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PRE-DIABETES / TYPE 2 DIABETES CHARACTERIZATION

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BIO-MONITORS

  • Elevated levels of HgbA1c indicate poor glucose control and increased risk endothelial damage.
  • HgA1c measures the average glucose over the past 2-3 months by measuring the amount of glucose accumulated on the surface of a red blood cell.
  • Individuals with poor control or high HbA1c levels are at risk for microvascular & macrovascular damage independent of lipid levels, as well as risk for atherogenic dyslipidemia.
  • For individuals who are not well controlled, use the lipid panel and lipoprotein subfractions to help make decisions in lipid lowering and lifestyle therapy.
  • Repeat quarterly until treatment goal is met, then every 6 months.
  • Cystatin C is a marker of renal function and risk stratification of heart failure. High levels are consistently predictive of a cardiovascular event or adverse outcome.
  • Cystatin C is a serum protein that is filtered out of the blood by the kidneys. It is steadily produced by cells in the body, and its low molecular weight allows it to be freely filtered by the glomerular membrane. Cystatin C levels are very sensitive to even small changes in GFR or mild renal impairment.
  • Cystatin C levels are independent of weight, height, muscle mass, age or gender.
  • Its concentration in the blood correlates with GFR, and studies show it is a better marker of kidney function than creatinine.
  • Treat underlying cause of renal disease. Assess endothelial function and consider lipid lowering therapy and lifestyle changes.
  • Repeat abnormal results every 3 to 6 months until goal met or stable, then annually.
  • Ongoing elevated fasting glucose is a sign of insulin resistance generally leading to diabetes and/or cardiovascular disease.
  • Insulin resistance induces endothelial injury and the cascade of events leading to plaque aggregation. These damages can exist years before glucose becomes elevated.
  • Elevated fasting glucose can cause microvascular changes to the kidneys, nerves and eyes.
  • For individuals with diabetes or prediabetes, consider endothelial function testing to guide how aggressive to be with lipid and blood pressure lowering therapy and lifestyle changes, especially if A1c and insulin levels are also elevated.
  • Repeat quarterly until treatment goal met, then every 6 months.
  • Individuals with ongoing elevated insulin levels are at increased risk of heart disease.
  • Higher insulin levels indicate impairment in insulin utilization or insulin resistance. Insulin resistance often causes high triglycerides, low HDL-C, high LDL-C and hampers weight loss efforts by not allowing the body to burn energy (calories) effectively.
  • Measuring insulin levels aids in identifying insulin resistant patients who may still have normal glucose levels.
  • Elevated insulin levels in conjunction with low HDL, high triglycerides and sd-LDL, helps to guide drug and lifestyle treatments.
  • Repeat abnormal insulin levels quarterly until treatment goal is met, then annually.

MICRONUTRIENT TESTS ASSOCIATED WITH DIABETES

Nutri meter
Vitamin B12
Deficiency common in diabetics because metformin depletes B12.

Vitamin B3
Preserves B-cell function in type 1 diabetics; Part of GTF (glucose tolerance factor) which facilitates insulin binding.

Vitamin D
Lowers risk of type 1 and 2 diabetes; Supresses inflammation of pancreatic B-cells; Vitamin D receptor gene linked to diabetes.

Vitamin E
Confers protection against diabetes by protecting pancreatic B-cells from oxidative stress induced damage; May prevent progression of type I diabetes.

Vitamin C
Lowers glycosylated hemoglobin (HbAIc) and fasting and post-meal glucose levels and in type 2 diabetics.

Inositol
Evidence suggests that inositol may be effective in treating diabetic neuropathy.

Carnitine
Reduces and even prevents pain from diabetic neuropathy; Improves insulin sensitivity by increasing glucose uptake and storge.

Glutamine
Stimulates a hormone called GLP-I (glucagon-like peptide I) that regulates insulin signaling and sensitivity.
Coenzyme Q10
Protects kidney from diabetes related damage; Improves glycemic control in type 2 diabetics.

Glutathione & cysteine
Glutathione-containing enzymes protect B-cells which are particularly sensitive to oxidative stress; Type 2 diabetics have abnormal antioxidant status; Supplementation with the glutathione precursor cysteine restores antioxidant status.

Lipoic Acid
Enhances glucose uptake in skeletal muscle tissue; Improves glucose tolerance in type 2 diabetics; Very effective treatment for diabetic neuropathy.

Zinc
Needed in the synthesis, storage and secretion of insulin; Protects pancreatic B-cells from damage; Affects the expression of genes linked to diabetes.

Magnesium
Deficiency reduces insulin sensitivity; Low magnesium exacerbates foot ulcers in diabetics.

Biotin
Stimulates glucose-induced insulin secretion in pancreatic B-cells; High dose biotin can improve glycemic control in diabetics.

Chromium
Helps insulin attach to cell's receptors increasing glucose uptake into cell; Supplementation trials show dose-dependent benefits for type II diabetics

PHYSICAL DIAGNOSTICS (PDxs)

  • Of patients with symptomatic autonomic neuropathy, 25-50% will die in the next 5-10 years.That is a 3 times higher rate than patients without autonomic dysfunction.
  • Reduction in heart rate variability is the earliest indicator of cardiovascular autonomic neuropathy and diabetes autonomic neuropathy in asymptomatic patients.
  • The autonomic nervous system works in balance by sympathetic and parasympathetic nerve activity. Dysfunction to either or both most often results in cardiovascular, gastrointestinal, genitourinary, and glucose regulation dysfunction.
  • ANS testing measures heart rate variability during rest, standing, deep breathing, and valsalva maneuver to provide a comprehensive autonomic balance analysis.
  • The American Diabetes Association recommends screening at onset for Type 2 diabetes and 5 years after diagnosis of Type 1 diabetes or if noted symptoms.
  • Tight glycemic control is the primary focus in diabetes. Treat underlying condition, lipids and blood pressure, with pharmacological therapy and lifestyle changes. Manage symptoms of effected systems.
  • If ANS dysfunction is identified, treat underlying condition and symptoms and reassess in 3 months. If no dysfunction identified, repeat annually.