A BASELINE MEASURE OF YOUR DISEASE
AND RISK PROFILE
Excerpted from Chapter 2: TESTS
The goal in the treatment
program laid out in this book is to give you the tools and the knowledge
to take control of your disease by normalizing blood sugars. My interest
is in treating not just the symptoms of diabetes, but diabetes itself.
Essential to treatment is learning to monitor your own blood sugars.
Before you begin to monitor and then normalize your blood sugars, you
should have a baseline analysis of your disease. How much of your pancreas
has “burned out” in part from high blood sugars? Have you
already developed some easily measured long-term complications of diabetes?
What are your risks for other diabetic complications?
Answering these questions will aid you and your doctor in learning
the extent and the consequences of the disease. Your test results will
also serve as valuable baseline data to which you will be able to compare
the effects of blood sugar normalization. Once your blood sugars have
been normalized, such tests can be repeated from time to time, to show
what you’re achieving. Your improvements will give both you and
your physician ongoing incentive for sticking to the program.
The remainder of this chapter describes a number of tests your doctor
or his laboratory can perform in order to give both of you a picture
of your diabetic condition. I have laid these out not because it’s
necessary for you to memorize them, research them, and know all the
ins and outs of them, but so that you can get the treatment you deserve.
By outlining these tests, I’m giving you a “shopping list”
of tests I perform on myself and on my patients.
Generally, I recommend as many as you can afford or your insurance
or health maintenance organization (HMO) will pay for. Completing more
of the tests will add more dimensions to the picture you gain of your
disease. As some of these tests are costly, any or all may be skipped
if you cannot afford them or if your insurance or HMO won’t pay
for them.
It is your physician’s obligation to provide you with copies
of all your test results, whether from laboratory tests or from physical
examinations. This is your right; however, you must request them. The
laws governing medical records vary state by state, and legislatures
are listening to health care consumers and making changes regularly.
At this writing, however, it is most often the case that medical records
are the property of the doctor, so do not neglect to request copies
of any results. Such results can be potentially of great value when
you visit another physician or specialist for treatment of any problems.
BLOOD AND URINE TESTS
Glycated Hemoglobin (HgbA1C)
Glucose binds to hemoglobin (the pigment of red blood cells) when new
red cells are manufactured. Since the average red cell survives about
four months, the percentage of hemoglobin molecules that contain glucose
(HgbA1C) provides an estimate of average blood sugar over this time
frame. One of the benefits of this test is that it gives your physician
an index by which to test the accuracy of your own blood glucose self-monitoring
results. If your measurements are strictly normal but your HgbA1C is
elevated, then your doctor has a clue that something is awry.
There are, however, a couple of significant drawbacks to this test.
First is that the test is only a measure of average blood sugars. Second,
elevated blood sugars may take 24 hours to have any long-term effect
on HgbA1C, and if blood sugar is elevated for only part of each day
and is normalized or too low the rest of the time, your HgbA1C results
may appear deceptively low. Thus, if your blood sugars are only elevated
for a few hours after meals, your HgbA1C may not be affected, but many
tissues and organs throughout your body will be injured.
The other drawback is that the upper and lower ranges of “normal”
values reported by most labs are usually erroneously high and low, respectively.
In other words, the ranges are usually much too wide. Thus, it’s
up to your physician to decide, based upon his experience, what the
proper normal range for his lab should be. Many doctors have their own
formulas for estimating average four-month blood sugar levels from HgbA1C.
A normal value should correspond to blood sugars of about 85–95
mg/dl. The experience I’ve had with the lab I use (the largest
in the United States) for my patients is that a truly normal HgbA1C
ranges from 4.2 percent to 4.6 percent, which corresponds to blood sugars
of about 83–90 mg/dl. Mine is consistently 4.5 percent.
Serum C-Peptide (Fasting)
C-peptide is a protein produced by the beta cells of the pancreas whenever
insulin is made. The level of C-peptide in the blood is a crude index
of the amount of insulin you’re producing. The level is usually
zero in type 1 diabetics, and within or above the “normal range”
in mild type 2 obese (insulin-resistant) diabetics.
If your blood serum C-peptide is elevated, this would suggest to your
physician that your blood sugar may be controllable merely by diet,
weight loss, and exercise. If, at the other extreme, your C-peptide
is below the limits of measurability, you probably require injected
insulin for blood sugar normalization. C-peptide measurements, to be
most significant, should be checked after a 12-hour fast when blood
sugars are normal. The test can be best interpreted if blood sugar is
measured at the same time.
Because a physician experienced in treating diabetes can probably make
such decisions with only the help of your blood sugar profiles (see
Chapter 4), this test, while of interest, is not absolutely necessary.
Complete Blood Count (CBC)
Part of most medical workups, this is a routine diagnostic test that
can disclose the presence of ailments other than diabetes. A CBC measures
the number of various types of cells found in your blood—white
cells, red cells, and platelets. A high level of white blood cells,
for example, can disclose the presence of infection, while too few red
blood cells
can indicate iron deficiency anemia. Many diabetics have inherited thyroid
dysfunction, which can cause low-normal to low white cell counts. A
white cell count less than 5 suggests that a full thyroid profile should
be performed. This must include free and total T3 and T4.*
A CBC can also detect certain hematologic malignancies, which are
usually more effectively treated the earlier they are discovered.
***********************************************************************************************************
* It’s worth noting that one of the hallmarks of diabetes is fatigue.
However, diminished
thyroid function can cause profound fatigue and coldness. If you’re
still “always tired” or “always cold” after
normalizing blood sugars, talk to your physician about a thyroid profile.
This test can be costly
***********************************************************************************************************
Standard Blood Chemistry Profile
This battery of twelve to twenty tests is part of most routine medical
examinations. It includes gauges for such important chemical indicators
of health as liver enzymes, blood urea nitrogen (BUN), creatinine, alkaline
phosphatase, calcium, and others. If you have a history of hypertension,
your doctor may want to add red blood cell magnesium to this profile.
Serum Albumin
Although serum albumin is usually included in the blood chemistry profile,
it is not widely appreciated that low levels are associated with double
the all-cause mortality of high levels. It is thus very important that
patients with low serum albumin receive further workup to determine
the cause.
To Read This Entire
Series Click Here
We would like to thank the publisher Little Brown and Company and Dr.
Richard K. Bernstein, for allowing us to provide excerpts from Diabetes
Solution.
Copyright © 2003 by Richard K. Bernstein, M.D.
All rights reserved. No part of this book may be reproduced in any form
or by any electronic or mechanical means, including information storage
and retrievalsystems, without permission in writing from the publisher,
except by a reviewer who may quote brief passages in a review.
Author’s Note
This book is not intended as a substitute for professional medical care.
The reader should regularly consult a physician for all health-related
problems and routine care.
For information on how you can purchase Diabetes Solution,
go to www.Diabetes-solution.net
Now on Special for $19.95. Regular $27.95
A savings of $8.00. Plus you will receive at no cost.
FREE BONUS with purchase of “Diabetes Solution”
FREE BONUS with purchase of “Diabetes
Solution”
“Getting to the Heart of Diabetes” is a guide to
understanding CVD, diabetes and insulin resistance. This is
a small guide with 4 chapters, Diabetes, Insulin Resistance, Controlling
Diabetes and Warning Signs for heart attacks and strokes. After reading
the booklet, your patient can take the next step by putting their new
knowledge into action. As part of the program patients receive the following
free of charge………….
1. Heart of Diabetes Journal to track your progress in managing your
diabetes and reducing your risk for cardiovascular disease;
2. 12-month subscription to Diabetes Positive magazine; and
3. Incentives throughout the year to help stay motivated.
ORDER NOW! www.diabetes-solution.net
or Call 1-800-798-6972 or
Email: info@diabetes-solution.net
