Monday, January 21, 2013

Unexplainable glucose elevations? Look for Patterns !

Diabetes Office Visit - The Goal
The goal of my book , iphone /pad App. , and Diabetes office visit  web site , is to improve  communication between people with diabetes and their physician and or diabetes educator.

 This is a new year  and after a recent conversation with a friend with diabetes  ,who claims to have read my book. I again realized that , despite the amazing new advances in diabetes care , the basic make up of a diabetes office visits has not changed that much for many people with diabetes.

Diabetes management in most medical offices is still doctors and diabetes educators setting down with patients and looking at home glucose values recorded on paper. How this data is recorded and presented to the physician has a major impact on the benefit achieved from the visit. Patients and their physicians are often frustrated trying to understand and explain the often unexplainable variations in glucose values.  The process of just living our daily lives , and the inability of our most sophisticated management tools to match the speed and agility of beta and alpha cells in a healthy pancreas , will continue to effect glucose test results.

I have found one exception , other than of an islet cell transplant for controlling glucose results.
Patients in the intensive care unit , heavily sedated and I controlled their intake with IV fluids , IV insulin and hourly glucose test. The controlling glucose levels problems returned as the patient started eating and taking subcutaneous insulin and oral medications again.

Take home message- look for patterns
  Do not focus on the occasional unexplainable glucose elevation look for patterns. Significant medical problems such as insulin deficiency and illness cause persistent glucose elevations. 

A common example is elevations of the fasting glucose:
 #1  First test and rule out unrecognized low sugars at 2 to 3 am. causing a rebound increase
 #2  In my experience insulin deficiency is the most common cause of persistant elevation of fasting
Tomorrow , more on  office ready usable glucose testing 

Have Fun ,Be smart  and if you have my book , Diabetes Office visit , please read chapters 3 and 4.
David Calder, MD

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Your comments and questions are appreciated. David Calder,MD