Understanding Diabetes: What Is HbA1c?

HbA1c refers to glycated haemoglobin, which identifies average plasma glucose concentration. 

HbA1c occurs when haemoglobin joins with glucose in the blood. Haemoglobin molecules make up the red blood cells in the blood stream.

When glucose sticks to these molecules it forms a glycoslated haemoglobin molecule – also known as A1c and HbA1c. The more glucose found in the blood, the more haemoglobin will be present. 

How does HbA1c return an accurate average measurement?

Due to the fact that red blood cells survive for 8-12 weeks before renewal, by measuring HbA1c an average blood glucose reading can be returned. For non-diabetics, the usual reading is 3.5-5.5%. For people with diabetes, an HbA1c level of 6.5% is considered good control, although some prefer numbers closer to non-diabetic. 

How does HbA1c differ from blood glucose level?

HbA1c is a longer-term average that is sent to a laboratory and usually conducted in hospital clinics.

Blood glucose is a current reading taken either by a healthcare professional or at home by an individual with diabetes using a glucometer.

When should HbA1c level be tested?

How often HbA1c levels should be taken depends on the person with diabetes and their history of control and treatment objectives.

Generally, the following are considered best practice in HbA1c regularity.

1. Once per 3 months if trying to get better control.
2. Once per 6 months if good control achieved and maintained.

There is little point in having HbA1c checked regularly if you are not making efforts to control your diabetes. Although HbA1c level alone does not predict diabetes complications, good control is known to lower the risk of complication.

How does an HbA1c show poorly controlled diabetes?

In well-controlled diabetes without a high level of glucose in the blood, a lower level of glycosylated haemoglobin will be returned.

If people with type 2 diabetes reduce their HbA1c level by 1%, there is a:

• 19% reduction is cataract extractions
• 16% decrease in heart failure
• 43% reduction in amputation or death due to peripheral vascular disease

In the case of poor control, with more glucose, a higher level of glycosylated haemoglobin will be returned.

But glucose levels change all the time, don't they? 

Blood glucose levels fluctuate constantly, literally on a minute by minute basis. Therefore, for micro adjustments and regular checking, blood glucose testing is advised. The HbA1c level changes very slowly over a 10 week period and is a more accurate method of determining blood sugar control.

From Diabetes.co.uk

Recommended Blood Pressure Level Differs For Heart Patients With Diabetes

The best blood pressure range for patients with diabetes and heart disease appears to be slightly higher than what is recommended for healthy adults, according to a study. Blood pressure greater than 140 is still associated with a nearly 50 percent increase in cardiovascular risk in these patients.

In fact, the blood pressure range considered normal -- less than 120 systolic and less than 80 diastolic -- may actually be risky for those with a combined diagnosis of diabetes and coronary artery disease, report University of Florida researchers from the International Verapamil SR-Trandolapril study, known as INVEST.

According to Rhonda Cooper-DeHoff, Pharm D, an associate professor of pharmacy and medicine at UF, optimum systolic blood pressure levels should be between 130 and 140 for patients coping with the diabetes-heart disease combination.

Efforts to reduce systolic blood pressure to below 130 did not offer any additional benefit to patients with diabetes and coronary artery disease, compared with reduction of systolic blood pressure to between 130 and less than 140.

"Sustained blood pressure lower than 120 is considered optimal for healthy people," Cooper-DeHoff said. "But, our data show that for these patients with diabetes, the range may actually cause an increased risk for heart attack, stroke, and death."

As many as two out of three adults with diabetes have high blood pressure. Blood pressure greater than 140 is still associated with a nearly 50 percent increase in cardiovascular risk in these patients.

"While lowering blood pressure to less than 140 is very important, based on our data and data recently published by others, it is now clear that in patients with diabetes, it is not necessary, and may be harmful to lower blood pressure too much," Cooper-DeHoff said.

In addition, the study for the first time reveals that this group of patients had an increased risk for death when their blood pressure was controlled to lower than 115 systolic -- the range recommended as normal by the American Heart Association.

The findings in the Journal of American Medical Association formalize a report Cooper-DeHoff made at the American College of Cardiology's 59th annual scientific session earlier this spring.

Heart disease or stroke is the top cause of death for people with diabetes, affecting more than 60 percent of patients, according to the AHA. High blood pressure, common in diabetes, doubles the risk of cardiovascular disease.

The INVEST study is the first to evaluate the effects of blood pressure-lowering in diabetic patients diagnosed with coronary artery disease. Researchers analyzed data collected from 6,400 patients from fall 1997 to spring 2003. The patients, who were 50 or older, were recruited from more than 850 sites in 14 countries.

The researchers further consulted the national death index for US-enrolled patients for an additional five years to compare death rates of patients based on their blood pressure category ranging from tightly controlled to non-controlled hypertension.

Journal of the American Medical Association, July 10, 2010

Diabetes: Urine Test For Diagnosing Blood Sugar Levels

Urine investigation is a mapping of chemical composition of urine. It is a viewing test which is a successful method of ascertaining the phase of diabetes mellitus. However, a mass of doctors recommend it to find out the route cause of a number of diseases.

Urine investigation for Diabetes Mellitus

Diabetes mellitus, otherwise known as just diabetes, is a indication of chaotic metabolism resulting in an augmented amount of blood sugar. Its cause could vary from ecological factors to hereditary causes. Diabetes is of two types - Type 1 and Type 2. People who are diagnosed with either of the two are asked to undertake yearly urine tests for microalbumin.

Urine Analysis - Its Types

Urine analysis for diabetes is generally of two types - chemical investigation and macroscopic (visual) scrutiny. The earlier is used for a more in depth investigation of urine (i.e. to check the levels of micro albumina) whereas the latter is more pinpointing in nature (color and amount in Type 1 diabetes). Of the two, it is the former which is a more solid indicator of diabetes.

Urine Test for Microalbuminuria

The need to carry out urine test in diabetes is the reality that the body tries to eliminate excess levels of sugar in the bloodstream. Kidneys have to work ultimately and in a more advanced stage of diabetes they get spoiled (also called micro albuminuria). When this happens, the function performed by the kidney reverses. It is no longer the blood impurities which are accepted in urine but vital protein. 

The protein (albumin) level is measured so that it indicates the phase of the test subject’s diabetes. The following tabulated consequences would provide you with a more precise indication -

1. 300 mg or more means a progressed stage of kidney disease.
2. 30 mg to 299 mg mean a premature stage of microalbuminuria.
3. 30 mg is measured as normal.

How is The Urine Analysis Performed?

Urine investigation begins with the collection of sample. The technique to gather the sample is different for men and women. However, the general point between the two is that the technique first involves cleaning the tip of the urinary tract so that any accumulated composite do not enter the sample.

Once the area is cleaned with sanitization swipes, individuals are asked to pass urine. Ideally, urine passed for the first few seconds is not to be collected as it may not have what laboratory technicians may be looking for. These chemicals come into view only after 5 to 6 seconds which are then collected in a clean sample cup. The quantity collected is about 10-15 ml. The sample should be taken for investigation within an hour or else the chemicals would start to decay.

Drugs Cannot Treat The Underlying Cause of Diabetes!

If you or someone you know is diabetic and taking medication for it, please understand that you cannot successfully treat the underlying cause of diabetes with drugs.

Avandia - the controversial drug that is linked to increased incidents of heart attacks (see my earlier posts) - works by making diabetes patients more sensitive to their own insulin, helping to control blood sugar levels.

In fact, most conventional treatments for type 2 diabetes utilize drugs that either raise insulin or lower blood sugar. Avandia, for example, lowers your blood sugar levels by increasing the sensitivity of liver, fat and muscle cells to insulin.

But you must understand that diabetes is NOT a blood sugar disease you may have been led to believe.

Type 2 diabetes is actually a disease caused by insulin resistance and faukty leptin signalling, both of which are regulated through your diet.

Conventional treatment, which is focused on fixing the symptom of elevated blood sugar rather than addressing the underlying disease, is doomed to fail in most cases.

Type 2 diabetes is virtually 100 percent avoidable, and can be effectively treated without medications in about the same percentage of cases.

Leptin, a relatively recently discovered hormone produced by fat, tells your body and brain how much energy it has, whether it needs more (saying "be hungry"), whether it should get rid of some (and stop being hungry) and importantly what to do with the energy it has (reproduce, upregulate cellular repair, or not).

In fact, the two most important organs that may determine whether you become (type 2, insulin resistant) diabetic or not are your liver and your brain, and it is their ability to listen to leptin that will determine this.

How is this done?

Well, that's the kicker. The only known way to reestablish proper leptin and insulin signaling is through a proper diet and exercise!

There is NO drug that can accomplish this, but following these simple guidelines can help you do at least three things that are essential for successfully treating diabetes: recover your insulin/leptin sensitivity, help normalize your weight, and naturally normalize your blood pressure.

As an aside, none of these will drastically raise your risk of a heart attack the way Avandia will … and in fact will have only positive benefits on your heart and your entire body:

• Severely limit or eliminate sugar and grains in your diet, especially fructose which is far more detrimental than any other type of sugar.Finding out your nutritional type will help you do this without much fuss. While nearly all type 2 diabetics need to swap out their grains for other foods, some people will benefit from using protein for the substitution, while others will benefit from using more vegetable-only carbohydrates. Therefore, along with reducing grains and sugars, determining your nutritional type will give you some insight into what foods you should use to replace the grains and sugars.
• Exercise regularly -- a must for anyone with diabetes or pre-diabetes. Typically, you'll need large amounts of exercise, until you get your blood sugar levels under control. You may need up to an hour or two a day. Naturally, you'll want to gradually work your way up to that amount, based on your current level of fitness.
• Avoid trans fats
• Get plenty of omega-3 fats from a high quality, animal based source.
• Get enough high-quality sleep every night.
• Optimize your Vitamin D levels. Recent studies have revealed that getting enough vitamin D can have a powerful effect on normalizing your blood pressure and that low vitamin D levels may increase your risk of heart disease.
• Monitor your fasting insulin level. This is every bit as important as your fasting blood sugar. You'll want your fasting insulin level to be between 2 to 4. The higher your level, the worse your insulin receptor sensitivity is.

So please remember that a drug will never treat the underlying cause of type 2 diabetes the way these lifestyle changes will.

It looks like Avandia is set to go the way of Vioxx, which was also pulled from the market after killing 60,000 people. You don't need to wait for the red tape to be removed to start looking out for your own health.

(Adapted from an article in Mercola.com) 

Diabetes Is Responsible For Many Heart Disease Deaths

Don't take diabetes lightly. More than one in 10 heart disease deaths may be attributable to diabetes. In fact, my friend Shiv Harsh, MD, says most heart specialists like him equate diabetes with onset of heart disease, as it were.

In a meta-analysis of more than 100 studies, diabetes was associated with a twofold increased risk of the disease and was estimated to be accountable for 11% of vascular deaths, according to Nadeem Sarwar, MD, of the University of Cambridge in England, and colleagues.

They reported their findings online in The Lancet and will present them during an oral session at the American Diabetes Association meeting.

“In this decade, about 10% of vascular deaths in populations in developed countries have been attributable to diabetes in adults, corresponding to an estimated 325,000 deaths per year in high-income countries alone,” Sarwar and colleagues wrote.

“This burden will increase if the incidence of diabetes continues to rise, even if rates of vascular disease continue to fall because of decreases in smoking, improvements in treatment, or other reasons,” they added.

There have been uncertainties about the magnitude of associations between heart disease risk and stroke, and diabetes and fasting glucose concentration.

So to quantify those associations for a wide range of circumstances, the researchers conducted a meta-analysis of individual risk factors in patients without vascular disease from studies in the Emerging Risk Factors Collaboration.

They included 698,782 patients in 102 prospective studies. The mean age was 52 and 43% were women, with the majority in Europe, North America, and Australia, and the remainder in Japan or the Caribbean.

A total of 7% of patients reported a history of diabetes at baseline.

Over the study periods, there were 52,765 nonfatal or fatal vascular outcomes.

The researchers found that patients with diabetes had around a twofold increased risk of heart disease, ischemic stroke, and other vascular deaths:

* Coronary heart disease: HR 2.0, 95% CI 1.83 to 2.19
* Ischemic stroke: HR 2.27, 95% CI 1.95 to 2.65
* Hemorrhagic stroke: HR 1.56, 95% CI 1.19 to 2.05
* Unclassified stroke: HR 1.84, 95% CI 1.59 to 2.13
* Other vascular deaths: HR 1.73, 95% CI 1.51 to 1.98

The researchers said that risk was about a third higher for fatal than nonfatal myocardial infarction, “perhaps suggestive of more severe forms of coronary lesions in people with diabetes than those without, differential response of the myocardium to ischemia, or possibly in part, differential coding of deaths from coronary heart disease.”

Risk of heart disease among diabetics was higher in women than in men, in patients ages 40 to 59 than those 70 and up, in nonsmokers than in smokers, and in those with below-average systolic blood pressure.

Risk of stroke was higher in women, the same younger age group, and in those with above average body mass index (BMI).

These findings, the researchers said, warrant further study.

Also, at an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% of vascular deaths, they added.

Yet only moderate associations were found between impaired fasting glucose and risk of heart disease and stroke.

Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L.

But risk of heart disease increased with increasing plasma glucose concentrations:

* 5.60 to 6.09 mmol/L: HR 1.11, 95% CI 1.04 to 1.18
* 6.10 to 6.99 mmol/L: HR 1.17, 95% CI 1.08 to 1.26

The researchers added that risk was “substantially higher” among those with concentrations of 7 mmol/L or higher.

The study was limited in that it may not be generalizable to patients in low- or middle-income countries. But that does not mean that the findings can be dismissed as a problem faced by diabetics in developed countries. In countries like India too evidence is emerging that diabetics face more risk of heart disease than non-diabetics.

In an accompanying commentary, Hertzel C. Gerstein, MD, of McMaster University in Hamilton, Ontario, said it remains unknown whether the spectrum of dysglycemia is causally related to cardiovascular outcomes.

Trials of glucose-lowering therapies have shown a modest reduction in myocardial infarction, but “the size of the effect strongly suggests that glucose is not the only player,” he wrote. Others could include fatty acid and lipoprotein metabolism, visceral fat deposition, hepatic function, and renin-angiotensin, among others.

“Any or all of these factors (and others) might promote cardiovascular disease through various known and unknown mechanisms,” Gerstein wrote. “Large, long-term clinical trials of insulin-replacement therapy, incretins, and other approaches targeting one or more of these abnormalities … are certain to shed more light on the link between dysglycemia and serious outcomes.”

 

Thank you Kristina Fiore/MedPage Today

Milestone In Diabetes Treatment: Wireless Blood Sugar Monitor

The day diabetes sufferers have dreamed of for decades may have finally arrived.

 

Researchers have developed an implantable sensor that continually monitors blood sugar then transmits the information to a receiver without wires.

 

The device was tested in a pig for more than a year without trouble.

 

A research team at the University of California at San Diego calls the device a "milestone in diabetes treatment."

The researchers say it also takes the field of diabetes a step closer to development of an "artificial pancreas" that could control the way the body handles blood sugar.

 

Scientists believe the device, that detects oxygen in the tissue where it's implanted to measure glucose, will be able to send information to cell phones.

 

That would be especially helpful for parents of diabetic children who spend days and nights worrying whether their child is threatened by nocturnal hypoglycemia.

 

Details of the research is reported in the journal "Science Translational Medicine."

The researchers hope to begin human trials for the device in a few months.

Black Tea Helps Fight Type 2 Diabetes

Patients with type 2 diabetes mellitus may be better off drinking black tea often, a new study published in the July 29, 2010 issue of Annals of Nutrition & Metabolism suggests.

The study found people with type 2 diabetes mellitus who drank black tea extract reduced oxidative stress and inflammation.

The study led by Neyestani TR and colleagues from the Shaheed Beheshti University of Medical Sciences in Tehran, Iran was intended to evaluate the possible effects of different daily doses of black tea intake on oxidative stress, inflammatory and metabolic biomarkers in patients diagnosed with type 2 diabetes mellitus.

The researchers gave a study group of 23 type 2 diabetics a series of different daily doses of black tea extract, 150,300, 450, and 600 ml of the extract during the weeks 1, 2, 3 and 4 respectively.  They gave also gave a control group of 23 patients 150 ml of black tea extract daily for four weeks.

The antioxidant capacity was boosted in both groups, the study found.

The study group of diabetics who used four cups of black tea extract a day experienced a significant decrease in  serum c-reactive protein and an increase in the glutathionine level.

The authors concluded that drinking black tea daily helps patients with diabetes mellitus.

Vitamin D is one of the nutrients that have been found protective against diabetes mellitus.

Thank you Jimmy Downs/FoodConsumer