Tips on Fructosamine
Test : listen what Dr S K Pal has to say? Ans: Fructosamine Test is not that
helpful in day to day clinical practice.
I, Dr Pal don’t recommend to do such tests (Fructosamine )which are insignificant.
Why dislike
Fructosamine tests ?? Because though like HbA1c Fructosamine is a
blood test in which glycated plasma
proteins are measured and expressed as percentage of total plasma proteins but
it(Fructosamine ) gives
information on average metabolic
control over the previous two weeks it is not yet regularly done in our country. It is more
useful than HbA1c to access
metabolic control during pregnancy.
Treat DM women by
yourself. Listen what Dr S K Pal has to say on the Advantages of HBA1c over Fructosamine?? Point 1;-HBA1c derived average glucose a new patient
friendly concept of expressing
metabolic control
Point 2
Glycosylated
haemolglobin HbA1c a gold standard in
assessing metabolic control is
expressed in % value. The bad aspect of HBA1c??
a) Even though it is an indicator of
average blood glucose control since the unit
of expression is to in mg% and
since the values are at variance with blood glucose values the expression is not patient friendly . Better at least for research work
one can perform continuous interstitial
fluid glucose monitoring for 48 hours( like Holters) every few months particularly who are on insulin
pump. monitoring seven times a day
three times a week for 4 months for
4 months In addition they were subjected
to HbA1c estimation 3 times at a
central laboratory in Europe Participants also
underwent self capillary glucose. From this data average glucose value was calculated and it’s correlation with HbA1c was worked out and a mathematical formula to
convert HbA1c in to average glucose value
was developed Interstitial fluid values
were scaled up by 5% to derive capillary glucose values
.
: Listen what Dr S K Pal has to say on rational & timely use of
Glucometer in family practice provided the paper strips are not out of stalk
& her/his eye sight is normal!! Presence of an maid servant who can read
English will beef immense help. The instrument warrants 2 yarely servicing.
In a day to day practice of a family physician or general
duty medical officer he commonly has to
deal with routine management including dosage adjustments and also handle
emergencies in a diabetic patient . thus
a properly functioning glucometer
with all the accessories is a must for him both in th clinic
and in emergency bag. Glucometer is an essential to a clinician as a
stethoscope blood pressure
apparatus and a torch.
Applications of
glucometer in family physician’s clinic
1)
When a patient
walks in with symptoms suggestive
of diabetes. Even though one should not solely rely on glucometer readings
when hyperglycemia is detected for value
will definitely help in planning of
further line of action including
the investigations
2)
When
a known diabetic visits the clinic for routine check upon the eve of his departure from the city
and thus does not have a time for
formal laboratory tests in near future.
3)
When a known diabetic attends the clinic with symptoms which may or may not be related to diabetes and does
not have a recent laboratory
blood glucose report.
4)
On
emergency visit. On the spot blood glucose
estimation is a must at
every emergency
Symptoms such as hunger
palpitations sudden sweating giddiness etc could be due to hypoglycemia Random blood glucose on the spots
helps to detect or rule out hypoglycemia. In case of hypoglycemia one should immediately
correct the low blood glucose level by
serving a carbohydrate snack like biscuits or refined sugar containing
liquids and subsequently reduce
dosage of his anti diabetic medications if required . In case in te patient is
semi conscious or unconscious 50 ml of 25% glucose should be injected intravenously . Hypoglycemia in patients
on alpha glucosidase inhibitors should be treated by administering
oral or intravenous glucose as it does
not respond to carbohydrate
snacks or table sugar On the spot
blood glucose estimation with
glucometer also helps to rule out hypoglycemia and think of alternative
condition Sudden sweating could be a
symptom of acute myocardial infarction since
hypoglycemia is more common there
is a tendency in patients to
assume that they are having
hypoglycemia and to consume two
teaspoons of sugar every 10 minutes. In
case of heart attack it leads to late diagnosis and loss of vital time before the patient is admitted in
intensive care unit. Thus timely on the spot blood glucose estimation can save
precious time and life as well as lots of money
by avoiding delay in
hospitalization in case of serious
condition such as acute myocardial
infarction or other cardiac emergencies
or by avoiding unnecessary
hospitalization in case of simple
hypoglycemic episode Prompt use of
glucometer and swift appropriate action in only one episode will more
than compensate for the entire investment cost
of glucometer.
Equipment required for home blood glucose
monitoring
1)
Reliable glucometer
2)
Chemically
treated strips compatible
with the meter
3)
Lancets
or fine needles to prick the finger for
a drop of blood
4)
Cotton swabs
5)
Methyl
alcohol or medicated spirit.
Glucometer : It is small electronic instrument which analyzes the concentration of glucose in a
drop of blood transferred on chemically treated plastic
stick from patient’s finger. The strip is inserted in a slot on the meter,. Glucometer runs on batteries. Several brands are available in our country.
The cost of the
meter varies from Rs 850/ to Rs 3000/
For those with high consumption of strips
many companies offer free
glucometers. The high end meters have
additional features such as varying memory capacity to store previous readings along with
date and time automatic
calculation and display of mean blood glucose
value of last 15 days
warning beep and message
if the values are out of
range on either side facility to download the readings to computer coding free operations etc.
Once
a drop of blood from finger after a
prick with the lancet or needle is deposited on the designated area on the
plastic strip which is inserted in the slot on the meter the blood glucose value is digitally displayed on the
meter screen in five to fifteen seconds. One plastic stick is
required for each test . The cost of strip works out to be
in the range of Rs 14 -25/
depending upon the meter and the number of strips purchased at a time. These strips are available
in vials usually each vial contains 25
strips. They have unopened expiry
period of about 16 months and six months
after the seal is opened. The disposable lancets and needles cost approximately
Res 1-4 the pain following finger prick particularly when spring loaded lancet
device is used is minimal and easily bearable. All meters come
with a spring loaded lancet
device at no extra cost
No comments:
Post a Comment