Archive for Diabetes 101

Hypoglycemia

Hypoglycemia

Hypoglycemia is an important condition when you have diabetes. It is important to know not only the signs and symptoms, but also how to manage hypoglycemia should you experience it.

Do you experience different signs and symptoms?

Do you have different ways of dealing with hypoglycemia?

Check out the video and share your knowledge.

Hemoglobin A1c Levels

Hemoglobin A1c Levels

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What You Need To Know About Your Hemoglobin A1c Levels

  • Your hemoglobin A1c levels measure your average blood sugar over the last 2 to 3 months.
  • Hemoglobin A1c levels give you an idea of how your diabetes control is doing overall.

What You Need To Do About Your Hemoglobin A1c Levels

  • You need to check your hemoglobin A1c level at least twice a year, and more frequently if your blood sugar is poorly controlled.
  • Talk with your doctor about your hemoglobin A1c goal, but most will want a level of 7% or less.

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What Do My Hemoglobin A1c Levels Mean?

Your hemoglobin A1c level gives you an idea of how well your blood sugar has been controlled over the last several months. This test lets you know if your diabetes plan is working or not.

Hemoglobin A1c levels are a reliable method of assessing how well your blood sugar has been controlled. Elevated levels over long periods of time are associated with the long-term complications of diabetes. After reviewing your hemoglobin A1c levels,  your doctor will recommend changes in your treatment plan or tell you that your diabetes plan seem to be going well.

How Does the Hemoglobin A1c Test Work?

When you have excess blood sugar in your bloodstream it binds with hemoglobin or glycates. The more excess blood sugar the more hemoglobin gets glycated. As a result, the higher your hemoglobin A1c the more poorly controlled your diabetes.

Because the average hemoglobin cell lives for 120 days, your hemoglobin A1c level can reflect your blood glucose control over that time.

In a person without diabetes, the hemoglobin A1c level is about 5%. According to new standards, diabetes can be diagnosed when the hemoglobin A1c level reaches 6.5%.

How Often Should I Have My Hemoglobin A1c Level Checked?

Your doctor will likely check your hemoglobin A1c level either as a screening test or when you are first diagnosed with diabetes. If your diabetes is under good control, you should have a hemoglobin A1c level checked at least every six months. If your diabetes plan is not achieving optimal control, your doctor may check your hemoglobin A1c level more often.

Are There Any Limitations For Hemoglobin A1c Levels?

Some patients have other medical conditions that limit the use of hemoglobin A1c levels in monitoring their diabetes. The hemoglobin A1c level is unreliable in patients with sickle cell disease or sickle cell trait.

In these patients hemoglobin is slightly different and the tests to measure glycated hemoglobin overestimate the actual blood glucose over the last three months. Alternatively the fructosamine test can be use to measure diabetic control.

Estimated Average Glucose And Hemoglobin A1c Levels

Can I convert hemoglobin A1c levels to an average glucose? Hemoglobin A1c levels can be converted to an estimated average glucose or eAG result. The eAG is more familiar to patients who are testing regularly at home.

For example, a hemoglobin A1c level of 10% converts to an eAG of 240 mg/dL while a hemoglobin A-1 C level of 6% converts to an eAG of 126 mg/dL. The chart below converts hemoglobin A1c levels to eAG.

HbA1c eAG
% mg/dl mm/l
5 97 5.4
5.5 111 6.2
6 126 7.0
6.5 140 7.8
7 154 8.6
7.5 169 9.4
8 183 10.1
8.5 197 10.9
9 212 11.8
9.5 226 12.6
10 240 13.4
10.5 255 14.1
11 269 14.9
11.5 283 15.7
12 298 16.5

You can also use the following formula to calculate your eAG:

28.7 X A1C – 46.7 = eAG

Sources:

Nathan MD, David M; Kuenen MD, Judith; Borg MD, Rikke; Zheng PHD, Hui; Schoenfeld PHD, David; Heine MD, Robert J for the A1c-Derived Average Glucose (ADAG) Study Group. “Translating the A1c Assay Into Estimated Average Glucose Values.” Diabetes Care Aug 2008 31(8):1473-1478.

A1C. American Diabetes Association. Accessed: April 22, 2013. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c

A1c and the eAG. Lab Tests Online. Accessed: April 2, 2013. http://www.labtestsonline.org/understanding/analytes/a1c/test.html

If You Have Diabetes, Know Your Blood Sugar Numbers! National Diabetes Education Program. National Institute of Health. Accessed: April 22, 2013. http://www.ndep.nih.gov/diabetes/pubs/KnowNumbers_Eng.pdf

Would You Have Bariatric Surgery For Your Diabetes?

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What You Need To Know- Diabetes Bariatric Surgery

  • Studies have demonstrated weight loss, improved glucose levels, and remission of diabetes in some patients.
  • Most studies have only looked at 2 years of postoperative data.

What You Need To Do- Diabetes Bariatric Surgery

  • Talk with your doctor to determine if you might be a good candidate for diabetes bariatric surgery.
  • Ask your doctor about the risks and benefits of surgical versus non-surgical treatment.

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Would you have bariatric surgery if it might improve or cure  your diabetes? More and more people are asking there insurance companies to do just that with more than 120,000 bariatric surgical cases per year in the U.S.

Diabetes Bariatric Surgery Questions

What sort of questions would you want to ask before undergoing diabetes bariatric surgery? This is a list of question you might want to discuss with your doctor before considering diabetes bariatric surgery:

  • How much weight might I be able to lose?
  • How long will it take me to lose weight?
  • What sort of changes will I need to make before surgery?
  • What will I be able to eat post-operatively.

What Is Diabetes Bariatric Surgery?

“Bariatric surgery” or weight loss surgery can help you lose weight. In general this is accomplished by making your stomach smaller. Other types of diabetes baraiatric surgery alter how your body absorbs food. No matter which type of surgery, decreased caloric intake will lead to weight loss.

What Are The Types Diabetes Bariatric Surgery?

There are several different types of weight loss surgery. The most common is the ‘gastric band’ where a band is placed around part of the stomach creating a small pouch. Your doctor can adjust the size of your stomach. This is the simplest weight loss surgery and involves the least amount of cutting, but is also associated with the least amount of weight loss.

In the gastric bypass procedure part of the stomach is removed to make a small pouch. This procedure is associated with the most weight loss, but can also cause some nutritional problems as your body may not absorb some nutrients as well after the operation.

A sleeve gastrectomy is a different surgical procedure, but is less likely to cause any of the complications associated with gastric bypass.

Diabetes Bariatric Surgery- Results

Bariatric surgery has demonstrated weight loss and improved diabetic control in patients in studies from 2 – 5 years following surgery.

In one study presented at the 29th Annual Meeting of the American Society for Metabolic and Bariatric Surgery, 67% of gastric bypass patients were in complete remission of their diabetes in the year following gastric bypass surgery. If patients were not on insulin and did not have reduced pancreatic function, the success rate jumped to 96%.  Many patients were off their diabetic medications within a couple of weeks.

In a Cleveland Clinic study, investigators compared gastric bypass, gastric sleeve, and intensive medical therapies and saw remission of diabetes in 42%, 37%, and 12%, respectively. Cleveland Clinic called bariatric surgery one of the “top medical innovations for 2013” and stated in the press release that “many diabetes experts now believe that weight-loss surgery should be offered much earlier as a reasonable treatment option for patients with poorly controlled diabetes —and not as a last resort.”

On the other hand, other scientists question whether or not bariatric surgery is as effective for diabetes. Investigators looked more than 4,000 patients with diabetes who underwent diabetes bariatric surgery, While 68% had a complete remission initially, more than one third of these patients ultimately redeveloped diabetes. Poor diabetic control before surgery, need for insulin before surgery, and longer time with diabetes were all predictors of redevelopment of diabetes.

 Diabetes Bariatric Surgery- Side Effects

Diabetes bariatric surgery is not without risk. While the surgery is generally associated with less than a 1% mortality rate, age greater than 65, BMI > 50, and more chronic medical problems increased the mortality rate. Additionally, when these procedures are preformed by surgeons and hospitals who do more than 100 cases per year, mortality was also lower. Additional potential complications include:

  • Bleeding
  • Wound infections
  • Blood clots
  • Heart and lung problems
  • Tears in your intestines causing leaks

 Diabetes Bariatric Surgery- What Would You Do

So what would you do? While some of the results seem impressive, there are real risks and a fair number of people ultimately redevelop diabetes. Please leave a rsponse- I would love to hear why you would or would not have diabetes bariatric surgery. Do you have other thoughts or concerns?

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Sources

1. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med 2012; 366:1567-1576

2. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obesity Surgery 2013; 23(1):93-102.

3. Top medical innovations for 2013- Cleveland Clinic

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What Everybody Ought To Know About Prediabetes

Prediabetes is an important medical condition because you are at higher risk for heart attacks and stroke. More importantly, if you take the steps outlined in this video, you may be able to prevent diabetes.  Learn what you need to know and do to take care of prediabetes.

What Is the Definition of Acanthosis Nigricans?

A brown to black hyperpigmentation of the skin. Acanthosis is commonly seen in skin folds such as under the arms or in the back of the neck.

Acantosis nigricans is commonly seen in obesity and can also mean that you have insulin resistance. Acanthosis nigricans may improve when insulin resistance improves.

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What Is Diabetes?

What Is Diabetes

You or a loved one may have recently been diagnosed, but can you really answer the question “What Is Diabetes?”

In general, diabetes is your body’s inability to naturally store and use glucose, the body’s main fuel, appropriately. As a result the sugar level in your blood increases. This condition is also referred to as diabetes mellitus.

What Is Diabetes- Glucose And Insulin

Most food contain sugar or glucose that is released into the blood stream as part of digestion when we eat. Once glucose is in the blood stream a hormone called insulin helps glucose go into different organs that need it. The insulin is produced in an organ called the pancreas.

There are 2 main types of diabetes- type 1 diabetes and type 2 diabetes. Type 1 is most commonly diagnosed in childhood, while type 2 is diagnosed in later life. In type 2 diabetes, your pancreas produces insulin, but the organs do not respond to it. Type 2 diabeteics are often called insulin resistant. In type 1 diabetics, the pancreas does not produce insulin.

What Is Diabetes- Who Will Take Care Of My Diabetes?

If you have not before, you will now see several different types of health care providers. Your diabetes team could include several of the following:

Physician– your diabetes doctor may be a primary care physician or it might be a specialist called an endocrinologist.

Diabetes nurse or diabetes educator– this healthcare professional teaches you how to better manage your diabetes. Your diabetes educator will help you develop a plan based on all the different things that your other health care professionals reccomend. For example, your doctor may reccomend that you begin an insulin treatment regimen. Your diabeteic educator will make sure that you know and understand all of the different steps to do this.

Dietician- a dietician will help you plan healthy eating habits to help get your diabetes under good control. Your dietician can also help you plan for eating out and times where sticking toyour special diet may be hard- like holidays.

Pharmacist- you are likely on at least one new medicine since being diagnosed with diabetes. Your local pharmacist can help you make sure that your diabetes medication do not interact with any medications given to you by other doctors.

Counselor A new diabetes diagnosis can be really hard on you or yuor family. Sometimes an experienced counselor to help with mental health issues is needed.

What Is Diabetes- Will I Need Medication

This will depend on which type of diabetes you have ben diagnosed with, but probably yes.

Anyone with type 1 diabetes will need to take insulin everyday. If you are diagnosed with type 2 diabetes than your doctor may give you a trial of diet and exercise. If you have symptoms of diabetes, your doctoe will probably start you on medication

What Is Diabetes- Will I Need Tests?

Yes. Whether you have type 1 or type 2 diabetes you are going to have to monitor your blood sugar. Depending on how recently you have been diagnosed, your doctor will liekly ask you to test your blood sugar anywhere from 1 to 4 times per day. Type 2 diabeteics generally test less often than type 1s. You use a blood glucose meter to do this.

Your doctor will also get a test to see how well your blood sugar has been controlled over the last several months. This test is called hemoglobin A1C or HbA1c.

No matter what type of diabetes you have, you will see a bunch of different doctors and ger a bunch of different tests. We are here to try to help make that journey easier.

Sources:

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). Accessed February 8, 2013. Diabetes Overview

Diabetes Basics: The ABCs of Diabetes

 

Do You Know The ABCs of Diabetes?

A: A1C & Aspirin
The HbA1C is a significant part of your diabetes plan. The HbA1C blood test helps you monitor how well your blood sugar is controlled. In terms of diabetes basics, the HbA1C measures your average blood sugar over the last 2-3 months. Your doctor will check your HbA1C at least 2 times per year. The lower your HbA1C the lower your risk of complications from diabetes. The HbA1C test will form the basics of diabetes monitoring for your long term control.

Depending on your risk factors, you may need to be taking aspirin. Not every diabetic needs to be on aspirin as in the past. The more risk factors you have the more likely you may need an aspirin a day.

Learn More

B: Blood Pressure

Keeping your blood pressure under control is an important part of your diabetes ABCs. Poorly controlled blood pressure leads to both complications such as:

  • Eye Problems
  •  Kidney Problems
  •  Heart Problems

Your doctor should measure your blood pressure at every visit. You can also check your blood pressure at home with simple monitoring devices or at many local places such as a pharmacy.

Learn More Diabetes Basics
What Should My Blood Pressure Be?

C: Cholesterol

If you have diabetes, you are more likely to have an elevated cholesterol. Your cholesterol levels are another important part of the ABCs of of diabetes. Elevated cholesterol increases your risk of heart attack and stroke. Treatment of elevated cholesterol in diabetics will attempt to lower your LDL or ‘bad’ cholesterol and elevate your HDL or ‘good cholesterol. Additionally, if your triglycerides are elevated, your doctor will likely try to lower this as well.

•    Your goal LDL should be less than 100 mg/ dl.
•    Your goal for triglycerides should be less than 150 mg/dl.
•    Your goal HDL cholesterol should be > 40 mg/dl.

Knowing your cholesterol and how you can manage it is another key to preventing complications and understanding the basics of diabetes.

D: Diabetes Education and Diabetes Educators

Patients often want a pill to fix their problems, but education is one of the most important diabetes ABCs. Appropriate education is essential to prevent diabetes complications. Diabetes requires significant amounts of self management to get your diabetes under good control. The only way to accomplish this is to arm yourself with appropriate knowledge. Through education you will learn how your diet and activity lead to changes in your diabetes control.

A diabetic educator is a person that has had significant training in the prevention and treatment of diabetes. This person can provide you with self-management skills and provide you with support as you begin your diabetes ABCs.

E: Eye Exam

This letter in  the diabetes ABCs reminds you to get your eye exam to prevent diabetes complications of the eye such as blindness. Diabetes is one of the leading causes of blindness in the U.S. and is totally preventable with good diabetic care and regular eye exams. The type of diabetes you have will determine the frequency and when you should have your first diabetes eye exam.

If you have type 1 diabetes, you need to have a dilated eye exam 3-5 years after your initial diagnosis, while patients with type 2 diabetes should see the eye doctor shortly after being diagnosed. Both should then see the eye doctor annually.

Learn More

  • Eye Exam

F: Foot Exam

The foot exam is another important part of your diabetes basics. This one of the ABCs of diabetes reminds you that you need a foot exam at least annually. Good foot care can prevent ulcers and other complications. The foot exam will alert your doctor to the potential for complications and will provide an opportunity to educate you on how to prevent diabetic foot problems.

G: Glucose control

Self monitoring of blood glucose is a very important part of your diabetic plan. Depending on whether you are type I or type II and how your control has been, your monitoring plan will be different. If you are type 1, you will probably be testing at least 3 times per day, while testing for type 2 will vary based on your goals.

H: Health Maintenance

There are many things we can do to improve our health, especially when you have diabetes. In the ABCs of diabetes, H is for health maintenance, specifically immunizations. If you have diabetes you need to make sure you get vaccinated against the flu virus and the bacteria associated with a common type of pneumonia.

Every diabetic over the age of 6 months should receive the flu vaccine every year. Diabetics should also receive the “pneumonia vaccine” at least once as an adult. If you were vaccinated before age 65, you should receive a second vaccine dose 5 years after your your 1st “pneumonia vaccine”.

Source

Samuel Abbate. Expanded ABCs of Diabetes. Clinical Diabetes 2009 21:128-132.

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