A Step Closer to Breath Test For Diabetes

Earlier I wrote about dogs that can sniff out a low blood sugar.

Here's a related story about how lab instruments may be able to sniff out early diabetes, as well as liver disorders and certain cancers, from compounds in our breath.

Research To Develop A Breath Test For Cancer And Diabetes

Researchers at Swansea University in the UK are using various technologies (gas chromatography, mass spectrometry, and thermal desorption) to analyze the concentrations of volatile organic compounds (VOCs) in breath.

Dr Masood Yousef, a senior research assistant at Swansea:

"Studies have shown that high concentrations of certain VOCs in breath can correlate with disease. For example, the odour of 'pear drops' esters and acetone in relation to diabetes, ammonia in relation to hepatitis, and dimethyl sulphide to cirrhosis. There are also certain compounds that seem to mark out particular types of cancer."

A breath test for diabetes and other conditions would be an inexpensive, safe, and convenient screening tool for early detection. Interventions could take place before a person presents with symptoms, improving long-term outlook. Let's hope researchers work out the details soon!
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Storing Glucose Test Strips

In the warmer and more humid conditions of summer, it's important to store your test strips and meter away from heat and direct sunlight. Heat and moisture can damage both the strip and the meter.

Manufacturers package instructions with strips that include information on their use during spells of unusual heat and humidity. Some manufacturers recommend storing strips in a dry place at room temperature, between about 68 to 86 degrees F. (This may preclude the bathroom.) Some advise against storing in the refrigerator. Those that allow refrigeration may state that strips should be brought to room temperature before using.

If you've recently weathered a storm, power outage, or other situation that exposed your strips to extreme conditions, refer to the instructions packaged with your strips. It wouldn't be a bad idea to run a control solution or control strip through your meter as a test.
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A Change May Be In the Works for HbA1c

You've just had an A1C (hemoglobin A1C) test. The result was 7.5%. What does that mean? How does that relate to the average blood glucose readings you take at home? If preliminary results from the ADAGE trial hold, that A1C lab result may be reported as average glucose, in the familiar mg/dl reading, beginning next year.

The ADAGE study is a clinical trial being conducted at a number of centers across North America, Europe, and Africa. Its goal is to confirm the relationship between HbA1C levels and average blood glucose. Preliminary findings, reported at the 2007 ADA Scientific Sessions, are showing that relationship is closely correlated, for both type 1 and type 2 diabetes. This could lead to results of an A1C test being reported as A1C-Derived Average Glucose (ADA-G).

What Is HbA1C?

Hemoglobin A1C is that portion or percent of total hemoglobin that has glucose attached to it. In people without diabetes, about 4% to 6% of their hemoglobin is glycosylated. Red blood cells that contain the hemoglobin circulate in the bloodstream for 3 or 4 months before being broken down and replaced. During that time the RBC can bond, irreversibly, to glucose in the bloodstream. Thus, A1C readings higher than about 6% indicate higher than normal amounts of glucose roaming the bloodstream in the past 120 days.

Using the Conversion Table from the ADA's 2005 Position Statement on Standards of Medical Care in Diabetes, the 7.5% A1C reading at the beginning of this post would equate to an average blood glucose of about 188 mg/dl:


If this change happens, instead of receiving a 7.5% HbA1C, you might receive a result such as 188 mg/dl ADA-G. Improved calibration of lab machines that measure glycosylated hemoglobin are also in the offing. These changes may make lab results easier to interpret leading to improved blood glucose management.
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Conversion Tool - A1C to Blood Glucose

An A1C test is not a direct measure of blood glucose, although the two can be correlated. Because of differences among labs in how they calculate A1C, and differences among individuals, conversions of A1C to blood glucose aren't exact. But they can give you an idea of what your average blood sugar has been over the last few months.

The Diabetes Tool Box, a service of the Diabetic Drug Store, has an online calculator that can convert your A1C reading to an average blood sugar reading. Try it!



Update - June 2008: If the above doesn't work, try ACCU-CHEK's:


Or you can get a sense of the relationship between A1C and blood glucose from the following table, excerpted from the American Diabetes Association's (ADA) 2005 position statement on Standards of Medical Care in Diabetes:

Correlation Between A1C Level
and Mean Plasma Glucose Levels

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For the ADA's 2005 Position Statement:
Standards of Medical Care in Diabetes, Diabetes Care, 2005

Calculate Your Heart Attack Risk

The National Cholesterol Education Program (NCEP) has posted an online tool that calculates your 10-year risk of having a heart attack.

Just enter your age, gender, cholesterol, and blood pressure info and let it do its crunching.



Note - This tool is not for those with diabetes or who already have heart disease, factors likely to shave a few years off your answer.

ABC's of Diabetes

Cardiovascular disease (CVD) is the leading cause of death among people with diabetes. If you have diabetes, you're up to 4 times more likely to have heart disease or suffer a stroke.

The National Diabetes Education Program (NDEP) developed a campaign entitled "Be Smart About Your Heart. Control the ABCs of Diabetes." to help reduce CVD and other diabetes complications.

The campaign focuses on three critical factors:

• Blood glucose - As reflected in your A1C
  
• Blood pressure
  
• Cholesterol

And recommends the following tests:


If you have diabetes, know someone who has it, or are a diabetes educator, the NDEP has free educational materials. They're available in English, Spanish, and 15 Asian and Pacific Islander languages. They include record forms for keeping track of test results. You can download the materials at:
Be Smart About Your Heart. Control the ABCs of Diabetes.

American Diabetes Alert Day

This coming Tuesday, March 28^th, has been designated American Diabetes Alert Day by the ADA. It's a day devoted to drawing attention to the disease, spreading the word about who is at risk, and finding those people who have it but don't know it.

Are you at risk? Take the ADA's free, online risk test:
Diabetes Risk Test

Do you suspect someone you know may be at risk? Send them an ADA Diabetes Alert E-card that includes a link to the risk test:
Diabetes Alert E-card

More Screenings

Having diabetes disposes you to a unique set of periodic check-ups, e.g. foot exams and kidney tests. (See Mark It On Your Calendar).

Yet even if you don't have diabetes there are several screenings that health professionals recommend we all get as we age.

The US Dept. of Health and Human Services lists the following guidelines for men and women at average risk for most diseases:

Women's Screenings:
Screening Tests and Immunizations Guidelines for Women

Men's Screenings:
Screening Tests and Immunizations Guidelines for Men

If you're over 45 and never been diagnosed with diabetes, it's advisable to get your blood sugar checked at least every 3 years, or more frequently if any of the following conditions apply:

• You're overweight.
  
• You have a family history of diabetes.
  
• You live a sedentary lifestyle.
  
• You have a history of gestational diabetes.
  
• You've been diagnosed with high blood pressure.
  
• You're a member of one of these ethnic groups: Hispanic/Latino, Native American, African American, Asian American, Pacific Islander.
  
• You have any of these symptoms:
  • Frequent urination
    
  • Excessive thirst
    
  • Unusual hunger
    
  • Fatigue
    
  • Unexplained weight loss
    
  • Blurry vision
    
  • Poor healing of wounds

Mark It On Your Calendar

Many people start the new year with a new calendar, appointment book or journal.

Since diabetes involves a relatively busy care schedule, it's helpful to mark your 2006 calendar with dates for recommended screenings and scheduled doctors' visits.

If you use insulin, your physician may be scheduling you for visits every 3 months. Even if you don't use insulin, the ADA recommends you see your doctor at least every 6 months to monitor your blood pressure, weight, and glycated hemoglobin (HbA1c).

Besides regular doctor visits, you may want to make entries for visits to your podiatrist, dentist, eye doctor, diabetes educator, or dietitian. The Diabetes Monitor offers a printable log where you can keep track of your visits, lab results, and goals. It includes the helpful list:

Things to Do At Least Once a Year

• Get a flu shot (October to mid-November).
  
• Get a pneumonia shot (if you’ve never had one).
  
• Get a dilated eye exam.
  
• Get a foot exam (including check of circulation and nerves).
  
• Get a kidney test.
  
  • Have your urine tested for microalbumin.
    
  • Have your blood tested for chemicals that measure your kidney function.
• Get a 24-hour urine test (if your doctor advises).
  
• Get your blood fats checked for:
  
  • Total cholesterol.
    
  • High-density lipoprotein (HDL).
    
  • Low-density lipoprotein (LDL).
    
  • Triglycerides.
• Get a dental exam (at least twice a year).
  
• Talk with your health care team about:
  
  • How well you can tell when you have low blood glucose.
    
  • How you are treating high blood glucose.
    
  • Tobacco use (cigarettes, cigars, pipes, smokeless tobacco).
    
  • Your feelings about having diabetes.
    
  • Your plans for pregnancy (if a woman).
    
  • Other ______________________

For the Diabetes Monitor's logbook:
Take Charge of Your Diabetes

November is National Diabetes Awareness Month

Communities typically offer free activities and programs during November.

If you have diabetes, care for someone with diabetes, or are concerned about your risk, watch your mail for flyers advertising free workshops, classes, or blood sugar screenings.

Today is World Heart Day

Visit the World Heart Day's site for news and activities in your region. (They have a section on diabetes that includes a number of recent news articles.)

The World Health Organization (WHO), a major sponsor of World Heart Day, is warning that the rapid increase in weight seen globally forecasts a daunting burden in caring for chronic diseases linked to weight. They estimate there are a billion people worldwide who are currently overweight; and they predict that number to rise by 50% over the next 10 years if trends continue.

Overweight and obesity are risk factors for many chronic conditions, including type 2 diabetes.

Yet, according to Dr. Robert Beaglehole, WHO Director of Chronic Diseases and Health Promotion, many chronic diseases attributable to weight are preventable:

"Approximately 80% of heart disease, stroke, and type 2 diabetes, and 40% of cancer could be avoided through healthy diet, regular physical activity and avoidance of tobacco use."

One method of determining overweight or obesity is by assessment of a person's Body Mass Index (BMI).

BMI Categories:
Overweight is a BMI ≥ 25
Obesity is a BMI ≥ 30

Do you know your BMI?

If not, you can calculate it here. Just enter your height and weight.

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Links:

World Heart Day - Sunday, September 25

The World Health Organization Warns of the Rising Threat of Heart Disease and Stroke as Overweight and Obesity Rapidly Increase

National Institutes of Health - BMI Calculator

Diabetes in Children - A Growing Concern

The Centers for Disease Control and Prevention (CDC) warns that type 2 diabetes is a "growing problem among US children and adolescents," and recommends better physician awareness to combat the problem.

They cite the following markers for diabetes in this age group:

• Between 10 and 19 years old
  
• Obese
  
• Strong family history of type 2 diabetes
  
• Insulin resistance
  
• Poor glycemic control (A1C = 10% to 12%)

A recent study appearing in the August issue of Archives of Pediatrics & Adolescent Medicine found one more predictor - waist size:

"Waist circumference is a predictor of insulin resistance syndrome in children and adolescents and could be included in clinical practice as a simple tool to help identify children at risk."

WebMD features a summary of the study, including examples of risky waist sizes:

• A 5-year-old boy or girl with a waist size of 22 inches or more
  
• A 10-year-old boy with a waist size of 26 inches or more
  
• A 10-year-old girl with a waist size of 25 inches or more
  
• A 15-year-old boy with a waist size of 31 inches or more
  
• A 15-year-old girl with a waist size of 28 inches or more

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For the study itself (abstract only, subscription required for full article):
Can Waist Circumference Identify Children With the Metabolic Syndrome?

For WebMD's summary:
Kids' Waists May Show Pre-Diabetes Problem

For the CDC's fact page on children and diabetes:
Epidemiology of Type 1 and Type 2 Diabetes Mellitus Among North American Children and Adolescents

Genes and Your Cholesterol

If you're active, watch your diet, and have been successful at maintaining a healthful weight, you may have managed to keep your cholesterol levels under control ... or not. Lifestyle wields control over your cholesterol response but so do your genes. It's quite possible that no matter how hard you work to keep your cholesterol levels down, the influence of your family's genes could thwart it.

A study due out in the July 8 issue of the American Journal of Clinical Nutrition found just that. Researchers tested the cholesterol response in identical twins (with identical genes), and found their levels were about the same - even though one exercised regularly while one was relatively sedentary, even though one ate a low-fat diet while the other ate a high-fat one.

Lifestyle matters, but it's always a good idea to monitor and manage your lipid levels with your healthcare provider.

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For a summary of the study:
Bad Cholesterol: Genes Make the Difference

For the study itself:
Concordant lipoprotein and weight responses to dietary fat change in identical twins with divergent exercise levels