Guest guest Posted February 4, 2004 Report Share Posted February 4, 2004 sweet! that's my Doctor B! regards, FYI > > Diabetes Solution Revised and Updated > The Complete Guide to Achieving Normal Blood Sugars > K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S. > A BASELINE MEASURE OF YOUR DISEASE > AND RISK PROFILE > Part 2 > Continued: TESTS > Cardiac Risk Factors > This is a battery of tests that measure substances in the blood that > may > predispose you to arterial and heart disease. > Important note: Sometimes, months to years after a patient has > experienced normal or near-normal blood sugars and resultant > improvements in the cardiac risk profile, we might see deterioration > in > the results of such tests as those for LDL, HDL, homocysteine, and > lipoprotein(a). All too often, the patient or his physician will > blame > our diet. Inevitably, however,we find upon further testing that his > thyroid activity has declined. Hypothyroidism is an autoimmune > disorder, > like type 1 diabetes, and is frequently inherited by diabetics and > their > close relatives. It can appear years before or after the development > of > diabetes and is not caused by high blood sugars. In fact, > hypothyroidism > can cause a greater likelihood of abnormalities of the cardiac risk > profile than can blood sugar elevation. The treatment of a low > thyroid > condition is oral replacement of the deficient hormone(s)-usually 1 > pill > daily. The best screening test is free T3. If this is low, then a > full > thyroid test profile should be performed. Correction of the thyroid > deficiency inevitably corrects the abnormalities of cardiac risk > factors > that it caused. > Lipid profile. > This profile measures fatty substances (lipids) in your blood and > includes total cholesterol, HDL (high-density lipoprotein), > triglycerides, and direct LDL (low-density lipoprotein). Other > cardiac > risk factors (discussed below) include C-reactive protein, > fibrinogen, > lipoprotein(a), and homocysteine, and may be more predictive. > Abnormalities > of these tests are frequently treatable and tend to improve with > normalization of blood sugars. > These tests should be performed after you have fasted for at least 8 > hours. The easiest thing is to have them scheduled in the morning. > If > you haven't fasted before the test, the results will be difficult to > interpret. > Maybe you've heard of " good " cholesterol and " bad " cholesterol? > Well, this is why a reading for total cholesterol by itself won't > necessarily reflect cardiac risk. Most of the cholesterol in our > bodies, > both good and bad, is made in the liver; it does not come from > eating so > called " heart attack foods. " If you've eaten a meal that's high in > cholesterol, your liver will adjust to make less of the " bad " > cholesterol, LDL. Serum triglyceride levels can vary dramatically > after > meals, with high carbohydrate meals causing high triglyceride > levels. > Some people-because they're obese or have high blood sugars or are > genetically predisposed-make more or dispose of less LDL than they > should, which can put them at a higher risk for cardiac problems. > High > levels of LDL increase the risk of heart disease, which makes LDL > the > " bad " cholesterol. HDL, on the other hand, is a lipid that reduces > the > risk of heart disease and is the " good " cholesterol. So it is the > ratio > of total cholesterol to HDL (total cholesterol ÷ HDL) that is > significant. You could have a high total cholesterol and yet, > because of > low LDL and high HDL, have a low cardiac risk. Conversely, a low > total > cholesterol but with a low HDL would signify increased risk. > Recently, > as more has become known about cholesterol, research has shown that > LDL > occurs in at least two forms-small, dense LDL particles (the > hazardous > form) and large, buoyant LDL particles. Although small, dense LDL is > not, at this writing, being measured by commercial labs, it can be > estimated by dividing the triglyceride measure by the HDL measure. > This > ratio is even more informative of cardiac risk than the traditional > cholesterol ÷ HDL ratio. > The only truly accurate measure of LDL is the direct LDL test. The > customary, indirect measure of LDL is estimated mathematically > andcan > result in values that are grossly in error. Direct measurement of > LDL, > however, may cost more than all the rest of your lipid profile. > Also important to remember is that-as we will discuss in Chapter > 9-fats > and cholesterol in the diet do not cause high-risk lipid profiles in > most people. On the other hand, diabetics tend to have lipid > profiles > that reflect increased cardiac risk, if their blood sugars have been > elevated for several weeks or months. > Homocysteine (fasting) > Recently discovered as a (nonlipid) cardiac risk factor is > homocysteine. > This is an amino acid that tends to be elevated in poorly controlled > diabetes and in individuals with kidney impairment or folic acid, > vitamin B-12, or vitamin B-6 deficiency. > Thrombotic risk profile > This profile includes levels of fibrinogen, C-reactive protein, and > lipoprotein(a). The latter two are " acute phase reactants, " or > substances that reflect ongoing infection and other in-flammation. > These > three substances are associated with increased tendency of blood to > clot > or form infarcts (blockages of arteries) in people who have had > sustained high blood sugars. > In the cases of elevated fibrinogen or lipoprotein(a), there is, > additionally, often an increased risk of kidney impairment or > retinal > disease. Obesity, even without diabetes, can cause elevation of > C-reactive protein. In my experience, all these tests are more > potent > indicators of impending heart attack than the lipid profile. > Treatments > are available for elevations of each of these. Blood sugar > normalization > will tend to reverse most of these elevations over the long term. > Fibrinogen can be elevated by kidney disease, even in the absence of > elevated blood sugars. It will tend to normalize if kidney disease > reverses. Lipoprotein(a) will also tend to normalize somewhat by > blood > sugar normalization, although your genetic makeup (and low estrogen > levels in women) can play a greater role than blood sugar.Abnormally > low > thyroid function is a common cause of low HDL and elevated LDL, > homocysteine, and lipoprotein(a). > Serum transferrin saturation, ferritin, total iron binding capacity > (TIBC) > These are all measures of total body iron stores, which tend to be > more > elevated in men than in premenopausal women. Iron is vital, but it > is > also potentially dangerous. Levels that are too high can indicate a > cardiac risk, cause insulin resistance, and are a risk factor for > liver > cancer. I will discuss insulin resistance at length in Chapter 6. > Higher > iron levels are more likely in men than in premenopausal women > because > of blood (iron) loss during menstruation. (This is why I recommend > iron-enhanced vitamin supplements only for those with an established > need.) Iron levels that are too low (iron deficiency anemia, which > is > more common in premenopausal women) can cause an uncontrollable urge > to > snack, which in turn can lead to uncontrollable blood sugars. Both > high > and low iron stores can easily determined > and readily treated. > Part One > > > > We would like to thank the publisher Little Brown and Company and > Dr. > K. Bernstein, for allowing us to provide excerpts from > Diabetes > Solution. > > Copyright © 2003 by K. Bernstein, M.D. > All rights reserved. No part of this book may be reproduced in any > form > or by any electronic or mechanical means, including information > storage > and retrievalsystems, without permission in writing from the > publisher, > except by a reviewer who may quote brief passages in a review. > > Author's Note > This book is not intended as a substitute for professional medical > care. > The reader should regularly consult a physician for all > health-related > problems and routine care. > > > > For information on how you can purchase Diabetes Solution, go to > www.Diabetes-solution.net > Now on Special for $19.95. Regular $27.95 A savings of $8.00. Plus > you > will receive at no cost. > FREE BONUS with purchase of " Diabetes Solution " > FREE BONUS with purchase of " Diabetes Solution " > " Getting to the Heart of Diabetes " is a guide to understanding CVD, > diabetes and insulin resistance. This is a small guide with 4 > chapters, > Diabetes, Insulin Resistance, Controlling Diabetes and Warning Signs > for > heart attacks and strokes. After reading the booklet, your patient > can > take the next step by putting their new knowledge into action. As > part > of the program patients receive the following free of charge..... > > 1. Heart of Diabetes Journal to track your progress in managing your > diabetes and reducing your risk for cardiovascular disease; > 2. 12-month subscription to Diabetes Positive magazine; and > 3. Incentives throughout the year to help stay motivated. > ORDER NOW! www.diabetes-solution.net or Call 1- or > Email: info@... > > of all the things I have lost, I miss my mind the most. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2004 Report Share Posted February 4, 2004 Thanks for the great info! BTW can you please put subjects that define the content since I have about 300 stored emails in my stored box and it would make it easier to find them. Thanks. regards, FYI > A BASELINE MEASURE OF YOUR DISEASE AND RISK PROFILE Part 2 > > > > Advertise Classifieds New Products Links > About > Us Contact Us Recommend Us FREE NEWSLETTER > Tools Test Your Knowledge > > > > Diabetes Solution Revised and Updated > The Complete Guide to Achieving Normal Blood Sugars > K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S. > A BASELINE MEASURE OF YOUR DISEASE > AND RISK PROFILE > Part 3 > Excerpted from Chapter 2: TESTS > Continued: > Renal Risk Profile > Chronic blood sugar elevation for many years can cause slow > deterioration of the kidneys. If caught early, it may be reversible > by > blood sugar normalization, as it was in my own case. Unless you > think > frequent hospital visits for dialysis might be a nice way to meet > people, it's wise to have periodic tests that reflect early kidney > changes. It is also wise to have all these periodically performed > together, as the results of each can clarify the interpretation of > all. > Several factors cause false positive results in some of these tests, > so > you should keep them in mind when your doctor schedules the tests. > You > should avoid strenuous or prolonged lower-body exercise (which would > include motorcycle or horseback riding) in the 48 hours preceding > the > tests. Additionally, if on the day the tests are to be performed > you are menstruating or have a fever, a urinary tract infection, or > active kidney stones, you should postpone the tests until these > conditions have cleared. > A basic renal risk profile should include the following: > Urinary kappa light chains > If early diabetic kidney disease is present, this test reports > " polyclonal kappa light chains present. " This means that small > amounts > of tiny protein molecules may be entering > the urine, due to leaky blood vessels in the kidneys. Because these > molecules are so small, they are the first proteins to leak through > tiny > pores in the blood vessels of the kidneys that may have been > affected by > disease. > This test requires a small amount of fresh urine. If the test report > states " monoclonal light chains present, " there is a possibility of > treatable malignancies of certain white blood cells. > Microalbuminuria > This less costly test can now be performed qualitatively (by > dipstick) > in your doctor's office, or quantitatively at outside laboratories. > It, > like the urinary kappa light chain test, can also reflect leaky > vessels > in the kidneys, but at a later stage, since albumin is a slightly > larger > molecule. > A quantitative measurement requires a 24-hour urine specimen, which > means you'll need to collect all the urine you produce in a 24-hour > period in a big jug and deliver it to your physician or laboratory. > Given the potential embarrassment of carrying a jug full of urine > around > at work, you might want to schedule your test on a Monday and > collect > the urine while at home on Sunday. Many of my women patients report > that > it's easier to collect urine initially in a clean paper cup, and > then > pour it into the jug. An easier screening test is the measurement of > the > albumin-to-creatinine ratio in a first morning urine sample. > 24-hour urinary protein > This test detects kidney damage at a later stage than the preceding > two > tests; it also requires a 24-hour urine collection. As with the > other > tests, false positive results can occur following strenuous > lower-body > exercise, as previously noted. > Creatinine clearance > Creatinine is a chemical by-product of muscle metabolism, and is > present > in your bloodstream all the time. Measuring the clearance of > creatinine > from the body is a way of estimating the filtering capacity of the > kidneys. Test values are usually higher than normal when a person is > spilling a lot of sugar in the urine, and eventually lower than > normal > when the kidneys have been damaged by years of elevated blood > sugars. It > is not surprising to see an appropriate drop in creatinine clearance > when blood sugars are normalized and urine glucose vanishes. > The creatinine clearance test requires a 24-hour urine collection, > and > your doctor will draw a small amount of blood to measure serum > creatinine. The most common cause of abnormally low values for this > test > is failure of the patient to collect all the urine produced in a > 24-hour > period. Therefore, if other kidney tests are normal, tests with low > values for creatinine clearance should be repeated for verification. > A low creatinine clearance without excess urinary protein signifies > a > nondiabetic cause of kidney impairment. When it is impractical to > make a > 24-hour urine collection, as for small children, a new test > requiring a > small amount of blood, crystatin-c, can be performed. > Serum beta2 microglobulin > This is a very sensitive test for injury to the tubules of the > kidneys, > which pass urine filtered from the blood. As with fibrinogen levels, > elevated values can also result from inflammation or infection > anywhere > in the body. Thus an isolated elevation of serum beta2 microglobulin > without the presence of urinary kappa light chains or microalbumin > is > probably due to some sort of infection, not to diabetic kidney > disease. > Such elevation is commonplace in people with AIDS. > 24-hour urinary glucose > This test too requires a 24-hour collection of urine, and is of > value > for proper interpretation of the creatinine clearance. > Note: If, as you've been reading about these tests, you've imagined > yourself lugging around multiple jugs of urine, most of us only need > one > 3-liter jug. This should give you an adequate specimen for your > physician to perform creatinine clearance, microalbumin, 24-hour > protein, and 24-hour glucose. Nevertheless, it's wise to bring home > two > empty jugs, just in case your urine output is very high. > > As indicated under " Cardiac Risk Factors, " significant kidney damage > is > also accompanied by elevations of serum homocysteine and fibrinogen. > > Part 4 Tests Continued > Part One, Part Two > > > > We would like to thank the publisher Little Brown and Company and > Dr. > K. Bernstein, for allowing us to provide excerpts from > Diabetes > Solution. > > Copyright © 2003 by K. Bernstein, M.D. > All rights reserved. No part of this book may be reproduced in any > form > or by any electronic or mechanical means, including information > storage > and retrievalsystems, without permission in writing from the > publisher, > except by a reviewer who may quote brief passages in a review. > > Author's Note > This book is not intended as a substitute for professional medical > care. > The reader should regularly consult a physician for all > health-related > problems and routine care. > > > > For information on how you can purchase Diabetes Solution, go to > www.Diabetes-solution.net > Now on Special for $19.95. Regular $27.95 A savings of $8.00. Plus > you > will receive at no cost. > FREE BONUS with purchase of " Diabetes Solution " > FREE BONUS with purchase of " Diabetes Solution " > " Getting to the Heart of Diabetes " is a guide to understanding CVD, > diabetes and insulin resistance. This is a small guide with 4 > chapters, > Diabetes, Insulin Resistance, Controlling Diabetes and Warning Signs > for > heart attacks and strokes. After reading the booklet, your patient > can > take the next step by putting their new knowledge into action. As > part > of the program patients receive the following free of charge..... > > 1. Heart of Diabetes Journal to track your progress in managing your > diabetes and reducing your risk for cardiovascular disease; > 2. 12-month subscription to Diabetes Positive magazine; and > 3. Incentives throughout the year to help stay motivated. > ORDER NOW! www.diabetes-solution.net or Call 1- or > Email: info@... > Print This > Archives > > > > > > > Get the FREE Diabetes In Control Newsletter! > * Free Diabetes Related Information. > * Participation in Current and Future Studies > * Participation in Surveys (honorariums) > * Information that better helps your patients. > * Stay Current with the most updated information on > treatments and medical devices. > * Learn about new studies......plus much more... > > > Simply Enter your Email Address Below to begin receiving > the > FREE Diabetes In Control Weekly Newsletter in your > mailbox. > > Please specify the format you can receive the newsletter > in > below > HTML Text AOL > > > Home Newsletters Education Features Studies > Search Advertise Tools Test Your Knowledge > About Us Contact Us Disclaimer Privacy Policy > Links > New Products > We subscribe to the HONcode principles of the Health On the Net > Foundation > ©Copyright 1999-2003 Diabetes In Control > For Questions about this website click here > > > of all the things I have lost, I miss my mind the most. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2004 Report Share Posted February 4, 2004 Concerning a test for insulin resistence, there is a thumb nail test done by the ratio trigs/hdl, where a ratio of < 3 is a good goal. xv ic|xc Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2004 Report Share Posted February 4, 2004 I am a little dense today. Could someone explain the ratio test below, please. FYI > > Concerning a test for insulin resistence, there is a thumb nail test done > by the ratio trigs/hdl, where a ratio of < 3 is a good goal. > > xv > ic|xc > > > > > Quote Link to comment Share on other sites More sharing options...
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