HBA1C

HbA1c. How many of us know exactly what this means?

Now all standard Diabetes centers, Hospitals and Clinicians have started recommending this test for their Diabetic patients. It would be apt to say that HbA1c is considered a gold standard investigation for diagnosis , Treatment and Followup of Diabetic patients. 

So what is HbA1c? 

It is a blood test which will give you an average sugar control for the past three months. It is otherwise called Glycated Hemoglobin or Glycosylated haemoglobin or glyycohemoglobin. This Glycated Hemoglobin comprises of HbA1c, HbA1a, HbA1b, HbS,HbC and HbF. HbA1c is more specific among the other mentioned components.

HbA1c has been used in many international studies for assessment of risk of developing complications of Diabetes. The normal level of HbA1c in a non-diabetic patient should range between 4.0-6.0%. 

American Diabetes Association  recommended the use of HbA1c as a diagnostic marker for diabetes & prediabetes in 2010. People with HbA1c of 6.5% and above are to be diagnosed as diabetes and HbA1c between 5.7-6.4%  are considered to be at risk of diabetes.

The target HbA1c in a Diabetic patient is <7% 

HbA1c is definitely a very good tool in the hands of the clinicians to provide a better control over diabetes. But, we also need to know factors that can affect this blood test. 

What will show faulty higher HbA1c readings?

HbF and HbG

Uraemia

Lead poisoning

Hypertriglyceridaemia

Alcoholism

Opiate addiction

Iron deficiency state

Postsplenectomy

Hyperbilirubinaemia

Chronic aspirin therapy

What will show faulty lower HbA1c readings?

HbS and HbC

Haemolytic anaemia

Pregnancy

Acute or chronic blood loss

Methods used for estimating HbA1c

Ion exchange chromatography

High-performance liquid chromatography

Isoelectric focusing

Agar gel electrophoresis

How frequent do we need to estimate HbA1c?

Usually, it should be done every 3 months and when controlled after every 6 months. In pregnancy

for tight control, monthly determination is necessary. In pregnancy a better marker of sugar(Glycemic) control is estimation of serum fructosamine.

OATS (AVENA SATIVA)

Oats were defined as "eaten by people in Scotland, but fit only for horses in England." The Scotsman's retort to this is, "That's why England has such good horses, and Scotland has such fine men!"

Oats is a recent addition to our menu. Oats is a European and North American crop. It was not considered as important as wheat or barley in the olden days. Oats were mostly weed like plants. It is said that Oats were first brought to North America with other grains in 1602 and planted on the Elizabeth Islands off the coast of Massachusetts. As early as 1786, George Washington sowed 580 acres to oats. By the 1860s and 1870s, the westward shift of oat acreage in the United States had moved into the middle and upper Mississippi Valley, which is its major area of production today. Russia, Canada, the United States, Finland, and Poland are the leading oat producing countries.

Oats has been used as livestock and human foods since ancient times. It has been used as pasture, hay or silage. Oat straw has been used as bedding for livestock.

There has been an increase in oats used for human food in recent years. Oat Bran has received considerable attention from the medical community for its role in reducing blood cholesterol. Nutrition experts believe that Beta glucans, the water-soluble fibres present in oat bran inhibit cholesterol, which helps prevent heart disease. Several breakfast cereals and bread products are made from oat flour and rolled oat products.
Oats might help reduce cholesterol and blood sugar levels and control appetite by causing a feeling of fullness. Oat bran might work by blocking the absorption from the gut of substances that contribute to heart disease, high cholesterol, and Diabetes

Dr.Riyaz Sheriff

CHOCOLATES IN DIABETES!

Eating chocolates spoils your blood sugar control!!

True!

But there is one kind of chocolate that will benefit you..

THE DARK CHOCOLATE

Advantages

• Dark chocolate contains 70-80% cocoa
• Good source of antioxidants
• Improves blood flow
• Helps in release of endorphins, makes you feel happy
• Helps reduce insulin resistance
• Hardens tooth enamel
• Rich in vitamins and minerals

Dark chocolate has many benefits but is also rich in fat.... So careful with the quantity!

PAIN- FREE BLOOD SUGAR MONITORING

Hi all,

Maybe a year back I had put up a post on Non invasive glucometer of the future. It’s every patient’s dream to check his blood sugars without pain. We, doctors would always be happy to provide such a painless option to the patient. It would also help us in better treatment. There are so many companies trying different technologies for non invasive measurement of blood sugars. Finally I found one which sounds promising. I felt it’s worth a share with you people.

This particular glucometer is from a company called Grove instruments. The device uses near-infrared (NIR) spectroscopy to read the Blood Glucose Level. For the device to function properly and give accurate readings, the grey slot of the device must be placed over high blood flow area, such as the finger or the earlobe. It takes a real-time Blood glucose level from the blood using light.  The current international standard requires glucometer to differ from the blood standard by less than 20% before the instruments is released to the public for mass usage. The data from the clinical trials shows that Grove’s device has a mean average relative difference (MARD) of 8 to 12%.  Grove Instruments has maintained this MARD for the past two years.

Grove instruments claim that this is the first true non-invasive device that has a shot of making it to mass production for human usage. The other key aspect to this device is the time it takes to produce a result, 20 seconds or less. That is quicker than an individual can prick their finger and take a reading; making Grove’s device more time efficient, cleaner, and less painful than the current state of BGL testing. By having this device as a means of BGL testing, the average number of times a day an individual checks their BGL should move closer to the recommended four times a day. This technology has been patented. It is supposed to have cleared all safety standards and will be in mass production soon. I am trying to get it touch with the company to find out when this machine will be available in the market. Will update you people as soon as I get some good news

Till then..... Bye

Enjoy life!! 

HOW TO STORE INSULIN!!

Store insulin in fridge. ( recommended temperature is 2-8 degree C)
Do not keep insulin in freezer or chill tray
Do not use insulin which is frozen
If you cannot store your insulin in refrigerator, keep it in cool and dry place
Keep insulin away from direct sunlight
Do not expose insulin to high temperatures. eg. in glove compartment
of car, near cooking range, on top of electronic equipment
when travelling by air insulin should be carried in hand baggage.
carry a prescription with you whenever you travel.

RARE CAUSE OF ELEVATED FASTING BLOOD SUGAR!!

Dr. Michael Somogyi speculated that hypoglycemia during the late evening induced by insulin could cause a corrective hormone response that produces hyperglycemia in the early morning. This phenomenon was
named as Somogyi phenomenon. Patients with somoygi phenomenon have a higher fasting blood sugar levels. It is a common mistake that the patient increases night dose insulin to control the fasting values but
still lands up with higher fasting values!
The causes of Somogyi phenomenon include

• Excess or ill-timed insulin
• Missed meals or snacks
• Inadvertent insulin administration.

Somogyi phenomenon is probably rare. It occurs in diabetes mellitus type 1 and is less common in diabetes mellitus type 2. If the cause is found out early and treated the prognosis for Somogyi phenomenon is
excellent, and there is no evidence of long-term sequelae.

WHY THIS HAPPENS??

The ability to suppress insulin release is an important physiologic response that people with type 1 Diabetes cannot carry out. Defense against hypoglycemia involves production of glucose from non-carbohydrate sources (gluconeogenesis and glycogenolysis) This mechanism is dependent on an intact glucose sensor system in the CNS, pancreas, and afferent nerves.

HORMONES WHICH HELP INCLUDE:

• The first to act and the most important hormone is Glucagon. Glucagon acts on the liver to stimulate glycogenolysis and gluconeogenesis
• Epinephrine increases the delivery of substrates from the periphery, decreases insulin release, stimulates glucagon release, inhibits glucose utilization by several tissues, and stimulates a warning system with sweating, anxiety, and tachycardia.
• Cortisol may aid in prolonged and severe cases of Somogyi phenomenon by blocking glucose use and stimulating hepatic glucose output
• Growth hormones are similar to those of cortisol

INVESTIGATIONS

Laboratory studies for identifying Somogyi phenomenon include fasting blood glucose, nocturnal blood glucose, HbA1c, and frequent glucose sampling. The fasting blood glucose level is expected to be inappropriately elevated due to hormonally induced rebound. A glucose reading in the middle of the night will disclose hypoglycemia as a result of insulin therapy. This will establish the diagnosis. Obtaining an HbA1C level may be helpful if it is within the reference range or low despite an elevated fasting glucose level. It supports the concept of a rebound fasting hyperglycemia in the face of normal glucose control. An elevated HbA1C does not rule out Somogyi phenomenon.

Frequent glucose monitoring may be necessary to confirm the diagnosis and look for other periods of hypoglycemia that may lead to rebound hyperglycemia. Frequent hypoglycemia is responsible for hypoglycemic unawareness, which may cause the typical symptoms of hypoglycemia to be missed.

Treatment & Management
Somogyi phenomenon should be suspected in patients presenting with atypical hyperglycemia in the early morning that resists treatment with increased insulin doses.

If nocturnal blood sugar is confirmatory or if suspicion is high, reduce evening or bedtime insulin. Clinical signs, including weight gain, normal daytime blood sugar levels, and relatively low HbA1c,
suggest over treatment.

We insist every patient to go for SMBG (self monitoring of blood glucose) and 7 point blood sugar charting. This will help identify somogyi phenomenon early and manage it efficiently. Controlling of fasting blood sugar is essential as there is evidence linking increased fasting blood sugar levels to microvascular complications.