Thursday, December 29, 2011
Wednesday, December 21, 2011
NMR lipid profile is a test that measures the number and size of lipoproteins such as LDL and HDL. This can be useful when trying to evaluate someones LDL cholesterol when they have an elevation of their Triglyceride level over 150mg/dl.
LDL is made in the liver and is produced is a spectrum of sizes varying from small to large LDL particles. The smaller size LDL is associated with increased risk of heart disease . Triglyceride elevation which is common in people with Type 2 diabetes is associated with an increase is the small dense LDL particles .
Apo b test is another way of this problem. See my blog Dec.14
What are the Benefits of A1c testing ?
This is a great question.
Glucose in blood binds to hemoglobin in red blood cells and remains attached for the life of the cell which is about 3 months. Higher glucose levels are associated with more glucose attachment . The chart below will give you an idea of how A1c results correlate with mean glucose test results..
Mean plasma glucose
Monday, December 19, 2011
Friday, December 16, 2011
This is an easy test to do on your own lab. and may help you and you physician make management decisions
Have fun Dr. Calder
Wednesday, December 14, 2011
We do have another way of evaluating LDL cholesterol .
It is possible to measure a protein , called Apo-b .
Apo-b lipoprotein is an integral part of each LDL particle regardless of it's size.
Recommended Goals 2009
ACC( American college of cardiology )
ADA ( American Diabetes Association )
LDL <100 mg/dl Apo b < 90 mg/dl
LDL < 70 mg/dl Apo b <80 mg/dl
Combining this test with your LDL result is another tool helping you and your doctor reduce your risk of heart disease.
What is non-HDL cholesterol ? Find out tomorrow .
Have fun. Dr. Calder
Tuesday, December 13, 2011
Many of us are satisfied with a call from our doctors office reporting that " every thing looks OK " .
I would like to encourage you to not accept that answer and use a different approach.
#1 always ask for a copy of your lab. reports
#2 Know what the recommended goals are for each test
#3 Any test not at the recommended goal is a reason to make an appointment and discuss the result
with your doctor
#4 Read and learn as much as you can about the test in question before seeing your doctor. Your
doctor is a wonderful source of wisdom and understanding if you just ask for the help.
Lets take a closer look at your lipid panel.
Your total cholesterol is made up of components of each of the other test.
Total cholesterol = 1/5 of triglycerides + HDL + LDL
Triglycerides- triglycerides are often the sleeper with a major impact on our other test results
LDL cholesterol is made in our liver and
LDL is produced in various sizes ,varying from small dense particles to larger fatter particles.
The size of the LDL particles changes with our triglyceride levels
High triglycerides are associated with an increase in small dense LDL particles and increased
risk of heart disease.
LDL cholesterol is usually not measured and instead is a calculated number.
LDL = Cholesterol - 1/5 of triglycerides - HDL
Changes in triglyceride levels have a major effect on your LDL test results
Higher triglycerides increase small dense LDL and lower appearing LDL results
Compare the LDL result by changing triglycerides from 150 mg/dl to 300 mg/dl
Total Cholesterol - 1/5 triglycerides - HDL = LDL Cholesterol
200mg/dl - 150/5 ( 30 ) - 40 = 130mg/dl
200 mg/dl - 300/5 (60) - 40 = 100 mg/dl
The decision to recommend a statin becomes a little more complex when elevated triglycerides are
included in the pictures. This is a common every day problem for people with type 2 diabetes.
The most common lipid profile for patients with Type 2 diabetes is a slight increase in total
cholesterol , LDL and triglycerides.
What about a Apo-b test. find out tomorrow.
Have fun Dr. Calder
Monday, December 12, 2011
We don't know because it is silent !
We know who is at risk .
We know what the risk factors are for heart disease.
We know that we can correct the risk factors and reduce the risk of developing heart disease.
We know that we have safe effective medications for reducing risk.
You may have noticed that long term becomes a little shorter as we approach Geezerhood .
issues of diabetes care. )
Saturday, December 10, 2011
He refered to another study the Cholesterol treament Trailists'Colalaboration which showed that women and people with type 1 diabetes over the age of 40 benefited from the use of statins.
I like final sentence in the CARDS study.
"THe debate about whether all patients with type 2 diabetes warrant statin treatment should now focus on whether any patient can reliably be identified as sufficiently low risk for this safe and efficacious treatment to be withheld" .
Upcoming topics on cholesterol. The > good , the < bad = < ugly outcome
How low to go with LDL cholesterol ( bad cholesterol ) ? Is there a level of optimal benefit ?
LDL is made in our___?____ . LDL cholesterol comes in small , medium and large sizes. What would you like to order ?
Is my LDL test results measured or just a calculated number?
Where are your triglycerides tonight ? Why should you care ?
My HDL ( good cholesterol )is 65 mg/dl. Why should I care about my LDL result ?
Will taking a " Statin drug " completely protect me from a heart attack ?
You can reduce your risk for developing heart disease and stroke. Become your doctors #1 assistant in maintaining your good health.
Reducing your heart disease risk is a game of numbers . Play hard ,understand your numbers , and win one day at a time ?
Have fun. Dr. Calder
Tuesday, December 6, 2011
There can sometimes be problems as the child assumes responsibility for this part of their life. Teenagers often seem to be very mature and at the same time have residual childhood behavior that can lead to making unwise decisions.
The problem of children especially teenage children providing false glucose test data to their parents and doctors is not unusual. How to deal with this sensitive issue is a problem for parents and health care providers.
My approach evolved over time. I believe that dealing with diabetes day to day can overwhelm any one, especially a child. I also think that diabetes can beat up a child but it cannot beat up a child and their parents working as a team.
Recognizing and accepting the problem is the first goal. Explaining to the parents and child very openly that this type of behavior is a common way of dealing with an unpleasant overwhelming job. It is no ones fault and may just be a way your child is asking for help.
Let the child know that you love them and that this type of behavior is not in his or her best interest. Explain that becoming independent is a part of growing up and that independence often proceeds our readiness to accept all of the responsibility of being independent. Let the child know that is nothing is seriously wrong and that this is a type of behavior and we have all experienced this to some degree. The child also needs to understand that the behavior is not in their best interest and that you will do anything to help them find another way of dealing with day to day requirements of having diabetes.
My mother raised 6 children with some occasional back up by my dad. They only went to the 5th and 6th. grade in school but were very wise. Mom or dad believed in hard work and independence but also encouraged enjoying being a child. Mom explained that childhood is brief and that being a responsible adult is a much longer part of our lives.
In summary, I suggest encouraging a teenager with diabetes management problems to enjoy being a child just a little longer and allow mom and dad to help them slowly accept the responsibility of dealing with this disease . Dr. Calder
Sunday, December 4, 2011
Friday, December 2, 2011
Wow ! why not become the number one medical assistant in caring for my diabetes.
Your doctor , diabetes educators and dietitians have the knowledge and wisdom to direct your diabetes care. They provide you with the tools and it is up to you to use those tools.
Many people with diabetes rely on their doctor or other health care provider to remind them when a test is needed and are satisfied when they are told every thing looks OK. You may say that understanding all of those test is just to difficult. I am here to tell you that all of the diabetes test results are just numbers. The recommended goals for those numbers is available from the American Diabetes Association or your doctors office.
All of our life situations are different and the recommended goals may not be the best goal for you . Your doctor can help you adjust the recommended goals to your specific situation. You and your doctor decide on specific target goals. "Just numbers". Now any number that is not at its recommended level is a reason for discussion with your doctor.
I would like to go back to our imaginary statistical primary care doctor from a few days ago who has 72.5 patients with diabetes and 223 patients with pre-diabetes and trying to track and manage 3546 test.
Your doctor could now have 295.5 trained diabetes medical assistants . As one of those assistants your job will be to track and manage 12 test on the person who is the most interested in their own health. You
Great things can happen with you being the number one medical assistant responsible for winning this game of numbers. Review this information from the National Institutes of Health and you decide if it is worth the effort.
Preventing Diabetes Complications. This information was taken from the, National Institute Of Diabetes,Digestive and Kidney Disease .
- Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1C blood test results, for example, from 8.0 to 7.0 percent, can reduce the risk of microvascular complications—eye, kidney, and nerve diseases—by 40 percent. The absolute difference in risk may vary for certain subgroups of people.
- In patients with type 1 diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease.
Blood Pressure Control
- Blood pressure control reduces the risk of cardiovascular disease—heart disease or stroke—among people with diabetes by 33 to 50 percent and the risk of microvascular complications—eye, kidney, and nerve diseases—by about 33 percent.
- In general, for every 10 mmHg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12 percent.
- No benefit of reducing systolic blood pressure below 140 mmHg has been demonstrated in randomized clinical trials.
- Reducing diastolic blood pressure from 90 mmHg to 80 mmHg in people with diabetes reduces the risk of major cardiovascular events by 50 percent.
Control of Blood Lipids
- Improved control of LDL, or bad, cholesterol can reduce cardiovascular complications by 20 to 50 percent.
Preventive Care Practices for Eyes, Feet, and Kidneys
- Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 percent.
- About 65 percent of adults with diabetes and poor vision can be helped by appropriate eyeglasses.
- Comprehensive foot care programs—ones that include risk assessment, foot-care education and preventive therapy, treatment of foot problems, and referral to specialists—can reduce amputation rates by 45 to 85 percent.
- Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30 to 70 percent. Treatment with particular medications for hypertension called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) is more effective in reducing the decline in kidney function than is treatment with other blood pressure lowering drugs.
- In addition to lowering blood pressure, ARBs and ACE inhibitors reduce proteinuria, a risk factor for developing kidney disease, by about 35 percent.
Having diabetes is not all bad. You know your enemy and you have the tools to win the battle. Pick up those tools and go to work. Your doctor and other health care providers are your best partners in this battle.