Knowing Your Numbers Tools for Better Health. Why numbers? Numbers for diagnosis. Lab tests used in diagnosis

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1 Knowing Your Numbers Tools for Better Health Kerem Ozer, M.D. Texas Diabetes and Endocrinology Why numbers? Lab tests used in diagnosis Lab tests to screen for conditions that people with type 1 diabetes are at increased risk for Lab tests to help decrease your risk for complications Numbers for diagnosis Glucose Primary source of energy Diabetes Fasting plasma glucose 126 mg/dl 2-hour plasma glucose 200 mg/dl during an oral glucose tolerance test In someone with high-glucose symptoms, a random glucose 200 mg/dl

2 Numbers for diagnosis Hemoglobin A1c Red blood cells which carry oxygen around in the blood are filled with a protein called hemoglobin In the normal 120-day lifespan of the red blood cell, glucose reacts with hemoglobin and forms hemoglobin A1c Numbers for diagnosis Hemoglobin A1c In individuals with poorly controlled and often, newly diagnosed diabetes, quantities of these molecules are much higher than in healthy people or people with well-controlled diabetes Hemoglobin A1c 6.5% can be used to diagnose diabetes Lab tests used in diagnosis Oral glucose tolerance test Measures the concentration of glucose in blood after a sugar load of 75 grams Glucose levels 2 hours after drinking the glucose solution 200 mg/dl are consistent with diabetes

3 Lab tests used in diagnosis Random plasma glucose Any glucose level equal to or above 200 mg/dl in an individual with symptoms of high sugar levels is consistent with diabetes Symptoms of elevated blood sugar levels may include Thirst Increased frequency of urination Hunger Celiac disease A condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats Celiac disease Children with type 1 diabetes should be screened for celiac disease by measuring levels of proteins that react with the intestinal lining These proteins may be referred to as tissue transglutaminase or anti-endomysial antibodies

4 Celiac disease Testing should be repeated in children with growth failure, problems with gaining weight, weight loss, diarrhea, flatulence, abdominal pain or difficulty absorbing nutrients Positive antibody test should prompt a referral to a gastroenterologist Endoscopy / biopsy and referral to a dietitian are the next steps Hypothyroidism Children with type 1 diabetes should be screened for underactive thyroid Proteins made by the immune system against the thyroid gland (antibodies) should be measured Hypothyroidism TSH (thyroid stimulating hormone) levels should be measured after glucose levels have been wellcontrolled If normal, they should be rechecked every 1-2 years They should be checked if the individual develops symptoms of thyroid problems

5 Hemoglobin A1c Checked once every three months Age-specific goals for A1c: <6 years of age: <8.5 percent 6 to 12 years of age: <8 percent 13 to 19 years of age: <7.5 percent Over 19 years of age: <7.0 percent Rough estimate Average sugar levels = (A1c 2) x 30 Age-specific goals for blood glucose at bedtime <6 years of age: 110 to 200 mg/dl 6 to 12 years of age: 100 to 180 mg/dl 13 to 19 years of age: 90 to 150 mg/dl Age-specific goals for blood glucose before meals <6 years of age: 100 to 180 mg/dl 6 to 12 years of age: 90 to 180 mg/dl 13 to 19 years of age: 90 to 130 mg/dl

6 Self-monitoring of blood glucose What does it mean Targets and how to reach them Weight / BMI Important aspect of care to decrease risk of coexisting insulin resistance Blood pressure Important aspect of care to decrease risk of complications

7 Urine protein Screening for kidney problems related to diabetes (nephropathy) Performed yearly for children 10 years of age with a five-year duration of diabetes Cut-off levels change based on assay used Lipid panel Important to decrease risk of heart disease or stroke Obtain lipid profile at diagnosis (after glycemic control is well established). If normal, repeat every 5 years. Begin at age 10 years (or onset of puberty, if earlier) Begin prior to age 10 years if there is a family history of early cardiovascular disease, or if child is overweight or obese Lipid panel If lipids are abnormal, annual monitoring is recommended If LDL cholesterol values are within the accepted risk levels (<100 mg/dl), a lipid profile should be repeated every 5 years

8 Lipid panel -Goals LDL <100 mg/dl HDL >35 mg/dl Triglycerides <150 mg/dl Lipid panel Treatment Decrease intake of saturated fat Maximize glycemic control Weight reduction, if indicated Medications Age >10 years AND LDL 160 mg/dl, OR LDL mg/dl if other risk factors for CVD Manage other CVD risk factors Blood pressure Tobacco Obesity Inactivity Summary Diagnosis Glucose Hemoglobin A1c Oral glucose tolerance test Screening Celiac disease Underactive thyroid Reduce complications Glucose Hemoglobin A1c Weight Blood pressure Urine protein Lipid panel

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