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A valuable laboratory test for evaluating blood sugar levels measure Glycosolated Hemoglobin also known as A1C. Proteins that have glucose molecules attached to them (glycosolated peptides) are elevated seven fold in diabetics. Normally 5-7% of hemoglobin is combined with glucose. Mild elevation in blood sugar results in an A1C concentration of 8-10%, while severe elevation results in concentrations of up to 20%.

Since the average life span of an RBC (red blood cell) is 120 days, the A1C assay represents time averaged value of hemoglobin over the preceding 2-4 months. It is extremely valuable in providing a simple, useful method for assessing treatment effectiveness and patient compliance. A1C determination along with a fasting blood sugar can be used in some cases to diagnose diabetes but it is not the sole criteria for diagnoses. Approximately one third of those with diabetes diagnosed with glycosolated hemoglobin have a normal A1C. An 1C coupled with fasting blood sugar and a 2 hour post prandial level provide a more accurate diagnosis. The A1C assay is helpful in determining the relative glucose load on the system and to monitor therapy.

The C-Peptide test can tell physicians the amount of insulin the pancreas is making.  However, this test is not for everyone.  It is used primarily for diabetes research, but there are times when it is useful, particularly in treating non-insulin dependent diabetes.  When insulin is released from the pancreas, most is soaked up by the liver where blood tests are unable to detect it.  C-Peptide goes through the liver and when the body produces a molecule of insulin, it also makes one of C-Peptide.  By measuring C-Peptide, the test gauges the amount of insulin made.  This test can detect the levels of insulin being made by type 2 diabetics.  With normal to high levels, oral agents are usually successful.  Low levels normally require insulin injections.

Syndrome X describes a cluster of abnormalities that owe their resistance largely to a high intake of refined CHO, especially in those who are generally predisposed.  The features of Syndrome X include mildly to moderately impaired glucose tolerance, increased insulin levels due to insulin resistance, high cholesterol and triglyceride levels, hypertension and upper body obesity.  The underlying metabolic factor is elevated insulin levels, which results from a high intake of refined CHO coupled with insulin resistance.  Other terms that describe this syndrome are Metabolic Cardiovascular Risk Syndrome, Metabolic Syndrome, Insulin Resistance Syndrome and Atherothrombogenic Syndrome.  Syndrome X has persisted and has become the most accepted term.  This is a condition that exists due to poor dietary and lifestyle choices.

In May, the New England Journal of Medicine linked the diabetic drug rosiglitazine (Avandia, Avandamet & Avandaryl) to heart attacks and heart related deaths.  The FDA on Nov. 14th, modified its black box warning to include information about potential increased risk for heart attacks.  The FDA warning is confusing however and provides no useful guidance to patients or physicians.  The new warning it is felt, should be revised to clearly note that using this drug carries serious risks.  Some entities have taken it upon themselves to prevent people from using this drug.

After conducting its own review in October 2007, the Department of Veterans Affairs removed rosiglitazone from the list of drugs its doctors may prescribe, concluding that “for some patients rosiglitazone may not afford the same margin of safety as alternative drug therapies”.

In November, Health Canada, the Canadian equivalent of the FDA, issued broad restrictions on the use of rosiglitazone.  It is no longer approved as a single treatment for diabetes or for use in combination with sulfonylureas (except for patients unable to take Metformin).  Neither is it approved for patients taking insulin or for patients diagnosed with either past or current heart failure, even if it is mild.  Health Canada advises patients to talk about the benefits and risks of continuing therapy, especially those with Heart Disease or at high risk for heart attack or heart failure.

It is felt that the FDA needs to ban this drug from the US market because there is not evidence of any beneficial clinical outcome for this drug and instead growing evidence of unique risks in multiple organ systems.  US citizens at risk from heart attack and failure should not take this drug.  Until the FDA takes appropriate steps to inform the American public about its dangers, Health Canada remains the sole source of this vital information.

The Joslin Diabetes Center Affiliate at The Western Pennsylvania Hospital, a national affiliate of the world-renowned Joslin Diabetes Center in Boston, offers comprehensive treatment to individuals in the tri-state area with diabetes. The American Diabetes Association (ADA) has awarded the Joslin Diabetes Center Affiliate at West Penn its prestigious three-year Certificate of Recognition for the Center’s Diabetes Self-Management Program. Through this program, patients are provided state-of-the-art information and the skills necessary for self-management of diabetes. The Center’s certified diabetes educators also offer additional services for patients and families. We seek a registered dietitian to assess, plan and implement diabetes education for patients and families. This position works collaboratively with physicians, assists with blood glucose management, and provides continuing education to health care professionals in the community. Candidates must possess excellent interpersonal and communication skills in a classroom teaching environment; have experience in diabetes education; and be a PA licensed LDN.  CDE is also required. We offer a competitive salary and flexible benefits package. For consideration, please visit our website at jobs.wpahs.org . Equal Opportunity Employer