A1C test helps diagnose diabetes

By Nancy Klobassa, R.N., and Peggy Moreland, R.N.

Our office recently received a call asking about a “new” blood test to diagnose diabetes. You may have heard on the news earlier this year that at the American Diabetes Association’s annual meeting an international committee of experts announced their consensus that the A1C blood test is an accurate way to diagnose diabetes.

The A1C test, also known as glycated hemoglobin or HbA1C, is a blood test that provides a picture of average blood sugar control for the past two to three months.

When you have uncontrolled diabetes, you have too much sugar in your blood stream. The extra blood glucose enters your red blood cells and sticks to the molecules of the hemoglobin.

The A1C measures the percentage of glycosylated hemoglobin in your blood and this gives your doctor an overview of your average blood glucose control over the past 2-3 months. So, the A1C test is not new, it is just that it’s now being recommended as a tool to diagnose diabetes.

The A1C helps:

  • Confirm self-testing blood glucose results
  • To evaluate whether or not your diabetes management plan is working
  • You see how healthy choices make a difference in blood sugar control

The A1C does not:

  • Replace daily self-testing of blood glucose
  • Measure your day-to-day control. You cannot adjust your insulin doses based on A1C tests

Daily self-testing of blood glucose and your log results are important to staying in effective control. The A1C test is used along with your daily blood glucose checks for the best possible control.

A1C chart

Learning about osteoporosis – What is osteoporosis?

What is osteoporosis?

Agency for Healthcare Research and Quality article.

Osteoporosis means that bones become less dense (or less solid). When bone density is low, bones become weak and easier to break. Bone density that is low enough for bones to break easily is called osteoporosis.

Who gets osteoporosis?

Half of all women 50 and older will have a broken bone from osteoporosis at some time during their life.

Osteoporosis is more likely for:

  • Women after menopause, mostly because the body has less estrogen.
  • Smaller and thinner women.
  • White or Asian women.
  • Women who have family members who had osteoporosis and broke a bone.
  • Women who smoke tobacco or drink too much alcohol.
  • Women who take certain medicines, like thyroid medicine or steroids.

Both men and women can have osteoporosis, but most of the research is about women.

What causes osteoporosis?

Bone is living tissue. Old and damaged bone is always being broken down and replaced with new bone. As you get older, your body loses minerals, like calcium. Calcium is needed to build new bone. If you have osteoporosis, it means your old bone is not being replaced fast enough by new bone.

Hormones in the body, like estrogen, help prevent bones from breaking down too fast. When you go through menopause, your body makes less estrogen. The loss of hormones is why women are more likely to have osteoporosis after menopause.

Images of Normal Bone with a dense matrix of bone matter, and an image of a bone with osteoporosis, with a very light and scattered matrix of bone matter.

How do I know if I have osteoporosis?

To find out if you have osteoporosis, your doctor will do a bone density test. Often this is a special x-ray test called a DXA (dex-ah). It measures the thickness of your bones. It can tell if your bones are getting weak. It does not say for sure if your bones will break. Your doctor or nurse can tell you if your bone density is low enough to mean that you have osteoporosis.

Which bones can break?

Osteoporosis can cause any bone to break. The most likely bones to break are the spine, hip, or wrist. Bones can break from a fall or just a hard bump.

Spine
Cracks in the bones of the spine can cause these bones to crunch together (compression fracture). This can cause backaches and pain. In fact, loss of an inch or more of height may be the first sign of osteoporosis.

Hip
A broken hip almost always needs to be repaired with surgery. Recovery from the operation can take a long time. A broken hip can raise the risk of serious problems, even death.

Wrist
A broken wrist makes it hard to use the arm and hand. It can also require surgery.

Should my child get the swine flu (H1N1) shot?

by CHILDREN’S HOSPITAL BOSTON STAFF

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by Adrienne Randolph, MD, MSc, Division of Critical Care Medicine

Tilmo, my taxi driver, was there as promised to take me to the Atlanta airport when I left the Centers for Disease Control and Prevention (CDC). He had dropped me off that morning so I could meet with six different influenza researchers and give a talk on life-threatening influenza in children.

“A letter has been sent home from my child’s school,” he said as we drove away. “I must decide whether or not he will get the swine flu shot. Doctor, what would you advise?”

I am an attending physician in the Medical-Surgical Intensive Care Unit (ICU) at Children’s Hospital Boston. In June and July of this year, we had an upsurge of admissions of children with influenza pneumonia who had profound hypoxia (oxygen deprivation) that wasn’t responding to treatment. I immediately said, “Get him vaccinated as soon as it is available. My three children will get the vaccine.”

He asked, “Are there any risks?”

The answer is not completely clear. Testing hasn’t yet been performed in an enormous number of children, and longer-term risks can’t be assessed. “There is a very small risk of developing neurologic side effects from the vaccine, but this virus causes a very severe pneumonia that can kill otherwise healthy children,” I told him. “The risks of not getting vaccinated are higher than the risks of getting vaccinated.”

I had weighed these risks carefully. In 1976-77, with the last swine flu vaccine, as many as 1 in 85,000 people vaccinated came down with Guillain-Barré syndrome — a neurologic condition that paralyzes the muscles, causing respiratory failure. In contrast, there were very few confirmed deaths from swine flu that year.

But it is clear that the 2009 swine flu is more severe. According to the CDC Web site, from August 30 to September 12 alone there were 4,569 hospitalizations and 364 deaths among U.S. adults and children from any type of influenza – and the only flu strain going around at the moment is the novel H1N1 influenza A swine-origin strain. Of the 114 children who died from influenza in the last year, from September 28, 2008 to September 12, 2009, 46 had influenza A H1N1 — the strain that started to infect people in April.

Because I was funded by the CDC in January to investigate why some children get sicker with influenza infection, I knew of severe flu cases in my study network, consisting of 30 pediatric ICUs. We’ve seen cases of encephalitis, an infection in the brain, and cases of influenza myocarditis, an infection of the cardiac muscle causing the heart to have severely depressed function.

We were almost back at the airport. Tilmo had one more question. “Is the vaccine made from swine? I have a problem because swine are considered unclean in my country.” Tilmo is from Ethiopia and is a Muslim. It took me a moment to reply: “The novel H1N1 strain of flu is called swine flu because part of the virus is of the same type that infects swine. It is not actually made of swine.”

I then realized that it is important for Muslim leaders to be educated about this. Despite the attempts of public health experts in many nations, the nickname “swine flu” just won’t go away, and it would be very worrisome if Muslims did not get vaccinated.

Four days after leaving the CDC, I learned that my research network was funded by the NIH to perform surveillance for life-threatening and fatal cases of swine flu in U.S. children. We are also in the final contest for CDC funding to study the effectiveness of the H1N1 vaccine in preventing life-threatening illness. Our government has quickly released millions of dollars to combat H1N1, and I hope that those who are able to get their children vaccinated will take advantage of the opportunity.