>In a previous article, sho…@altair.krl.caltech.edu (Tim Shoppa) says:

>>>How frequently would you have to test to make the HB1AC test
>>absolutely unnecessary?  Many diabetics who check their
>>blood sugars religiously 4 times a day will rarely check their
>>blood sugars at other than before meal times, while the large
>>spikes in blood sugar most likely take place between meals.

>Well, then, they are checking their bg’s at the wrong times.  The more
>useful measure is 1-2 hours *after* a meal.

It depends what you’re using it *for*.  For long-term planning and
checking your current regimen, yeah.  For short-term, "how much insulin
do I need for *this* injection?", before meals is more useful.

                                                        Rachel

–
Rachel Meredith Kadel or, for the adventurously inclined, Bean-na-Sidhe
rka…@fas.harvard.edu
Honorary Fellow of Brad’s School of Piano Tuning and Bible Technology

>Sound like you’ll be entered into the marketing database and targeted
>for mailings etc. later.  Keep this information private.

>If you are doing frequent BG monitoring, the A1C may not be as important.

>It is however valuable to doctors, because people naturally try to become
>more careful about control when expecting to visit the doctor soon.  I
>used to become more "complient" with doctors orders when a visit was due.
>The A1C gives the physician a two month overall view of patients
>condition, not just the careful tweaking the patient did for a few days
>to get a good "fasting BG" result.

Another example of what happens when people lift quotes out of context.  
By the time the 3rd or 4th person chimes in, the intent of the original
post becomes completely distorted.  All I said was that it is incorrect
to tell *all* diabetics, regardless of type or degree of control, to have
three or four A1C tests a year.  No one disputes that it’s a valuable
test for doctor and patient alike.  But it is by no means required if
doctor and patient are satisfied about degree of control without it.  And
for BD, Lilly, and Boeringer Mannheim to say otherwise is a marketing
ploy having nothing to do with good medicine.

–
David Cohler, South Pasadena

David Cohler <ar…@lafn.org> wrote:
>The cover letter, from "Martha Griffin, Diabetes Care Specialist,"
>evidently an employee of BD, states categorically that "People
>with diabetes should take (an Hb1AC — glycolsolated hemoglobin —
>test) three to four times a year."  She neglects to mention that
>the test, while indeed an excellent indicator of overall bg
>control, is nonetheless *absolutely unnecessary* for diabetics
>whose control is good (as measured by frequent home monitoring)
>and who are thus on the right track without it.

Don’t forget that *many* of the diabetics out there are not
undergoing what some call "intensive therapy".  The reasons
why they aren’t are wide and varied, but a significant chunk
could benefit from a Hb1AC.

How frequently would you have to test to make the HB1AC test
absolutely unnecessary?  Many diabetics who check their
blood sugars religiously 4 times a day will rarely check their
blood sugars at other than before meal times, while the large
spikes in blood sugar most likely take place between meals.
The A1C number is a convenient quick test that says something
about the overall average level, instead of the levels at the
before-mealtime tests that are most often done.  It’s not
a full replacement for individual blood glucose measurements,
though.

>  For such people,
>just one A1C a year might be defendable, but three or four is an
>absolute waste of resources.

Once a year is something I could live with.  My doctor would
probably prefer to have it done more often, though.

>  Griffin further urges all diabetics
>to ask their doctors about the test — as if MD’s didn’t know
>about it already.

Many GP’s (again, not all diabetics are under intensive treatment
and many don’t even see an endocrinologist regularly) probably don’t
know about the A1C test, or how to use it.

>  The effect of this hectoring is to get doctors
>to prescribe tests which may be totally unnecessary, and thereby
>to put more money into the pockets of various product and service
>providers — the ripple effect of which is to drive up health care
>and insurance costs.

I believe the lab charge for a A1C test is about $20-$30;
depending on exactly what sort of home blood glucose strips are
being used, this would pay for fifty or so home glucose
tests at random times to come up with the same average that the
A1C measures.  Whether those fifty extra tests
would be of the same use as the A1C is something that probably
depends on the doctor and patient.

Tim. (sho…@altair.krl.caltech.edu)

If I had only realized that up front I wouldn’t have wasted my time!
Maybe if they read this we can see the results published in ADA Forcast!

In article <1995Nov28.231006.7…@lafn.org>, ar…@lafn.org (David Cohler)
wrote:

- Hide quoted text — Show quoted text -

> I dunno about the rest of you who may have received the latest so-
> called "PACE" survey form from BD, but I am irked at what looks to
> be more like a marketing ploy than a sincere effort to propagate
> accurate info about maintaining good bg control.

> The cover letter, from "Martha Griffin, Diabetes Care Specialist,"
> evidently an employee of BD, states categorically that "People
> with diabetes should take (an Hb1AC — glycolsolated hemoglobin —
> test) three to four times a year."  She neglects to mention that
> the test, while indeed an excellent indicator of overall bg
> control, is nonetheless *absolutely unnecessary* for diabetics
> whose control is good (as measured by frequent home monitoring)
> and who are thus on the right track without it.  For such people,
> just one A1C a year might be defendable, but three or four is an
> absolute waste of resources.  Griffin further urges all diabetics
> to ask their doctors about the test — as if MD’s didn’t know
> about it already.  The effect of this hectoring is to get doctors
> to prescribe tests which may be totally unnecessary, and thereby
> to put more money into the pockets of various product and service
> providers — the ripple effect of which is to drive up health care
> and insurance costs.

> The "survey" itself (which is actually a thinly disguised attempt
> to gather marketing info) asks 9 questions about various aspects
> of bg control — including, of course, what products you use.
> Some of the questions appear to have been written by nondiabetics.
> For example, question #7: "How many times a day do you inject
> insulin?"  The checkbox answers are limited to "1," "2," "3," and
> "4 or more."  It apparently did not occur to the questioner that
> "As many as necessary to maintain good control" is a probable (and
> possibly the best) answer.  Ditto for the question, "How often do
> you test your blood sugar?"  "As often as necessary" is *not*
> among the optional answers.

> Well, look, the sponsors of this mailing (BD, Lilly, & Boehringer
> Mannheim) make excellent products for diabetics.  But I resent
> their blatant effort to boost sales via a marketing ploy they
> choose to call a "National Diabetes Care Survey."  I wish they had
> spend the money on *product* R & D instead of on marketing R & D.

> —
> David Cohler, South Pasadena

=I’m hopeful some people can help me.  My husband was diagnosed with type 2
=in November 1994 at the age of 33. He is of average weight. He is taking
=the max amount glucophage and 2.5 mg. of glucotrol.  He is sensitive to
=insulin; his BG plummets with as little as 2 units.

He might want to experiment with timing of injections.  If his diabetes is
characterized by impaired early-phase insulin release, and he injects at such a
time that the insulin doesn’t take effect until his blood sugar level has
already increased substantially, then that might explain the apparent insulin
sensitivity (basically, the action of the injected insulin permits glucose
metabolism, triggering a massive late-phase insulin release, so the BG isn’t
really plumetting with 2 units of insulin: it’s plumetting with the 2 units he
injected plus the considerably larger amount his body releases in response),
and there’s a chance that, by injecting earlier, so that the insulin begins to
take effect before the blood sugar spike, the apparent sensitivity could be
avoided.  He should, of course, discuss the idea with his doctor before trying
it.
—————————————————————————
I  try  very  hard  to say exactly what I mean.  I’d appreciate it if you’d
bear that in mind and not try to "interpret"  my  posts  to  fit  your  own
preconceived notions if I’m posting in a serious thread.  Remember:  If you
throw a strawman into a heated debate, flames are likely to be the result.

Paula Carr