What additional monitoring does the doctor do?

What additional monitoring does the doctor do?

Blood Glucose: The American Diabetes Association has the set the recommendations for health care providers on what they should be doing and what should be available for the optimal care of patients with diabetes. Among these recommendations are the monitoring of blood glucose either by fingerstick or through a venipuncture and lab testing. It should be used to supplement the information obtained from the patients regular home blood glucose readings, and used if the provider feels the patients is currently too high to too low in the office. Office testing also allows the physician to see if the patient's results at home are accurate.

Continuous Glucose Sensors (CGMS): There are also currently available Continuous Glucose Sensors (CGMS). These devices function similar to a Holter monitor of the heart. A small cannula is inserted into the superficial tissue of the abdomen (the subcutaneous tissue). The needle is removed and the sensor remains. It is taped in place and connected to an external device about the size of a pager. This records glucose values at an interval of roughly 20 minutes over a 72 hour period. At the end of that period, the recorded glucose values are down-loaded, and information is reviewed. Patients usually keep a log over the 72 hour period of how they feel, what they eat, and what their fingerstick readings are to compare with the sensor. This data is especially great for athletes, patients who are unpredictable in their highs and lows, and those who can't seem to find a pattern to their finger stick glucose readings. While a fascinating device for patients, the CGMS has not be proven to actually improve blood sugar control, though it does help to provide insight.

Hemoglobin A1C Testing: The hemoglobin A1C test is very important in the monitoring of blood glucose control in diabetes. In brief, hemoglobin A1C is a term used to describe a series of chemical reactions which occur when red blood cells are exposed to glucose. A red blood cell lives for about 3 months, so this reading is an average of 3 months worth of blood sugar control. Many different types of methods are available in the lab to determine the A1C levels. Regardless, the A1C level has been shown to predict the risk for developing complications of diabetes, much in the same way that cholesterol levels are predictive of heart disease. The A1c test should be performed routinely in all patients with diabetes, first to document the degree of glycemic control at initial assessment then to follow the patient as part of their diabetes management. It should be performed at 3 month intervals.

A blood sample can be obtained through a usual venous blood draw (through the vein) and sent to a laboratory for A1C measurement. Alternatively, many physicians who specialize in diabetes now have A1c machines in their office, which will read a fingerstick blood sample within a few minutes.

There are a few conditions in which the A1C values may be inaccurate, and these mostly are a result of problems with the red blood cells. For example, if the red cells are too few (as with anemia, which may be due to many different causes, see "Anemia"), results may be falsely low. Similarly, in conditions where the red blood cells loose their spherical shape (as in thalassemias, sickle cells disease and spherocytosis), falsely low readings can occur. The A1C is a valuable tool in helping to individualize patient care so that glycemic goals can be achieved.

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Dr Marwah