Guest guest Posted October 8, 2011 Report Share Posted October 8, 2011 I bought a 10-test unit and several tests went to waste b/c they had an expiration time of 120 days from the time the unit was brought to room temperature, which must be done before you can do the first test. I bought it mainly wanting to use it for an uninsured patient with newly diagnosed DM, since our local lab really rips off self-pay patients. (And the benevolent state of NY does not allow the use of those cool, on-line, discount labs.) Anyway, with my insured patients, I found I usually wanted other tests, as well (lipids, metabolic panel, TSH, etc), so it seemed easier just to have the lab do the HbA1c with the other stuff. I never did have the opportunity to bill an insurer for a test to see how much they would pay. In retrospect, I should have used up my tests even when I was sending something else to the lab, just to get some reimbursement, but I was very busy and the time just slipped away... Sharlene > > Is anyone doing on-site office A1c tests? How is the reimbursement > structured for this? I see that A1cNow (Bayer) costs about > $215 for meter and 20 tests. This would be handy. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 8, 2011 Report Share Posted October 8, 2011 I use the A1cNow all the time. They're not a money-maker, but all payers cover the cost of the test, at least. I'm comfortable that they are reasonably accurate. If someone is going to the lab anyway, I usually don't do it in the office. But it is very handy when they don't need much else, to be able to have the result in 5 minutes. They have a very long shelf life as long as you keep them refrigerated. When I use one, I just pull another out to get it to room temperature. I always use ONE before it expires at room temp. (In the past, there were more problems with these that caused wasted tests, but that rarely happens to me now.) Harech > > Is anyone doing on-site office A1c tests? How is the reimbursement > structured for this? I see that A1cNow (Bayer) costs about > $215 for meter and 20 tests. This would be handy. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 8, 2011 Report Share Posted October 8, 2011 We have actually been thinking of doing this, but have not made the leap. We do in office INR's and that works well. I would think being able to discuss the A1C level at the visit would be much better patient care. I noted that Costco has a meter for $30, but am not sure who makes or if it reliable enough. From: [ ] On Behalf Of [edwardsronaldj@...] Sent: Friday, October 07, 2011 5:45 PM To: practiceimprovement1 Subject: A1c office testing Is anyone doing on-site office A1c tests? How is the reimbursement structured for this? I see that A1cNow (Bayer) costs about $215 for meter and 20 tests. This would be handy. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 8, 2011 Report Share Posted October 8, 2011 , When I read the instructions for A1C NOW, I interpreted them to mean that both the monitor itself and the test pouches had to be at room temperature at the time of use and discarded if not used within 120 days after coming to room temperature. I see now that may not be correct, so I guess I will call the company. Do you know how much Medicare pays you for the test? Sharlene > > > > Is anyone doing on-site office A1c tests? How is the reimbursement > > structured for this? I see that A1cNow (Bayer) costs about > > $215 for meter and 20 tests. This would be handy. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2011 Report Share Posted October 9, 2011 Please name product you are considering and code that would be appropriate to bill... Thanks To: Sent: Saturday, October 8, 2011 5:20 PMSubject: Re: A1c office testing , When I read the instructions for A1C NOW, I interpreted them to mean that both the monitor itself and the test pouches had to be at room temperature at the time of use and discarded if not used within 120 days after coming to room temperature. I see now that may not be correct, so I guess I will call the company. Do you know how much Medicare pays you for the test?Sharlene> >> > Is anyone doing on-site office A1c tests? How is the reimbursement> > structured for this? I see that A1cNow (Bayer) costs about> > $215 for meter and 20 tests. This would be handy.> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2011 Report Share Posted October 9, 2011 Yes, my understanding is that the plastic monitor is just electronics and not sensitive to being at room temp. Medicare pays me $13.66. You could look up your rate on your Medicare contractor's website. CPT is 83036. Haresch > > > > > > Is anyone doing on-site office A1c tests? How is the reimbursement > > > structured for this? I see that A1cNow (Bayer) costs about > > > $215 for meter and 20 tests. This would be handy. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2011 Report Share Posted October 9, 2011 I had an a1c machine with the cartridges, forgot the name. Can't make a profit on the tests, especially if any of them error on you, which ends up being a loss on the ten pack not to mention the cost of the machine. The only way I see to make it work is if you have people come in for the test , then review it with them along with a visit, extended hopefully moving up to a level 99214. Otherwise it was a money loser for me. Steve Horvitz, D.O. Founder of the Institute for Medical Wellness stown, NJ Www.drhorvitz.com > > > > > > > > Is anyone doing on-site office A1c tests? How is the reimbursement > > > > structured for this? I see that A1cNow (Bayer) costs about > > > > $215 for meter and 20 tests. This would be handy. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2011 Report Share Posted October 10, 2011 I already bill 215's on all my diabetic visits, most last 45 mintues and include mostly counseling. From: [ ] On Behalf Of drhorvitz [drhorvitz@...] Sent: Sunday, October 09, 2011 1:44 PM To: Subject: Re: A1c office testing I had an a1c machine with the cartridges, forgot the name. Can't make a profit on the tests, especially if any of them error on you, which ends up being a loss on the ten pack not to mention the cost of the machine. The only way I see to make it work is if you have people come in for the test , then review it with them along with a visit, extended hopefully moving up to a level 99214. Otherwise it was a money loser for me. Steve Horvitz, D.O. Founder of the Institute for Medical Wellness stown, NJ Www.drhorvitz.com > > > > > > > > Is anyone doing on-site office A1c tests? How is the reimbursement > > > > structured for this? I see that A1cNow (Bayer) costs about > > > > $215 for meter and 20 tests. This would be handy. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2011 Report Share Posted October 14, 2011 My husband does ALOT of diabetes care. We go through a box of 10 every three weeks. I have found it very helpful to have the results right at the office visit. Have actually been using hgb a1c's as my diagnostic test for over 2 years, I see now that this is either going to be or is the new preferred way. We got our machine from McKesson free. It can also do other tests, but they aren't CLIA -waived, so we don't do them. We also keep the cartridges in the fridge, except for the current box. The test cartridges aren't tough to use, although remember to pull the foil out AFTER the cartridge is inserted into the machine (learn from my expensive mistake). We use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small profit for us (?$1 higher reimbursement than cost, include charging for fingerstick), but the grin on my patient's face when they see their first point drop >1% is worth it!. Definitely a help in management. Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2011 Report Share Posted October 14, 2011 Also, use it when evaluating people for abnormal weight gain or inability to lose weight. Hgb a1c between 5.7% and 6.4% (pre-diabetes) is almost always associated with insulin resistance in our 'fluffy' state of Iowa. Enables me to talk about exercise and diabetic diets early, at the beginning of the disease process and start people on metformin. Could do this anyway, but gives me a visual to use to support this new-to-the-patient-concept. My husband does ALOT of diabetes care. We go through a box of 10 every three weeks. I have found it very helpful to have the results right at the office visit. Have actually been using hgb a1c's as my diagnostic test for over 2 years, I see now that this is either going to be or is the new preferred way. We got our machine from McKesson free. It can also do other tests, but they aren't CLIA -waived, so we don't do them. We also keep the cartridges in the fridge, except for the current box. The test cartridges aren't tough to use, although remember to pull the foil out AFTER the cartridge is inserted into the machine (learn from my expensive mistake). We use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small profit for us (?$1 higher reimbursement than cost, include charging for fingerstick), but the grin on my patient's face when they see their first point drop >1% is worth it!. Definitely a help in management. Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer. -- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2011 Report Share Posted October 14, 2011 lynette, have you compared the fingerstick in house hba1cs to blood drawn? > > > My husband does ALOT of diabetes care. We go through a box of 10 every > > three weeks. I have found it very helpful to have the results right at the > > office visit. Have actually been using hgb a1c's as my diagnostic test for > > over 2 years, I see now that this is either going to be or is the new > > preferred way. We got our machine from McKesson free. It can also do other > > tests, but they aren't CLIA -waived, so we don't do them. We also keep the > > cartridges in the fridge, except for the current box. The test cartridges > > aren't tough to use, although remember to pull the foil out AFTER the > > cartridge is inserted into the machine (learn from my expensive mistake). We > > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small > > profit for us (?$1 higher reimbursement than cost, include charging for > > fingerstick), but the grin on my patient's face when they see their first > > point drop >1% is worth it!. Definitely a help in management. > > > > > > Lynette I Iles MD > > 301 South Iowa > > Ste 2 > > Washington IA 52353 > > Flexible Family Care > > 'Modern medicine the old-fashioned way' > > This e-mail and attachments may contain information which is confidential > > and is only for the named addressee. If you have received this email in > > error, please notify the sender immediately and delete it from your > > computer. > > > > > > -- > Lynette I Iles MD > 301 South Iowa > Ste 2 > Washington IA 52353 > Flexible Family Care > 'Modern medicine the old-fashioned way' > This e-mail and attachments may contain information which is confidential > and is only for the named addressee. If you have received this email in > error, please notify the sender immediately and delete it from your > computer. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2011 Report Share Posted October 15, 2011 Now there is some data out that HgbA1C's can be under diagnosing DM that a 2 hour GTT would have caught? I admit to a bit of confusion. Has anyone figured it out? To: Sent: Friday, October 14, 2011 11:54 AMSubject: Re: A1c office testing lynette,have you compared the fingerstick in house hba1cs to blood drawn?> > > My husband does ALOT of diabetes care. We go through a box of 10 every> > three weeks. I have found it very helpful to have the results right at the> > office visit. Have actually been using hgb a1c's as my diagnostic test for> > over 2 years, I see now that this is either going to be or is the new> > preferred way. We got our machine from McKesson free. It can also do other> > tests, but they aren't CLIA -waived, so we don't do them. We also keep the> > cartridges in the fridge, except for the current box. The test cartridges> > aren't tough to use, although remember to pull the foil out AFTER the> > cartridge is inserted into the machine (learn from my expensive mistake). We> > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small> > profit for us (?$1 higher reimbursement than cost, include charging for> > fingerstick), but the grin on my patient's face when they see their first> > point drop >1% is worth it!. Definitely a help in management.> >> >> > Lynette I Iles MD> > 301 South Iowa> > Ste 2> > Washington IA 52353> > Flexible Family Care> > 'Modern medicine the old-fashioned way'> > This e-mail and attachments may contain information which is confidential> > and is only for the named addressee. If you have received this email in> > error, please notify the sender immediately and delete it from your> > computer.> >> > > > -- > Lynette I Iles MD> 301 South Iowa> Ste 2> Washington IA 52353> Flexible Family Care> 'Modern medicine the old-fashioned way'> This e-mail and attachments may contain information which is confidential> and is only for the named addressee. If you have received this email in> error, please notify the sender immediately and delete it from your> computer.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2011 Report Share Posted October 15, 2011 Myria, We use fasting glucose, A1c and 2 hour GTT and postprandial accuchecks for patients with diabetes and metABOLIC SYNDROME. This becomes clear over months and years of following patients numbers and weight. There is an art to this, I have not seen great science with patients with impaired fasting glucose, except exercise and weight loss. I have a patient with peripheral neuropathy but not diabetic by any of the above parameters. To: " " < >Sent: Friday, October 14, 2011 8:01 PMSubject: Re: Re: A1c office testing Now there is some data out that HgbA1C's can be under diagnosing DM that a 2 hour GTT would have caught? I admit to a bit of confusion. Has anyone figured it out? To: Sent: Friday, October 14, 2011 11:54 AMSubject: Re: A1c office testing lynette,have you compared the fingerstick in house hba1cs to blood drawn?> > > My husband does ALOT of diabetes care. We go through a box of 10 every> > three weeks. I have found it very helpful to have the results right at the> > office visit. Have actually been using hgb a1c's as my diagnostic test for> > over 2 years, I see now that this is either going to be or is the new> > preferred way. We got our machine from McKesson free. It can also do other> > tests, but they aren't CLIA -waived, so we don't do them. We also keep the> > cartridges in the fridge, except for the current box. The test cartridges> > aren't tough to use, although remember to pull the foil out AFTER the> > cartridge is inserted into the machine (learn from my expensive mistake). We> > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small> > profit for us (?$1 higher reimbursement than cost, include charging for> > fingerstick), but the grin on my patient's face when they see their first> > point drop >1% is worth it!. Definitely a help in management.> >> >> > Lynette I Iles MD> > 301 South Iowa> > Ste 2> > Washington IA 52353> > Flexible Family Care> > 'Modern medicine the old-fashioned way'> > This e-mail and attachments may contain information which is confidential> > and is only for the named addressee. If you have received this email in> > error, please notify the sender immediately and delete it from your> > computer.> >> > > > -- > Lynette I Iles MD> 301 South Iowa> Ste 2> Washington IA 52353> Flexible Family Care> 'Modern medicine the old-fashioned way'> This e-mail and attachments may contain information which is confidential> and is only for the named addressee. If you have received this email in> error, please notify the sender immediately and delete it from your> computer.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2011 Report Share Posted October 15, 2011 I ask, does it matter. If you know the FBS is high and the Hgb A1 C is “at risk†but at a controlled level then does having a frankly abnormal 2 hr GTT change anything? If there HgbA1C is less than 6.5 I don’t put them on medication. There is no evidence that it does any good to do so. So does it matter if their 2 hr GTT is abnormal if their sugars are in good control? They don’t load themselves with that level of carbs apparently. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of MyriaSent: Friday, October 14, 2011 9:01 PMTo: Subject: Re: Re: A1c office testing Now there is some data out that HgbA1C's can be under diagnosing DM that a 2 hour GTT would have caught? I admit to a bit of confusion. Has anyone figured it out? To: Sent: Friday, October 14, 2011 11:54 AMSubject: Re: A1c office testing lynette,have you compared the fingerstick in house hba1cs to blood drawn?> > > My husband does ALOT of diabetes care. We go through a box of 10 every> > three weeks. I have found it very helpful to have the results right at the> > office visit. Have actually been using hgb a1c's as my diagnostic test for> > over 2 years, I see now that this is either going to be or is the new> > preferred way. We got our machine from McKesson free. It can also do other> > tests, but they aren't CLIA -waived, so we don't do them. We also keep the> > cartridges in the fridge, except for the current box. The test cartridges> > aren't tough to use, although remember to pull the foil out AFTER the> > cartridge is inserted into the machine (learn from my expensive mistake). We> > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small> > profit for us (?$1 higher reimbursement than cost, include charging for> > fingerstick), but the grin on my patient's face when they see their first> > point drop >1% is worth it!. Definitely a help in management.> >> >> > Lynette I Iles MD> > 301 South Iowa> > Ste 2> > Washington IA 52353> > Flexible Family Care> > 'Modern medicine the old-fashioned way'> > This e-mail and attachments may contain information which is confidential> > and is only for the named addressee. If you have received this email in> > error, please notify the sender immediately and delete it from your> > computer.> >> > > > -- > Lynette I Iles MD> 301 South Iowa> Ste 2> Washington IA 52353> Flexible Family Care> 'Modern medicine the old-fashioned way'> This e-mail and attachments may contain information which is confidential> and is only for the named addressee. If you have received this email in> error, please notify the sender immediately and delete it from your> computer.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2011 Report Share Posted October 15, 2011 Kathy,There is evidence that treating prediabetes with medication can help. This article from 2009 found that metformin can decrease the rate of conversion from prediabetes to diabetes:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669003/This 2011 article reports that lifestyle changes and metformin both cut medical costs for patients with prediabetes:http://diabetes.webmd.com/news/20110629/diet-metformin-cut-medical-cost-for-prediabetes-patientsI regularly offer a trial of metformin to my prediabetic patients if their HbA1C is between 5.7% and 6.5% and has not decreased despite attempts at lifestyle changes. I don't bother checking a GTT if their HbA1C is abnormal. SetoSouth Pasadena, CA I ask, does it matter. If you know the FBS is high and the Hgb A1 C is “at risk” but at a controlled level then does having a frankly abnormal 2 hr GTT change anything? If there HgbA1C is less than 6.5 I don’t put them on medication. There is no evidence that it does any good to do so. So does it matter if their 2 hr GTT is abnormal if their sugars are in good control? They don’t load themselves with that level of carbs apparently. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of MyriaSent: Friday, October 14, 2011 9:01 PMTo: Subject: Re: Re: A1c office testing Now there is some data out that HgbA1C's can be under diagnosing DM that a 2 hour GTT would have caught? I admit to a bit of confusion. Has anyone figured it out? To: Sent: Friday, October 14, 2011 11:54 AMSubject: Re: A1c office testing lynette,have you compared the fingerstick in house hba1cs to blood drawn?> > > My husband does ALOT of diabetes care. We go through a box of 10 every> > three weeks. I have found it very helpful to have the results right at the> > office visit. Have actually been using hgb a1c's as my diagnostic test for> > over 2 years, I see now that this is either going to be or is the new> > preferred way. We got our machine from McKesson free. It can also do other> > tests, but they aren't CLIA -waived, so we don't do them. We also keep the> > cartridges in the fridge, except for the current box. The test cartridges> > aren't tough to use, although remember to pull the foil out AFTER the> > cartridge is inserted into the machine (learn from my expensive mistake). We> > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small> > profit for us (?$1 higher reimbursement than cost, include charging for> > fingerstick), but the grin on my patient's face when they see their first> > point drop >1% is worth it!. Definitely a help in management.> >> >> > Lynette I Iles MD> > 301 South Iowa> > Ste 2> > Washington IA 52353> > Flexible Family Care> > 'Modern medicine the old-fashioned way'> > This e-mail and attachments may contain information which is confidential> > and is only for the named addressee. If you have received this email in> > error, please notify the sender immediately and delete it from your> > computer.> >> > > > -- > Lynette I Iles MD> 301 South Iowa> Ste 2> Washington IA 52353> Flexible Family Care> 'Modern medicine the old-fashioned way'> This e-mail and attachments may contain information which is confidential> and is only for the named addressee. If you have received this email in> error, please notify the sender immediately and delete it from your> computer.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 15, 2011 Report Share Posted October 15, 2011 Let's make believe we do not have testing other than a fbs. Track the fbs over time with an expanding waistline and a family history of diabetes. What else do you need to start counseling on diabetes prevention? Horvitz, D.O. stown, NJ > > > > > > > My husband does ALOT of diabetes care. We go through a box of 10 every > > > > three weeks. I have found it very helpful to have the results right at the > > > > office visit. Have actually been using hgb a1c's as my diagnostic test for > > > > over 2 years, I see now that this is either going to be or is the new > > > > preferred way. We got our machine from McKesson free. It can also do other > > > > tests, but they aren't CLIA -waived, so we don't do them. We also keep the > > > > cartridges in the fridge, except for the current box. The test cartridges > > > > aren't tough to use, although remember to pull the foil out AFTER the > > > > cartridge is inserted into the machine (learn from my expensive mistake). We > > > > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small > > > > profit for us (?$1 higher reimbursement than cost, include charging for > > > > fingerstick), but the grin on my patient's face when they see their first > > > > point drop >1% is worth it!. Definitely a help in management. > > > > > > > > > > > > Lynette I Iles MD > > > > 301 South Iowa > > > > Ste 2 > > > > Washington IA 52353 > > > > Flexible Family Care > > > > 'Modern medicine the old-fashioned way' > > > > This e-mail and attachments may contain information which is confidential > > > > and is only for the named addressee. If you have received this email in > > > > error, please notify the sender immediately and delete it from your > > > > computer. > > > > > > > > > > > > > > > > -- > > > Lynette I Iles MD > > > 301 South Iowa > > > Ste 2 > > > Washington IA 52353 > > > Flexible Family Care > > > 'Modern medicine the old-fashioned way' > > > This e-mail and attachments may contain information which is confidential > > > and is only for the named addressee. If you have received this email in > > > error, please notify the sender immediately and delete it from your > > > computer. > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2011 Report Share Posted October 16, 2011 Me too. Five patients in past 2 years with peripheral diabetic neuropathy with normal fasting glucose, no increased thirst or hunger but presented with numb feet. One picked up by neuro, others by me. Scary. Certainly confirming that for many years symptoms just don't show up in diabetes til damage is done. To: " " < >Sent: Friday, October 14, 2011 9:24 PMSubject: Re: Re: A1c office testing Myria, We use fasting glucose, A1c and 2 hour GTT and postprandial accuchecks for patients with diabetes and metABOLIC SYNDROME. This becomes clear over months and years of following patients numbers and weight. There is an art to this, I have not seen great science with patients with impaired fasting glucose, except exercise and weight loss. I have a patient with peripheral neuropathy but not diabetic by any of the above parameters. To: " " < >Sent: Friday, October 14, 2011 8:01 PMSubject: Re: Re: A1c office testing Now there is some data out that HgbA1C's can be under diagnosing DM that a 2 hour GTT would have caught? I admit to a bit of confusion. Has anyone figured it out? To: Sent: Friday, October 14, 2011 11:54 AMSubject: Re: A1c office testing lynette,have you compared the fingerstick in house hba1cs to blood drawn?> > > My husband does ALOT of diabetes care. We go through a box of 10 every> > three weeks. I have found it very helpful to have the results right at the> > office visit. Have actually been using hgb a1c's as my diagnostic test for> > over 2 years, I see now that this is either going to be or is the new> > preferred way. We got our machine from McKesson free. It can also do other> > tests, but they aren't CLIA -waived, so we don't do them. We also keep the> > cartridges in the fridge, except for the current box. The test cartridges> > aren't tough to use, although remember to pull the foil out AFTER the> > cartridge is inserted into the machine (learn from my expensive mistake). We> > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small> > profit for us (?$1 higher reimbursement than cost, include charging for> > fingerstick), but the grin on my patient's face when they see their first> > point drop >1% is worth it!. Definitely a help in management.> >> >> > Lynette I Iles MD> > 301 South Iowa> > Ste 2> > Washington IA 52353> > Flexible Family Care> > 'Modern medicine the old-fashioned way'> > This e-mail and attachments may contain information which is confidential> > and is only for the named addressee. If you have received this email in> > error, please notify the sender immediately and delete it from your> > computer.> >> > > > -- > Lynette I Iles MD> 301 South Iowa> Ste 2> Washington IA 52353> Flexible Family Care> 'Modern medicine the old-fashioned way'> This e-mail and attachments may contain information which is confidential> and is only for the named addressee. If you have received this email in> error, please notify the sender immediately and delete it from your> computer.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2011 Report Share Posted October 16, 2011 if you are in lyme endemic areas be sure to chk for this pathogen but do a full western blot through Igenex lab in california the local lebs use a marblot kit test tha only has a 60% sensitivity Re: A1c office testing Myria and all, I am seeing a lot of this, too. Peripheral neuropathy without obvious cause, although sometimes with an FBS of 101 and/or HbA1c of 5.7-6.0. I have heard it can come in advance of frank diabetes, but I also recently read (in UpToDate) that statins have been associated with peripheral neuropathy, and the patients I have with this are on statins. I wonder if we are seeing statin-induced neuropathy and not realizing it, because it takes awhile to develop. I certainly see a lot of the statin-induced myalgias, even in patients who are determined to keep taking something for their lipids. And initially, many doctors were denying that this was real, because CPKs were not elevated. Does anybody out there have more thoughts/observations/experiences with this? Sharlene > > > > > My husband does ALOT of diabetes care. We go through a box of 10 every > > > three weeks. I have found it very helpful to have the results right at the > > > office visit. Have actually been using hgb a1c's as my diagnostic test for > > > over 2 years, I see now that this is either going to be or is the new > > > preferred way. We got our machine from McKesson free. It can also do other > > > tests, but they aren't CLIA -waived, so we don't do them. We also keep the > > > cartridges in the fridge, except for the current box. The test cartridges > > > aren't tough to use, although remember to pull the foil out AFTER the > > > cartridge is inserted into the machine (learn from my expensive mistake). We > > > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small > > > profit for us (?$1 higher reimbursement than cost, include charging for > > > fingerstick), but the grin on my patient's face when they see their first > > > point drop >1% is worth it!. Definitely a help in management. > > > > > > > > > Lynette I Iles MD > > > 301 South Iowa > > > Ste 2 > > > Washington IA 52353 > > > Flexible Family Care > > > 'Modern medicine the old-fashioned way' > > > This e-mail and attachments may contain information which is confidential > > > and is only for the named addressee. If you have received this email in > > > error, please notify the sender immediately and delete it from your > > > computer. > > > > > > > > > > > -- > > Lynette I Iles MD > > 301 South Iowa > > Ste 2 > > Washington IA 52353 > > Flexible Family Care > > 'Modern medicine the old-fashioned way' > > This e-mail and attachments may contain information which is confidential > > and is only for the named addressee. If you have received this email in > > error, please notify the sender immediately and delete it from your > > computer. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2011 Report Share Posted October 16, 2011 peripheral neuropathy can precede the diagnosis of diabetes by 10 years grace > > > > > > > My husband does ALOT of diabetes care. We go through a box of 10 every > > > > three weeks. I have found it very helpful to have the results right at the > > > > office visit. Have actually been using hgb a1c's as my diagnostic test for > > > > over 2 years, I see now that this is either going to be or is the new > > > > preferred way. We got our machine from McKesson free. It can also do other > > > > tests, but they aren't CLIA -waived, so we don't do them. We also keep the > > > > cartridges in the fridge, except for the current box. The test cartridges > > > > aren't tough to use, although remember to pull the foil out AFTER the > > > > cartridge is inserted into the machine (learn from my expensive mistake). We > > > > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small > > > > profit for us (?$1 higher reimbursement than cost, include charging for > > > > fingerstick), but the grin on my patient's face when they see their first > > > > point drop >1% is worth it!. Definitely a help in management. > > > > > > > > > > > > Lynette I Iles MD > > > > 301 South Iowa > > > > Ste 2 > > > > Washington IA 52353 > > > > Flexible Family Care > > > > 'Modern medicine the old-fashioned way' > > > > This e-mail and attachments may contain information which is confidential > > > > and is only for the named addressee. If you have received this email in > > > > error, please notify the sender immediately and delete it from your > > > > computer. > > > > > > > > > > > > > > > > -- > > > Lynette I Iles MD > > > 301 South Iowa > > > Ste 2 > > > Washington IA 52353 > > > Flexible Family Care > > > 'Modern medicine the old-fashioned way' > > > This e-mail and attachments may contain information which is confidential > > > and is only for the named addressee. If you have received this email in > > > error, please notify the sender immediately and delete it from your > > > computer. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 Alpha lipoic acid has some nice data for diabetic neuropathy. But then I would question that it was a peripheral neuropathy caused by diabetes. How can you have a complication before you have the disease? Kathy Saradarian, MDBranchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of pricklyfinger2007 Sent: Sunday, October 16, 2011 4:42 PMTo: Subject: Re: A1c office testing peripheral neuropathy can precede the diagnosis of diabetes by 10 years grace > > > > > > > My husband does ALOT of diabetes care. We go through a box of 10 every> > > > three weeks. I have found it very helpful to have the results right at the> > > > office visit. Have actually been using hgb a1c's as my diagnostic test for > > > > over 2 years, I see now that this is either going to be or is the new> > > > preferred way. We got our machine from McKesson free. It can also do other> > > > tests, but they aren't CLIA -waived, so we don't do them. We also keep the > > > > cartridges in the fridge, except for the current box. The test cartridges> > > > aren't tough to use, although remember to pull the foil out AFTER the> > > > cartridge is inserted into the machine (learn from my expensive mistake). We > > > > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small> > > > profit for us (?$1 higher reimbursement than cost, include charging for> > > > fingerstick), but the grin on my patient's face when they see their first > > > > point drop >1% is worth it!. Definitely a help in management.> > > >> > > >> > > > Lynette I Iles MD> > > > 301 South Iowa> > > > Ste 2 > > > > Washington IA 52353> > > > Flexible Family Care> > > > 'Modern medicine the old-fashioned way'> > > > This e-mail and attachments may contain information which is confidential > > > > and is only for the named addressee. If you have received this email in> > > > error, please notify the sender immediately and delete it from your> > > > computer.> > > > > > > > > > > > > > > > -- > > > Lynette I Iles MD> > > 301 South Iowa> > > Ste 2> > > Washington IA 52353> > > Flexible Family Care > > > 'Modern medicine the old-fashioned way'> > > This e-mail and attachments may contain information which is confidential> > > and is only for the named addressee. If you have received this email in > > > error, please notify the sender immediately and delete it from your> > > computer.> > >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 kathy, disease diagnosis is always delayed just because numbers are just slowly going down this last year. hba1c was initially thought as FBS driven now it's post prandial, routine testing for physicals dont include coverage for hba1c. fluctuations in cellular glucose are thought to be the reason for periph nerve cell dysfunction. as in PMR may be a paraneoplastic thing... heralding symptom, etc.. my take home for this is: all chocoholics out there - including jean - come, cry on my shoulder.. youre not alone. grace ps.. r lipoic acid is better at 50 to 150 mg/day whereas ALA is dose at 600-1200 mg... any other thoughts? > > > > > > > > > My husband does ALOT of diabetes care. We go through a box of 10 > every > > > > > three weeks. I have found it very helpful to have the results right > at the > > > > > office visit. Have actually been using hgb a1c's as my diagnostic > test for > > > > > over 2 years, I see now that this is either going to be or is the > new > > > > > preferred way. We got our machine from McKesson free. It can also do > other > > > > > tests, but they aren't CLIA -waived, so we don't do them. We also > keep the > > > > > cartridges in the fridge, except for the current box. The test > cartridges > > > > > aren't tough to use, although remember to pull the foil out AFTER > the > > > > > cartridge is inserted into the machine (learn from my expensive > mistake). We > > > > > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a > small > > > > > profit for us (?$1 higher reimbursement than cost, include charging > for > > > > > fingerstick), but the grin on my patient's face when they see their > first > > > > > point drop >1% is worth it!. Definitely a help in management. > > > > > > > > > > > > > > > Lynette I Iles MD > > > > > 301 South Iowa > > > > > Ste 2 > > > > > Washington IA 52353 > > > > > Flexible Family Care > > > > > 'Modern medicine the old-fashioned way' > > > > > This e-mail and attachments may contain information which is > confidential > > > > > and is only for the named addressee. If you have received this email > in > > > > > error, please notify the sender immediately and delete it from your > > > > > computer. > > > > > > > > > > > > > > > > > > > > > -- > > > > Lynette I Iles MD > > > > 301 South Iowa > > > > Ste 2 > > > > Washington IA 52353 > > > > Flexible Family Care > > > > 'Modern medicine the old-fashioned way' > > > > This e-mail and attachments may contain information which is > confidential > > > > and is only for the named addressee. If you have received this email > in > > > > error, please notify the sender immediately and delete it from your > > > > computer. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 also that the brain has a significant amount of fat... so why lose the weight? grace > > > > > > > > > My husband does ALOT of diabetes care. We go through a box of 10 every > > > > > three weeks. I have found it very helpful to have the results right at the > > > > > office visit. Have actually been using hgb a1c's as my diagnostic test for > > > > > over 2 years, I see now that this is either going to be or is the new > > > > > preferred way. We got our machine from McKesson free. It can also do other > > > > > tests, but they aren't CLIA -waived, so we don't do them. We also keep the > > > > > cartridges in the fridge, except for the current box. The test cartridges > > > > > aren't tough to use, although remember to pull the foil out AFTER the > > > > > cartridge is inserted into the machine (learn from my expensive mistake). We > > > > > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small > > > > > profit for us (?$1 higher reimbursement than cost, include charging for > > > > > fingerstick), but the grin on my patient's face when they see their first > > > > > point drop >1% is worth it!. Definitely a help in management. > > > > > > > > > > > > > > > Lynette I Iles MD > > > > > 301 South Iowa > > > > > Ste 2 > > > > > Washington IA 52353 > > > > > Flexible Family Care > > > > > 'Modern medicine the old-fashioned way' > > > > > This e-mail and attachments may contain information which is confidential > > > > > and is only for the named addressee. If you have received this email in > > > > > error, please notify the sender immediately and delete it from your > > > > > computer. > > > > > > > > > > > > > > > > > > > > > -- > > > > Lynette I Iles MD > > > > 301 South Iowa > > > > Ste 2 > > > > Washington IA 52353 > > > > Flexible Family Care > > > > 'Modern medicine the old-fashioned way' > > > > This e-mail and attachments may contain information which is confidential > > > > and is only for the named addressee. If you have received this email in > > > > error, please notify the sender immediately and delete it from your > > > > computer. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 Correlation between fingerstick hgb a1c and venous was excellent, never more than .2 difference. We double tested almost everyone for 2 months. Now, we do a double test/ spot check every 4-6 months. Still running very accurate. Since I did ob for so long, I got used to watching post-prandial sugars. My brain made the jump that this was probably also the best indicator of early diabetes (ie 2hr GTT). The easiest way to get a handle on PP sugars was to do a hgb a1c. By the time 'diabetes' is diagnosed, something like 50% of islet cells are already gone. I use ALOT of metformin due to the studies that show a postponing of diabetes for up to 5 years, even after use is stopped. I actually spend alot more time addressing insulin resistance than I do mild to moderately high cholesterol, as DM is so much worse of a disease than the risk of high cholesterol. Agree with the NNT data on the statins. Unless secondary prevention, definitely not motivating to use. I come from a family with high cholesterol on both sides. Extensive DM on my mother's side. The young die in their 80's from smoking or ignoring their diabetes. Otherwise, 90's-100's. I'm not thinking the high cholesterol genetics are very significant! Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 Also agree on statins, little data for primary prevention. I have looking all over for an article that shows that diabetic neuropathy can precede long term hyperglycemia. If you have the reference, can you send it? From: [ ] On Behalf Of Lynette Iles [liles64@...] Sent: Monday, October 17, 2011 10:03 AM To: Subject: Re: Re: A1c office testing Correlation between fingerstick hgb a1c and venous was excellent, never more than .2 difference. We double tested almost everyone for 2 months. Now, we do a double test/ spot check every 4-6 months. Still running very accurate. Since I did ob for so long, I got used to watching post-prandial sugars. My brain made the jump that this was probably also the best indicator of early diabetes (ie 2hr GTT). The easiest way to get a handle on PP sugars was to do a hgb a1c. By the time 'diabetes' is diagnosed, something like 50% of islet cells are already gone. I use ALOT of metformin due to the studies that show a postponing of diabetes for up to 5 years, even after use is stopped. I actually spend alot more time addressing insulin resistance than I do mild to moderately high cholesterol, as DM is so much worse of a disease than the risk of high cholesterol. Agree with the NNT data on the statins. Unless secondary prevention, definitely not motivating to use. I come from a family with high cholesterol on both sides. Extensive DM on my mother's side. The young die in their 80's from smoking or ignoring their diabetes. Otherwise, 90's-100's. I'm not thinking the high cholesterol genetics are very significant! Lynette I Iles MD 301 South Iowa Ste 2 Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 Didn't the article show that diet and exercise actually made more of an improvement than Metformin, that was my recollection. I routinely give them 3 months, and some tips on making the changes, if they can't I give the Metformin. Low glycemic index diets work the best for metabolic syndrome. C Cote To: Sent: Friday, October 14, 2011 8:10:53 PMSubject: Re: Re: A1c office testing Kathy, There is evidence that treating prediabetes with medication can help. This article from 2009 found that metformin can decrease the rate of conversion from prediabetes to diabetes: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669003/ This 2011 article reports that lifestyle changes and metformin both cut medical costs for patients with prediabetes: http://diabetes.webmd.com/news/20110629/diet-metformin-cut-medical-cost-for-prediabetes-patients I regularly offer a trial of metformin to my prediabetic patients if their HbA1C is between 5.7% and 6.5% and has not decreased despite attempts at lifestyle changes. I don't bother checking a GTT if their HbA1C is abnormal. Seto South Pasadena, CA I ask, does it matter. If you know the FBS is high and the Hgb A1 C is “at risk†but at a controlled level then does having a frankly abnormal 2 hr GTT change anything? If there HgbA1C is less than 6.5 I don’t put them on medication. There is no evidence that it does any good to do so. So does it matter if their 2 hr GTT is abnormal if their sugars are in good control? They don’t load themselves with that level of carbs apparently. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of MyriaSent: Friday, October 14, 2011 9:01 PMTo: Subject: Re: Re: A1c office testing Now there is some data out that HgbA1C's can be under diagnosing DM that a 2 hour GTT would have caught? I admit to a bit of confusion. Has anyone figured it out? To: Sent: Friday, October 14, 2011 11:54 AMSubject: Re: A1c office testing lynette,have you compared the fingerstick in house hba1cs to blood drawn?> > > My husband does ALOT of diabetes care. We go through a box of 10 every> > three weeks. I have found it very helpful to have the results right at the> > office visit. Have actually been using hgb a1c's as my diagnostic test for> > over 2 years, I see now that this is either going to be or is the new> > preferred way. We got our machine from McKesson free. It can also do other> > tests, but they aren't CLIA -waived, so we don't do them. We also keep the> > cartridges in the fridge, except for the current box. The test cartridges> > aren't tough to use, although remember to pull the foil out AFTER the> > cartridge is inserted into the machine (learn from my expensive mistake). We> > use a DCA Vantage Analyzer by Siemens. I think it is a wash or a small> > profit for us (?$1 higher reimbursement than cost, include charging for> > fingerstick), but the grin on my patient's face when they see their first> > point drop >1% is worth it!. Definitely a help in management.> >> >> > Lynette I Iles MD> > 301 South Iowa> > Ste 2> > Washington IA 52353> > Flexible Family Care> > 'Modern medicine the old-fashioned way'> > This e-mail and attachments may contain information which is confidential> > and is only for the named addressee. If you have received this email in> > error, please notify the sender immediately and delete it from your> > computer.> >> > > > -- > Lynette I Iles MD> 301 South Iowa> Ste 2> Washington IA 52353> Flexible Family Care> 'Modern medicine the old-fashioned way'> This e-mail and attachments may contain information which is confidential> and is only for the named addressee. If you have received this email in> error, please notify the sender immediately and delete it from your> computer.> Quote Link to comment Share on other sites More sharing options...
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