Islets of Hope treatment options for persons with diabetes

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By Lahle Wolfe

Sources
Diabeteshealthonline
Labtestsonline.org


Diabetes Treatment & Management
Diabetes Type 1
Diabetes Type 2 
Pre-Diabetes
Gestational Diabetes
Diabetes Insipidus
Treating Hypoglycemia
Treating Hyperglycemia
Monitoring Blood Sugar
Diabetes Complications

How to Give a Glucagon Shot (illustrated)


Conventional Treatments
Pancreas Islet Cell Transplant
Pancreas (Organ) Transplant
Stress Management
Lifestyle Changes


Complimentary Treatments
Alternative & Complementary Mini Site Index
Acupuncture
Biofeedback, Meditation & Prayer
Chiropractic Care
Diabetes "Cures"
Herbals & Natural Remedies
Homeopathy
Vitamins and Supplements
Yoga


Insulin Therapy
Conventional vs. Intensive
    Insulin Therapy
Insulin Delivery Devices


What are normal and target blood glucose ranges? 

Print Blood Glucose
Reference Guide


Diabetes Care Tips Blood Glucose Monitoring

Meters: How They Work and Meter Features

Alternative Testing Sites

Why Should I Test My Blood Glucose?

When Should I Test My Blood Glucose?

Meter Accuracy

Non-Invasive Blood Glucose Monitoring Devices


Why can't I test for fructosamine at home?

The one company that produced fructosamine home tests in the U.S. discontinued the product line in 2002 when it was purchased by another company.  The new company had liability concerns over the test strips producing false highs.


Blood Sugar Conversion Tool

Convert mmol/L to mg/dL (or vice versa)


Study information links about medical conditions where fructosamine testing may be preferrable over the HbA1c

Glycemic Monitoring in Diabetics with Sickle Cell Plus ß-Thalassemia Hemoglobinopathy

Herediatary Spherocystosis - Shortened lifespace on Hb cells:  frustosamine testing may be superior to HbA1c testing in diabetes glycemia control (pdf version)

Case Study: Potential Pitfalls of Using HbA1c as the Sole Measure of Glycemic Control  - Two instances where persons were diabetic, but reassured they were not based on falsely low HbA1c test results. Both patients were, however, diabetic.


Links to more information on fructosamine tests

Paddocklabs.com - Information on fructosamine and HbA1c testing  .pdf version

Are they comparable?  A study in the comparison of fructosamine with glycosylated hemoglobin and plasma proteins as measures of glycemic control suggests the
two tests produce 
similar results.

HbA1c superior to fructosamine testing in pediatric use:
Fructosamine and glycated haemoglobin in the assessment of long term glycaemic control in diabetes.

Utility of serum fructosamine as a measure of glycemia in young and old diabetic and non-diabetic subjects

Assessment of diabetic control by HbA1c and fructosamine measurement

islets of hope diabetes medical library                      main Treatment Information page
Diabetes Tests                                                                                             main Diabetes Tests page

Fructosamine testing
 
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Mini Site Index
What is fructosamine?
What is a fructosamine test?
What does the test show?
What are normal values for a fructosamine test? (chart)
Who might benefit from having a fructosamine test done?
Things that may have an effect on fructosamine test results
When might fructosamine test results not be accurate?  

What is fructosamine?

Fructosamine is a protein that attaches to glucose in the bloodstream.  If a patient’s fructosamine is elevated, then the patient's average glucose level over the previous 2 to 3 weeks has also been elevated.


What is a fructosamine test?

Studies, including  The Diabetes Control and Complications Trial (DCCT, show that keeping your HbA1c at or below 7% (7.0 on the test scale) is associated with a dramatic reduction in risk for developing long-term diabetes complications.  Other studies that address amputation (the need for amputation, and surgical outcome) clearly show that HbA1c results have a strong impact on a patients outcome post-surgery.  HbA1c levels also have a direct impact on how well chronic infections heal, and whether or not gangrene will result.  But an HbA1c test is not the only test that may be used to measure overall glycemic control in persons with diabetes.  Sometimes, an alternative test, the fructosamine test,  may be used to complement, or substitute for the HbA1c when an HbA1c may not be accurate or more rapid information about glucose control is needed.  

This fructosamine test has been used since the 1980s.  Unlike the HbA1c test which measures glucose control over the previous 120 days, the fructosamine test is a measure of blood glucose (blood sugar) control during the previous 2-3 weeks. The fructosamine test can be beneficial for women with diabetes that become pregnant, or for those that have changes in their care plan, or a medical condition that requires closer monitoring of overall blood glucose control.

Although the HbA1c test is more commonly used today, the American Diabetes Association (ADA)  recognizes both tests as being a useful tool in monitoring diabetes control.  The ADA has stated that fructosamine testing may be useful in persons where an HbA1c test may not produce reliable results.


How is the test performed?

The fructosamine test is a simple blood test that measures glycated protein (a protein that has bonded with a glucose molecule).  Because it measures the average glucose over the previous 2-3 weeks the test is not affected by food you may eat during the day of the test. Therefore, there is no need to perform a fasting fructosamine test; it can be done at any time during the day.


What does the test show?

The test measure the presence of fructosamine.  Generally, the concentration of fructosamine, the higher the average blood glucose (sugar) level.  

Trends are as important as absolute values when using the fructosamine test as a measure of overall glycemic control. For example, a trend from normal to high may be an indication of poor blood glucose control.  And the reverse is true, that, a trend from high to normal, may indicate that there is good blood glucose control.

Fructosamine tests do not replace the need to daily blood glucose (sugar) monitoring.  The results of fructosamine testing need to be compared with a patient's daily diabetes log because certain things can affect test results.

Islets of Hope Health Tip:  Remember, your doctor needs the information from your daily diabetes log to compare with the results of your fructosamine test.  When daily self blood glucose monitoring (SBGM) data conflicts with the results of a fructosamine test, your doctor may want to investigate further to see if there are other underlying medical concerns that have affected your fructosamine results.  See more detail below under "When might fructosamine test results not be accurate?"


What are normal values for a fructosamine test?

 

Fructosamine Test Levels and Glucose Control

Test Value

Indication

Under 265

Normal fructosamine level

265-280

Excellent blood glucose (sugar) control

280-300

Good blood glucose (sugar) control

320-340

Fair blood glucose (sugar) control

Over 350

Poor blood glucose (sugar) control


Who might benefit from having a fructosamine test?

Fructosamine tests may be useful when:

  • A person has abnormal levels of red blood cells, or has had transfusions, loss of red blood cells, or hemolytic anemia is present.  Fructosamine testing may also be a more reasonable test for persons with hemochromatosis because of the frequent need to donate blood in order to help control iron levels.
     
  • There are rapid changes in diabetes treatment such as going from shot therapy to insulin pump therapy, or from the additional or substantial changes in medication and diet.  A fructosamine test can be used to determine how well the new care plan is working after only a few weeks.
     
  • For women with diabetes that become pregnant, an HbA1c test can only be administered 2 or 3 times during her pregnancy.  Since tight glucose control is essential to both mother and baby, fructosamine testing can be performed at more frequent levels and will show a more accurate picture of the dynamics of blood glucose control.

Islets of Hope Health Tip:  Although a fructosamine test can be a useful tool for some persons with diabetes, fructosamine concentrations of well-controlled diabetics can be the same as with those of non-diabetics (both may show a "normal" value of fructosamine levels).  For this reason the fructosamine test is not useful as a screening test for diabetes and those newly diagnosed with diabetes should have an HbA1c test done instead.


Things that may have an effect on test results

  • a high amount of fat in the blood (lipemia)
  • high levels of ascorbic acid (vitamin c)


When might a fructosamine test not be accurate?

Fructosamine results should be considered a part of the overall context of the patient’s total clinical findings and not as an absolute determination for how well a patient is managing their diabetes. That is, results should be compared with daily blood glucose (sugar) monitoring, and other health information.

False, low fructosamine results may be seen with decreased protein levels or increased protein loss, or, when there is a change in the type of protein produced by the body.  Also, just as can be true with the HbA1c test, persons whose blood glucose levels erratically fluctuate from high to low (brittle diabetes) may appear to have near normal, or even normal levels, of fructosamine, when in fact their glucose control is not adequate.  

If a patient's fructosamine test results conflict with self blood glucose monitoring (SBGM), the fructosamine test might not be an accurate reflection of overall blood glucose control.  For example, if a person has many SBGM readings in the 100-120 range but a high fructosamine level of 400, the two do not reconcile.

Your doctor can check for reasons why your fructosamine is lower or higher than your SBGM readings indicate.  He/she may with to do a complete blood count (CBC) test (see side bar for more information), or check for other medical problems like hyperthyroidism (elevated thyroid levels) or liver disease.

As with an HbA1c, certain things can falsely lower or elevate results of a fructosamine test.  Fructosamine results and may be falsely lowered by:

  • Malnutrition (nutritional deficiencies of iron, folate, vitamin B12, or vitamin B6)
  • Severe burns or other reason for loss of protein fluid
  • Hyperthyroidism (high thyroid levels either from disease or too much medication)
  • Hemolysis (RBC destruction)
  • Erratic fluctuations in blood glucose (sugar) levels

Conversely, the following can cause a fructosamine test to yield falsely higher results:

  • Elevated serum albumin
  • Elevated IgA levels
  • Liver disease (cirrhosis or hepatitis), and
  • Occasionally, the medication Isoniazid (sometimes used to treat tuberculosis)

 

   

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Page Updated 05/28/2006