test Results

Sickle cell trait could alter diabetes test results Sickle cell trait could alter diabetes test results Media Contact: Karen Bascom at 601-815-3940 or [email protected] . Published in News Stories on February 09, 2017 Researchers from Brown University and the Jackson Heart Study say that physicians should be aware of new findings about a blood test used to monitor diabetes. The results could mean missed chances to treat diabetes in African-Americans with a common genetic trait. University of Mississippi Medical Center scientists co-authored the study , published Feb. 7 in the Journal of the American Medical Association. The results show that in people with the same fasting glucose level, sickle cell trait is associated with a lower than expected hemoglobin A1C, or HbA1c. Diabetes is an important and prevalent risk factor in the Jackson Heart Study, said Dr. Adolfo Correa, UMMC professor of medicine, JHS director and co-author of the paper. If not controlled, diabetes over time will result in damage to the heart, kidneys and eyes, as well as cause unhealthy levels of cholesterol and blood lipids, high blood pressure and reduced cardiovascular health, he said. The JHS is a collaboration between UMMC, Jackson State University and Tougaloo College. It is the largest study of African-American cardiovascular health, following 5,300 community members since 2000. This recent paper studied 4,620 people from the JHS and the Coronary Artery Risk Development in Young Adults study, or CARDIA, with similar fasting and two-hour blood glucose levels. We found that, despite similar results on other measures of blood sugar control, people with sickle cell trait had lower A1c results than people without sickle cell trait, said Beth Lacy, a Ph.D. candidate in epidemiology at Brown and first Continue reading >>

Hemoglobinopathies May Distort Hba1c – A Caution To Practitioners

Hemoglobinopathies May Distort Hba1c – A Caution To Practitioners

Measuring glycated hemoglobin (HbA1c) gives us a patient’s long term average blood glucose levels.1 Since HbA1c measures the percentage of patients’ glycosolated hemoglobin, patients who possess variants of hemoglobin can exhibit false readings. Such variants, called hemoglobinopathies, can include inherited hemoglobin variants, elevated fetal hemoglobin, and hemoglobin S and E which are prevalent in people of Southeast Asia, Mediterranean, and African descent. 2 One variant of particular concern is the sickle cell trait. People with this trait have inherited biological differences affecting the formation of their hemoglobin and erythrocytes, which in turn affects their levels of glycated hemoglobin. 5 People who have the sickle cell trait have both normal hemoglobin A and hemoglobin S. In the U.S., African Americans are at a higher risk of having the sickle cell trait, and approximately 18.7 percent of African Americans who are 20 years and older have diabetes. 2 In people who have both the sickle cell trait and diabetes, about 1 million people in the U.S., using HbA1c to measure blood glucose levels can be prone to anomalies. People with these hemoglobin variants can have falsely low or high levels which can lead to improper treatment including: HbA1c readings that are different than expected; HbA1c levels that are extremely different from previous HbA1c readings; or low correlations between HbA1c and self-monitored glucose levels. 2 Normally, for every 25-32mg/dL increase in blood glucose levels, there is a 1% increase in HbA1c in patients without any hematologic variants. 3 But with patients who do have any hematologic disorders, this corresponding increase in HbA1c does not occur. In a published article regarding sickle cell and diabetes, an African American wo Continue reading >>

Chapter 19 - Endocrine And Hematologic Emergencies

Chapter 19 - Endocrine And Hematologic Emergencies

In ________, there are fewer insulin receptors, so insulin resistance develops. Diabetes mellitus type 1 is an autoimmune disorder in which the individual's immune system produces antibodies to the pancreatic beta cells, and therefore the pancreas cannot produce insulin. (T/F) A patient who is hyperglycemic may have Kussmaul respirations and sweet, fruity breath. (T/F) A patient with dry and warm skin indicates hypoglycemia. A patient with dry and warm skin indicates hyperglycemia. (T/F) A patient in symptomatic hypoglycemia is more critical and more likely to suffer from permanent problems than the condition of a patient with hyperglycemia or diabetic ketoacidosis. (T/F) The only contraindications to oral glucose are an inability to swallow and unconsciousness. - A hereditary condition in which the patient lacks one or more of the blood's normal clotting factors, which results in uncontrollable bleeding. A tendency toward the development of blood clots as a result of an abnormality of the system of coagulation. Diabetes is a metabolic disorder in which the body's ability to metabolize what is impaired? Which of the following is a normal glucose level in an adult? You are treating a 36-year-old patient displaying the following signs and symptoms: rapid, shallow respirations; pale, cool, clammy skin; tachycardia; weakness on the left side of the body; and confusion and irritability. What should you suspect? You are treating a 36-year-old patient displaying the following signs and symptoms: rapid, shallow respirations; pale, cool, clammy skin; tachycardia; weakness on the left side of the body; and confusion and irritability. What should you suspect? The condition in which blood clots as a result of an abnormality of the system of coagulation is called what? The conditio Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Diabetes Insipidus article more useful, or one of our other health articles. Diabetes insipidus (DI) is a condition caused by hyposecretion of, or insensitivity to the effects of, antidiuretic hormone (ADH), also known as arginine vasopressin (AVP). ADH is synthesised in the hypothalamus and transported as neurosecretory vesicles to the posterior pituitary. There it is released into the circulation, governed by plasma osmolality. Its deficiency or failure to act causes an inability to concentrate urine in the distal renal tubules, leading to the passage of copious volumes of dilute urine. Usually the person with this condition passes >3 litres/24 hours of low osmolality (<300 mOsmol/kg) urine. There are two major forms of DI: Cranial DI: decreased secretion of ADH. Decreased secretion of ADH reduces the ability to concentrate urine and so causes polyuria and polydipsia. Nephrogenic DI: decreased ability to concentrate urine because of resistance to ADH in the kidney. There are two other forms of DI (both caused by deficiencies in ADH; however, the deficiencies do not result from a defect in the neurohypophysis or kidneys): Gestational DI: results from degradation of vasopressin by a placental vasopressinase. Gestational DI may be associated with increased complications of pregnancy, including pre-eclampsia.[1] Primary polydipsia (dipsogenic DI): caused by a primary defect in osmoregulation of thirst. Dipsogenic DI has been reported in tuberculous meningitis, multiple sclerosis and neurosarcoidosis. The combined prevalence of cranial DI and nephrogenic D Continue reading >>

Understanding Risk

Understanding Risk

Keep your stroke risks low with regular checkups and treatment for these conditions if you have them. If you have high blood pressure (or hypertension), know your numbers and keep them low. High blood pressure is the leading cause of stroke and the most significant controllable risk factor for stroke. Many scientists attribute our current decline in stroke-related deaths to the successful treatment of high blood pressure. Manage HBP. If you smoke cigarettes, take steps to stop. Recent studies confirm that cigarette smoking is another crucial risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system and pave the way for a stroke to occur. Additionally, the use of birth control pills combined with cigarette smoking can greatly increase the risk of stroke. Quit smoking now and lower risks. Downloadable PDF. If you have diabetes (Type 1 or 2), keep blood sugar controlled. Diabetes Mellitus is an independent risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. While diabetes is treatable, the presence of the disease still increases your risk of stroke. Learn how to lower risks with diabetes and pre-diabetes. Statistics on diabetes and cardiovascular risks. If your diet is poor, eat foods that improve your heart and brain health. Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can increase blood pressure. Diets with high calories can lead to obesity. Also, a diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke. Learn how you can eat better. If you're physically inactive, starting moving and being more a Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

What are the types of diabetes insipidus? Central Diabetes Insipidus The most common form of serious diabetes insipidus, central diabetes insipidus, results from damage to the pituitary gland, which disrupts the normal storage and release of ADH. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking desmopressin, a person should drink fluids only when thirsty and not at other times. The drug prevents water excretion, and water can build up now that the kidneys are making less urine and are less responsive to changes in body fluids. Nephrogenic Diabetes Insipidus Nephrogenic diabetes insipidus results when the kidneys are unable to respond to ADH. The kidneys' ability to respond to ADH can be impaired by drugs-like lithium, for example-and by chronic disorders including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of nephrogenic diabetes insipidus is never discovered. Desmopressin will not work for this form of diabetes insipidus. Instead, a person with nephrogenic diabetes insipidus may be given hydrochlorothiazide (HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again, with this combination of drugs, one should drink fluids only when thirsty and not at other times. Dipsogenic Diabetes insipidus Dipsogenic diabetes insipidus is caused by a defect in or damage to the thirst Continue reading >>

Sickle Cell Trait And Development Of Microvascular Complications In Diabetes Mellitus

Sickle Cell Trait And Development Of Microvascular Complications In Diabetes Mellitus

Sickle Cell Trait and Development of Microvascular Complications in Diabetes Mellitus Endocrinology, Department of Internal Medicine, and Departments of Public Health Sciences and Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and Information Services, North Carolina Baptist Hospital, Winston-Salem, North Carolina Dr. Anthony J. Bleyer, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157. Phone: 336-716-4513; Fax: 336-716-4318; E-mail: ableyer{at}wfubmc.edu Background and objectives: Many African Americans (AA) have both sickle cell trait (SCT) and diabetes mellitus. The objective of this study was to determine whether individuals with diabetes mellitus and SCT have higher rates of microvascular complications relative to those without SCT. Design, setting, participants, & measurements: This was a retrospective study comparing albuminuria, estimated GFR (eGFR), and microvascular complications in AA with diabetes on the basis of presence of SCT. The study included 821 outpatients who underwent hemoglobin A1c (HbA1c) testing, and presence of SCT was determined using the HbA1c assay. Medical record review and telephone interviews were performed for AA participants. Results: Data were obtained on 376 AA patients (110 with SCT, 245 with neither SCT nor hemoglobin C trait, and 21 with hemoglobin C trait) and 445 European Americans. The mean eGFR and urinary protein excretion were similar between the three AA subgroups. Analysis revealed that 36.3% of AA nontrait and 22.7% of AA SCT participants had retinopathy, peripheral vascular disease, or end-stage kidney disease (P = 0.01). After adjustment for diabetes duration, age, insulin use, and gender, differences in the prevalence of microvascular comp Continue reading >>

Shared Flashcard Set

Shared Flashcard Set

Details Title Chapter 17 Questions Description Emergency Care and Transportation of the Sick and Injured Total Cards 86 Subject Health Care Level Undergraduate 1 Created 03/12/2014 Click here to study/print these flashcards. Create your own flash cards! Sign up here. Additional Health Care Flashcards Cards Term Common signs and symptoms of diabetic coma include all of the following EXCEPT: A. warm, dry skin B. rapid, thready pulse C. cool, clammy skin D. acetone breath odor Definition C. cool, clammy skin Term Diabetes is MOST accurately defined as a/an: A. abnormally high blood glucose level B. disorder of carbohydrates metabolism C. lack of insulin production in the pancreas D. mass excretion of glucose by the kidneys Definition B. disorder of carbohydrates metabolism Term A 28-year old female patient is found to be responsive to verbal stimuli only. her roomate states that she was recently diagnosed with type 1 diabetes and has had difficulty controlling her blood sugar level. She further tells you that the patient has been urinating excessively and has progressively worsened over the last 24 to 36 hours. On the basis of this patient's clinical presentation, you should suspect that she: A.has a urinary tract infection B. has low blood glucose level C. has overdosed on her insulin D. is signically hyperglycemic Definition D. is signically hyperglycemic Term The signs and symptoms of insulin shock are the result of: A. prolonged and severe dehydration B. fat metabolism within cells C. increased blood glucose levels D. decreased blood glucose levels Definition D. decreased blood glucose levels Term Kussmaul respirations are an indication that the body is: A. trying to generate energy by breathing deeply B. attempting to eliminate acids from the blood C. compensating for Continue reading >>

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