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Diagnosis and Monitoring of Diabetes Mellitus

The most common screening technique for diabetes is a fasting blood sugar test like the one I gave Joe. Physicians also use a sugar challenge test, in which an individual is given a sugar load (a pop like drink that is loaded with sugar), and then takes a blood sugar level test two hours later.

Most physicians believe that a two-hour blood sugar above l90 (definitely above 200) is the level needed to diagnose diabetes. A normal two-hour blood sugar level should be less than l l0 and definitely less than 130. (Patients who have a slightly elevated fasting blood sugar and a two-hour blood sugar between 130 and 190 are classified as having glucose intolerance-preclinical diabetes-and not actual diabetes.)

Since a blood sugar measurement indicates only how a patient is doing at a particular moment, another helpful test is a hemoglobin A1C, which reveals the amount of sugar found in a red blood cell. (I like to have a patient with diabetes or diabetic tendencies have this test done every four to six months.) Since our red blood cells remain in the body for approximately 140 days, this test is a great indicator of how well a patient is truly controlling his or her diabetes. The normal range for a hemoglobin A1C, in most labs is 3.5 to 5.7.

The goal for a diabetic is to keep tight control so that the hemoglobin A1C remains below 6.5 percent. When patients are able to do this, their risk of developing a secondary complication is less than 3 percent. But if they maintain a hemoglobin A1C of greater than 9 percent, their risk of developing a secondary complication related to diabetes jumps to 60 percent. This comes as a shock, especially in light of the fact that the average treated diabetic in the United States maintains a hemoglobin A1C of 9.2. Needless to say, this is not a great endorsement for our health-care system when it comes to diabetes.

Of greater concern is the fact that at the time of actual diagnosis of diabetes by a physician, a majority (more than 60 percent) of these patients already have major cardiovascular disease.' This puts the patient at a disadvantage before he even starts treatment. You see, once insulin resistance begins, the process of atherosclerosis (hardening of the arteries) accelerates dramatically. This is why it is critical for physicians to recognize Syndrome X in their patients as soon as possible and encourage lifestyle changes that can correct the problem. A patient may have Syndrome X many years before he truly becomes diabetic. By this time treatment to reverse damage is simply too late.

"What Your Doctor Doesn't Know About Nutritional Medicine May Be Killing You."
Dr. Ray Strand http://www.raystrand.com/bookstore.asp