Download The Hemoglobin A1c (HbA1c) Test for Diabetes

The Trinity
Hypertension (High Blood Pressure)
Hypertension is often the first problem that appears chronologically, due to a) the genetic
component, b) reduced physical activity levels. 90-95% of all cases are primary, meaning
there is no specific medical cause.
Hypertension is a chronic medical condition in which the systemic arterial blood pressure
is elevated. It is the opposite of hypotension. Persistent hypertension is one of the risk
factors for stroke, myocardial infarction, heart failure and arterial aneurysm, and is a
leading cause of chronic kidney failure.
Hypertension is monitored by taking the Blood Pressure
Systolic blood pressure is the blood pressure in vessels during a heartbeat. Diastolic
blood pressure is the pressure between heartbeats.
Normal
Borderline
Hypertension
Systolic
<120
120-139
>140
and
or
or
Diastolic
<80
80-89
>90
Most hypertension can be well controlled with medication, but compliance has to be
high, as bp meds have to be taken daily. Although patients often initially indicate a
preference for making lifestyle changes rather than taking medication, most eventually
end up on meds due to limited lifestyle change.
Bp also has to be monitored regularly, as medication and/or lifestyle change effectiveness
often declines over time and/or due to changes in patients life circumstances.
Combinations of meds are commonly used when the effectiveness of one drug declines,
and some meds actually contain two different drugs.
ex. Hyzaar: Combination of hydrochlorothiazide and losartan. Hydrochlorothiazide is a
thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt,
which can cause fluid retention. Losartan is a angiotensin II receptor antagonist.
Losartan keeps blood vessels from narrowing, which lowers blood pressure and improves
blood flow.
Hypercholesterolemia (High Cholesterol)
High cholesterol may appear quite early when familial (even in the teens), but more
commonly develops in mid-life.
High blood cholesterol is the presence of high levels of cholesterol in the blood. It is not
a disease but a metabolic derangement that can be caused by many diseases and can in
turn contribute to many other diseases, notably cardiovascular disease. It is closely
related to the terms "hyperlipidemia" (elevated levels of lipids) and
"hyperlipoproteinemia" (elevated levels of lipoproteins).
Elevated cholesterol in the blood is due to abnormalities in the levels of lipoproteins, the
particles that carry cholesterol in the bloodstream. This may be related to diet, genetic
factors (such as LDL receptor mutations in familial hypercholesterolemia) and the
presence of other diseases such as diabetes and an underactive thyroid.
The test for cholesterol that is usually performed is a blood test called a lipoprotein
profile. Cholesterol levels should be measured at least once every five years by everyone
over the age of 20. Men aged 35 and older and women age 45 and older should be
screened for lipid disorders annually. The lipoprotein profile includes:
* LDL (low density lipoprotein cholesterol, also called "bad" cholesterol)
* HDL (high density lipoprotein cholesterol, also called "good" cholesterol)
* Triglycerides (fats carried in the blood from the food we eat. Excess calories,
alcohol, or sugar in the body are converted into triglycerides and stored in fat cells
throughout the body.)
Cholesterol is an essential structural component of mammalian cell membranes, where it
is required to establish proper membrane permeability and fluidity. However, LDL
cholesterol can build up on the walls of your arteries and increase your chances of getting
heart disease. That is why LDL cholesterol is referred to as "bad" cholesterol. The lower
your LDL cholesterol number, the better it is for your health.
Calories ingested in a meal and not used immediately by tissues are converted to
triglycerides and transported to fat cells to be stored. Hormones regulate the release of
triglycerides from fat tissue so they meet the body's needs for energy between meals.
Diets high in carbohydrates, with carbohydrates accounting for more than 60% of the
total caloric intake, can increase triglyceride levels. Of note is how the correlation is
stronger for those with higher BMI (28+) and insulin resistance (more common among
overweight and obese). Alcohol consumption can also increase trigs.
Total cholesterol
Desirable
Borderline
High
9-12 hour fasting lipoprotein levels (mg/dl)
<200
200-239
>239
LDL
Optimal
Near Optimal
Borderline
High
<100
100-129
130-159
>160
HDL
Low
<40 men; <50 premenopausal women
High (desirable)
>60
Triglycerides
Normal
Borderline
High
Very High
<150
150-199
200-499
>500
Hypercholesterolemia is treated by reducing dietary cholesterol intake and administration
of certain medications. In strictly controlled surroundings, such as a hospital ward
dedicated to metabolism problems, a diet can reduce cholesterol levels by 15%; in the
real world 5% reduction is very good. Dietary change is, however, very important to
long-term management of cholesterol levels.
Current guidelines suggest starting everyone with High LDL on mediation. Statins (or
HMG-CoA reductase inhibitors) are a class of drug used to lower cholesterol levels
Minimum useful doses are: simvastatin, 40 mg/d; pravastatin, 40 mg/d; lovastatin, 40
mg/d; atorvastatin, 20 mg/d; or an equivalent dose of another statin. Increasing dosages
are used if effectiveness diminishes over time. There are infrequent, but potentially
dangerous side effects of statins, so blood tests for liver function are routinely
administered when taking statins (every 3-6 months), along with lipid profiles to check
cholesterol control. There are increasing concerns about higher dose statin use (ex. FDA
has recently indicated physicians should find an alternative to 80 mg/d or higher doses of
simvastatin (zocor), which is widely used.
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes—is a group of metabolic diseases
in which a person has high blood sugar, either because the body does not produce enough
insulin, or because cells do not respond to the insulin that is produced. This high blood
sugar produces the classical symptoms of polyuria (frequent urination), polydipsia
(increased thirst) and polyphagia (increased hunger).
There are three main types of diabetes:
* Type 1 diabetes: results from the body's failure to produce insulin, and presently
requires the person to inject insulin. (Also referred to as insulin-dependent diabetes
mellitus, IDDM for short, and juvenile diabetes.)
* Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use
insulin properly, sometimes combined with an absolute insulin deficiency.
* Gestational diabetes: is when pregnant women, who have never had diabetes before,
have a high blood glucose level during pregnancy. It may precede development of type 2
DM.
Glucose Testing: Immediate blood sugar; 65-99 mg/dl is the normal range, thus values
>100 indicate elevated glucose. Easily tested with glucometer at home.
The Hemoglobin A1c (HbA1c) Test for Diabetes
The hemoglobin A1c test -- also called HbA1c, glycated hemoglobin test, or
glycohemoglobin -- is an important blood test used to determine how well your diabetes
is being controlled. Hemoglobin A1c provides an average of your blood sugar control
over a six to 12 week period and is used in conjunction with home blood sugar
monitoring to make adjustments in your diabetes medicines.
Hemoglobin is a substance within red blood cells that carries oxygen throughout your
body. When your diabetes is not controlled (meaning that your blood sugar is too high),
sugar builds up in your blood and combines with your hemoglobin, becoming "glycated."
Therefore, the average amount of sugar in your blood can be determined by measuring a
hemoglobin A1c level. If your glucose levels have been high over recent weeks, your
hemoglobin A1c test will be higher. The amount of hemoglobin A1c will reflect the last
several weeks of blood sugar levels, typically encompassing a period of 120 days.
What's a Normal Hemoglobin A1c Test?
For people without diabetes, the normal range for the hemoglobin A1c test is between 4%
and 6%. Because studies have repeatedly shown that out-of-control diabetes results in
complications from the disease, the goal for people with diabetes is an hemoglobin A1c
less than 7%. The higher the hemoglobin A1c, the higher the risks of developing
complications related to diabetes.
People with diabetes should have this test every three months to determine whether their
blood sugars have reached the target level of control. Those who have their diabetes
under good control may be able to wait longer between the blood tests, but experts
recommend checking at least 2 times a year.
Patients with diseases affecting hemoglobin such as anemia may get abnormal results
with this test. Other abnormalities that can affect the results of the hemoglobin A1c
include supplements such as vitamins C and E and high cholesterol levels. Kidney
disease and liver disease may also affect the result of the hemoglobin A1c test.
Management & Treatment
Management concentrates on keeping blood sugar levels as close to normal
("euglycemia") as possible without presenting undue patient danger. This can usually be
with close dietary management, exercise, and use of appropriate medications (insulin
only in the case of type 1 diabetes mellitus. Oral medications may be used in the case of
type 2 diabetes, as well as insulin).
Patient education, understanding, and participation is vital since the complications of
diabetes are far less common and less severe in people who have well-managed blood
sugar levels. Wider health problems may accelerate the deleterious effects of diabetes.
These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack
of regular exercise.
Anti-diabetic drugs treat diabetes mellitus by lowering glucose levels in the blood. With
the exceptions of insulin, exenatide, and pramlintide, all are administered orally and are
thus also called oral hypoglycemic agents or oral antihyperglycemic agents. There are
different classes of anti-diabetic drugs, and their selection depends on the nature of the
diabetes, age and situation of the person, as well as other factors.
Diabetes mellitus type 1 is a disease caused by the lack of insulin. Insulin must be used in
Type I, which must be injected or inhaled.
Diabetes mellitus type 2 is a disease of insulin resistance by cells. Metformin is usually
the first-line medication used for treatment of type-2 diabetes. Initial dosing is 500 mg
once daily, then if need be increased to 500 mg twice daily up to 1000 mg twice daily. It
is also available in combination with other oral diabetic medications. It is the primary
oral med for diabetes that does not cause weight gain.