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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

New Way to Control Glycemic Variability

June 10th, 2009 · 6 Comments

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The A1C is certainly the gold standard to see how well we are controlling our diabetes. But even gold isn’t good enough for us.

The A1C doesn’t show our glycemic variability. For those of us who have our blood glucose levels under reasonably good control, our glycemic excursions are even more important than our average level.

A low A1C level can mask a lot of lows and highs. The experts call these hypos and hypers “glycemic variability” or “glycemic excursions.” Our level can be all over the place, while our A1C looks fine.

“Excursions are very important in terms of diabetic complications,” says Donald Bergman, M.D, “because that’s what triggers the oxidators, the inflammation of the blood vessels, the whole cascade of complications.” Dr. Bergman is a leading endocrinologist who spoke to the press at last month’s convention of the American Association of Clinical Endocrinologists, or AACE, in Houston.

A new way for us to find out our excursions or glycemic variability got a lot of attention both at the AACE convention and this month’s convention of the American Diabetes Association in New Orleans. It’s the GlycoMark test from GlycoMark Inc. in Winston-Salem, North Carolina.

While I wrote about it four years ago in Diabetes Health magazine and then three years ago here, the GlycoMark has been slow to catch on with our doctors. Until now.

After all, we have other ways to find out how much glycemic variability we have. We can do fingerstick tests two hours after the first bite of every meal, and we can even analyze our numbers with some blood glucose meters — if we give those meters lots of data. The WaveSense Jazz blood glucose meter from AgaMatrix Inc. in Salem, New Hampshire, incorporates “glucose variability tracking.” The Accu-Chek Smart Pix Device Reader incorporates indexes that some people think will help. These are the low blood glucose index and the high blood glucose index that Dr. Boris Kovatchev, associate director of the University of Virginia Center for Biomathematical Technology, developed.

Wearing one of the continuous blood glucose monitors from Medtronic Diabetes, DexCom Inc., and Abbott Diabetes Care will also tell us how wild our levels might be. But few of us do fingerstick tests regularly enough to determine our glycemic variability. And even fewer of us wear a continuous blood glucose monitor.

Enter the GlycoMark. Each time we test with it, the GlycoMark reflects the previous two weeks of our after-meal levels. When I interviewed GlycoMark President Eric Button, he told me that it is available through all the major laboratories that our doctors use. While they don’t have a home test kit yet, Eric told me that they have it in development.

A research study presented Saturday at the American Diabetes Association convention established that the GlycoMark test accurately shows our blood glucose swings. The abstract of the study, “1,5 AnhydroGlucitol Concentrations and Measures of Glucose Control and Glucose Variability in T1DM and T2DM Patients,” is available online as Abstract 882-P.

The study shows that the GlycoMark test is a particularly good check for those of us whose A1C levels are less than 8 percent. Previous studies found that as many as 40 percent of people with type 2 diabetes who have A1C’s of 8 percent or less “experience glucose swings that need medical intervention,” Eric says.

Dr. Bergman told me that he is now ordering it on all of his patients who have diabetes. “I like the concept that it specifically reflects postprandial sugar,” he says. “While I haven’t made up my mind about the GlycoMark yet, I want to get a sense, independent of what the literature says, on how effective it is in correlating to their fingerstick tests four times per day.”

Meanwhile, Endocrinologist Nancy Bohannon, M.D., was already prescribing the GlycoMark test to her diabetes patients when I interviewed her four years ago for my Diabetes Health article. She directs clinical research at St. Luke’s Hospital in San Francisco.

A few days ago I asked her if she still prescribes the GlycoMark test. “Absolutely,” she replied. “Every time I order an A1C now. This is assuming that they have A1Cs that are under 7. If you use it on people whose A1Cs are 8 or great, it is a waste of money and blood. But for people who are trying to get tight control, it is a very good reflections of their post-prandial blood sugars.”

Alan Garber, M.D., is another endocrinologist who has been prescribing the GlycoMark test to some of his patients for several years. He is a professor of medicine at Baylor College of Medicine in Houston. Dr. Garber told me that the GlycoMark is most useful for people with A1C levels between 6 and 8 percent.

He agreed with me that most doctors — much less those of us who have diabetes — haven’t even heard about the GlycoMark test yet. But that’s about to change, especially when you ask your doctor to prescribe it.

This is a mirror of one of my articles that was originally published on Health Central.

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6 responses so far ↓

  • 1 John // Jul 13, 2009 at 7:27 am

    I’m 3 months #2 diabetic, indicators are all border line a1c of 6.2 / 133mg . When doing finger tests for after eating could you explain more about this. When the start time is? does it make a difference which foods you eat first?
    Also all these test how accurate are they 1,2,5or 10% variance
    Your sites been very helpfull Thanks John Grantham

  • 2 David Mendosa // Jul 13, 2009 at 4:07 pm

    Dear John,

    That’s a good question!

    The start time is when you take the first bite of the meal. The general advice is to then check your blood glucose level exactly 2 hours later. Some people would prefer to check it at the probably high point, however. That’s about 75 minutes later. You decide, but be consistent. Note that the level you need to stay below at first (later you can set higher standards) is, according to most (but not all organizations) no more than 140 mg/dl.

    The accuracy question is even harder! First it depends on your meter, user error (often not getting enough blood on the test strip), and the age of the test strip (never use an expired one and in fact they tend to be inaccurate in the last couple of months of their rated life.

    Best regards,

    David

  • 3 rajesh // Jul 23, 2009 at 4:05 am

    hi
    Your info on the site is excellent.
    thanks you.
    iam having sugar levels of average 126/180 throuought year. tested on monthly basis.
    recently my A1c is 4.2.
    my symptoms are : 1. weekness in the legs
    2.sweating
    3. dry throat

    Am I diabatic ? and need to use medication.
    Please advice me
    regards
    Rajesh

  • 4 David Mendosa // Jul 23, 2009 at 8:57 pm

    Dear Rajesh,

    Unfortunately, with those numbers there’s no way to tell if you have diabetes. That’s because on the basis of your fingerstick tests it sure sounds like it. But on the basis of your A1C it doesn’t at all. Something doesn’t sound right with that combination. Please see a doctor for a diagnosis.

    Best regards,

    David

  • 5 rajesh // Jul 23, 2009 at 10:06 pm

    Dear Mr.David

    Thnaks .
    I have consulted a doctor. whenever i eat rice the sugar levels are going up 140/250 .
    I explained about my symptoms.
    he advised to take glycomet tablet 250 mg morning and evening.
    after using this tablet for seven days , i am still getting the same symptoms.
    I am also taking less carb food and doing walking slowly
    please advise me
    thanks
    Rajesh

  • 6 David Mendosa // Jul 24, 2009 at 7:01 am

    Dear Rajesh,

    My advice would be to cut WAY BACK on your carbs and see what happens to your numbers and symptoms. If you eat no more than 6 grams of carbs for breakfast, and 12 grams each for lunch, dinner, and a snack at least 4 hours before and after a meal, you can control your diabetes, if that is indeed what you have.

    Best regards,

    David

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