Home Blood Glucose Test Glucometer 5

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  • Hemoglobin A1C is the blood test with a memory. Hemoglobin is the protein in red blood cells that carries oxygen. These blood cells stay in circulation for 2-3 months. It is not used to diagnose just to monitor blood sugar control. It is performed two times a year. A hemoglobin of 6% indicates good control and level>8% indicates action is needed.
  • There are several diagnostic tests that can be used to determine the presence and type of diabetic neuropathy. Reviewing the patients’ symptoms can help determine if neuropathy is present and to what extent. It is important to remember that all other potential causes of, for example, muscle weakness and numbness, be ruled out before making a diagnosis of diabetic neuropathy. All patients with diabetes should receive an annual foot exam in which the foot is assessed for skin sensation using a monofilament (Semmes-Weinstein 5.07 (10-g)), skin integrity (calluses and sores, especially between toes), bone deformities or deformities in the foot’s structure or biomechanics, and vibration perception. Ankle reflexes should also be tested. Quantitative sensory testing (QST) (responses to pressure, vibration, and temperature) should be used to determine loss of sensation or sensitivity of nerves. X-ray can be used to verify bone deformities. Nerve conduction studies can detect possible nerve damage by assessing the transmission of nerve impulses. Impulses that are slower or weaker than normal may indicate damaged nerves. EMG, in conjunction with nerve conduction studies, can help determine if there is damage to muscle or nerve by assessing how well muscles respond to nerve impulses. When autonomic neuropathy is suspected, ultrasound of internal organs such as the bladder can assist in determining if there is any abnormal function or structure to the organ. For example, does the bladder empty completely after urination?
  • Home Blood Glucose Test Glucometer 5

    1. 1. S.SUNITHA THENDRAL ‘06
    2. 2. <ul><li>URINE &quot;GLUCOSE &quot; </li></ul><ul><ul><li>lacks sensitivity = positivity in disease </li></ul></ul><ul><ul><li>poor specificity = negativity in health </li></ul></ul><ul><li>Problems </li></ul><ul><ul><li>renal threshold variable 6 to 15 mmol/L </li></ul></ul><ul><ul><li>interferences : Clinitest / Glucose oxidase strips </li></ul></ul><ul><li>IF URINE TEST POSITIVE </li></ul><ul><li>A CONFIRMATORY BLOOD TEST IS NEEDED </li></ul>
    3. 4. <ul><li>Diagnosis </li></ul><ul><ul><li>Patient is symptomatic plus </li></ul></ul><ul><ul><ul><li>Casual plasma glucose (non-fasting) is 200 mg/dl OR </li></ul></ul></ul><ul><ul><ul><li>Fasting plasma glucose of 126 mg/dl or higher OR </li></ul></ul></ul><ul><ul><ul><li>Two hour plasma glucose level of 200 mg/dl or greater during an oral glucose tolerance test </li></ul></ul></ul>
    4. 5. <ul><li>A venous blood sample will be collected for the determination of fasting glucose </li></ul><ul><li>Load of 75g of glucose is ingested within 5 min </li></ul><ul><li>Blood samples will be collected at timed intervals (30min, 60min, 120min) for the determination of glucose </li></ul>
    5. 6. <ul><ul><li>Plasma glucose (mmol/L) </li></ul></ul><ul><ul><li> 0 min 120 min </li></ul></ul><ul><ul><li>Non diabetic < 6.1 < 7.8 </li></ul></ul><ul><ul><li>Impaired glucose tolerance 6.1 - 6.9 >7.8 - 11.1 </li></ul></ul><ul><ul><li>Diabetic > 7.0 > 11.1 </li></ul></ul>
    6. 7. <ul><li>HbA1c is stable glycosylated hemoglobin </li></ul><ul><li>Its percentage concentration indicates cumulative glucose exposure </li></ul>
    7. 8. <ul><li>A good indicator of blood glucose control. </li></ul><ul><li>Gives a % that indicates control over the preceding 2-3 months. </li></ul><ul><li>Performed 2 times a year. </li></ul><ul><li>A hemoglobin of 6% indicates good control and level >8% indicates action is needed. </li></ul>Lowering HbA 1C Reduces Risk of Complications
    8. 11. <ul><li>TO PREVENT TIMELY EMERGENCIES </li></ul><ul><li>OF HYPO AND HYPER GLYCEMIA </li></ul><ul><li>AMOUNT OF INSULIN TO BE USED BEFORE MEALS </li></ul><ul><li>EFFECT OF DIET AND EXERCISE ON BLD GLUCOSE </li></ul><ul><li>NEW GLUCOMETER ARE ATACHED WITH INSULIN PUMPS TO MONITER THE AMOUNT OF INSULIN TO BE RELEASED </li></ul><ul><li>COMPLICATIONS ; INFECTIONS IF FINGERS NOT CLEANED PROPERLY </li></ul><ul><li>HARDENING OF SKIN IF REPEATEDLY PRICKED </li></ul>
    9. 12. <ul><li>MICRO ALBUMINURIA </li></ul><ul><li>SERUM CREATININE (NORMAL <_ 1) </li></ul><ul><li>RELATIVE : </li></ul><ul><li>24 HR PROTEIN IN URINE </li></ul><ul><li>Blood levels of phosphorus, calcium, bicarbonate, and potassium </li></ul><ul><li>Hemoglobin </li></ul><ul><li>Hematocrit </li></ul><ul><li>Protein electrophoresis - urine </li></ul><ul><li>Red blood cell (RBC) count </li></ul><ul><li>HIGH BLOOD PRESSURE </li></ul>
    10. 14. <ul><li>Visual acuity testing ;ABILITY OF EYE TO FOCUS </li></ul><ul><li>SLIT LAMP EXAMINATION; CATARACT AND CHANGES IN ETINA </li></ul><ul><li>GONIOSCOPY;DRAIN ANGLE - GLAUCOMA </li></ul><ul><li>FLUORESCEIN ANGIOGRAM; LEAKING BLD VESSEL IN RETINA(DISTORTED VISION) </li></ul>
    11. 15. <ul><li>People with type 1 diabetes who are age 10 and older should have an eye exam within 3 to 5 years after diabetes is diagnosed and then every year </li></ul><ul><li>People with type 2 diabetes should have an exam as soon as diabetes is diagnosed and then every year </li></ul>
    12. 18. <ul><li>Assess symptoms - muscle weakness, muscle cramps, prickling, numbness or pain, vomiting, diarrhea, poor bladder control </li></ul><ul><li>Comprehensive foot exam </li></ul><ul><ul><li>Skin sensation and skin integrity </li></ul></ul><ul><ul><li>Quantitative Sensory Testing (QST) </li></ul></ul><ul><ul><li>X-ray </li></ul></ul><ul><li>Nerve conduction studies </li></ul><ul><li>Electromyographic examination (EMG) </li></ul><ul><li>Ultrasound </li></ul>
    13. 20. <ul><li>NORMAL RANGE </li></ul>ANALYTE NORMAL VALUE (MG/DL) TOTAL PLAMA LIPID 400 – 600 TOTL CHOLESTROL 150 – 200 HDL 30 – 75 LDL 80 -175 TRIGLYCERIDE 40 -150 PHOSPHOLIPID 150 -200 FREE FATTY ACID 10 - 20
    14. 21. <ul><li>SERUM CHOLESTROL <220 MG/DL </li></ul><ul><li>LDL >160MG/DL </li></ul><ul><li>HDL<35 MG/DL </li></ul><ul><li>WHY DM HAS HIGH RISK FOR MI? </li></ul><ul><li>LACK OF INSULIN ACTIVATES LIPASE </li></ul><ul><li>GLYCATION OF LDL INCREASES ITS HALF LIFE </li></ul>

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