Sunday, July 18, 2010

Glycemic control and short-term long-term with both hands

Host: users Hello everybody, welcome to the family doctor online, today we are honored Shenzhen Second People's Hospital Endocrine Division Director Professor Luo Guochun to talk to us about the problem of diabetes treatment. The detection of diabetes among the project is to test one of them, "glycosylated hemoglobin", but many people do not know what effect this test items are, in fact, glycosylated hemoglobin in diabetes have been used for the detection of which for many years, has asked Professor Luo with We talk about the role of detection of glycated hemoglobin, glycated hemoglobin Why should pay attention to?

Luo Guochun: "glycosylated hemoglobin" is the hemoglobin inside red blood cells, and some combination of glucose, it is called "glycated hemoglobin." Glycosylated part of the rise represents the increase in blood glucose, glycosylated hemoglobin has been determined for the detection of diabetes for many years, but there are many diabetic patients do not understand about this test.

Glycated hemoglobin is characterized by relatively long time to reflect blood glucose, and relatively stable, but merely reflects the determination of blood glucose blood glucose level at that time, other times not reflect blood glucose levels. Therefore, the significance of blood glucose has some limitations, it is best fasting blood glucose (including postprandial blood glucose), while detection of glycated hemoglobin, a shorter length can be a good expression in patients with immediate and recent (2-3 months) the blood glucose level.

Moderator: normal glycated hemoglobin range?

Luo Guochun: Determination of different laboratories may have some differences, the normal value is typically 4 to 6% level. For diabetic patients, there is a glycated hemoglobin control standards, a slightly different control standards at home and abroad, according to Diabetes Branch of Chinese Medical Association to develop standards to control below 6.5%, that is glycosylated hemoglobin over 6.5% on behalf of glycemic control bad.

Moderator: postprandial blood glucose and fasting blood glucose, glycosylated hemoglobin which had great influence?

Luo Guochun: high levels of glycated hemoglobin, the representative of the overall glucose level, is already reflected in the postprandial blood glucose, also reflects the fasting blood glucose, postprandial blood glucose and fasting blood glucose, but the proportion of time is not the same. Comparison of fasting blood glucose levels, "good" when the time is not too high level, so postprandial blood glucose on glycosylated hemoglobin will be larger. Sometimes normal fasting glucose, glycosylated hemoglobin, postprandial blood glucose may also be higher there.

Moderator: glycated hemoglobin is too low to say it?

Luo Guochun: Low blood sugar is not generally long, that diabetes does not appear to reduce the level of glycated hemoglobin, so the lower the level of glycated hemoglobin is not important whether the increase is critical.

Moderator: Some users asked for breakfast blood glucose levels are normal, but doctors have told him that glycated hemoglobin is too high, they did not understand why you say it?

Luo Guochun: If the fasting blood glucose and / or postprandial blood glucose level to a certain extent when the glycosylated hemoglobin will increase performance. If found glycosylated hemoglobin increased, while fasting glucose normal, only to illustrate the level of blood glucose was normal, but the total period of time after it is elevated blood sugar. Therefore, patients thought that a good glycemic control, in fact, higher glycosylated hemoglobin that does not control blood sugar Recently good. Therefore, more reliable determination of glycated hemoglobin and important because it reflects a period of time the level of overall glycemic control.

Moderator: glycated hemoglobin measured how much time before a more appropriate

Luo Guochun: red blood cell metabolism, a process that is generally 60-90 days, can see its metabolic rather long time, so glycated hemoglobin in the blood can stay a long time, which is well reflected in blood glucose over time, clinical generally measured 3 months time, if too long an effect measured not so good, because there is no continuity. If the year closed beta four times, once every 3 months test, which can reflect the year four times the blood sugar control.

Moderator: For children and the elderly, the metabolic rate of glycated hemoglobin different?

Luo Guochun: glycated hemoglobin level is increased, the differences between different age groups may be, but the difference is not obvious.

Moderator: If the patient measured high levels of glycated hemoglobin, then in the next few months in the diet or the treatment of what can be adjusted?

Luo Guochun: We usually daily fasting blood glucose and postprandial blood glucose test, blood glucose levels are reflected in the day, discovered in time to adjust after the treatment. However, glycosylated hemoglobin increased, suggesting that not nearly good blood glucose control for a long time, then the (previous phase) treatment on the need to adjust. To know whether the actual blood glucose level increased, not simply a fasting plasma glucose or postprandial blood glucose results. Can not say that today's high or low blood sugar, and to explain all the problems. In general, we must look glycated hemoglobin, also at the same day of blood glucose levels, both of which can see better understand the overall blood sugar levels.

Moderator: patients have different agents, some with insulin therapy, some with oral hypoglycemic agents, the two treatment on glycosylated hemoglobin have different?

Luo Guochun: If hypoglycemic effect of oral hypoglycemic agents is not good, can be reflected through the detection of glycated hemoglobin oral not good, to make a quick switch to the better treatment modalities, such as insulin. Treatment failure with oral drugs, use of insulin therapy or can get a good effect.

Moderator: That is glycated hemoglobin test can be used as the basis to judge the efficacy of treatment?

Luo Guochun: Clinically, diabetes, glycated hemoglobin generally not as a diagnostic tool, but as a treatment monitoring tool, glycated hemoglobin level of treatment measures to change the judge as the basis of this indicator is very useful.

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