A 58 year old male - type II diabetic diagnosed more than 6 years ago, who developed acute pancreatitis which has become chronic over the past 2 years - has been having increasing difficulty maintaining optimum blood glucose levels H1c around 10. He's been taking the maximum therapeutic dose of avandamet for more than a month and has just been put on amaryl. Fasting C-peptide came back 1.4 ng/ml.
He controlled his glucose well up until a few months ago with only diet and exercise. Does this inability to control his BG and the low normal C-peptide suggest increasingly severe pancreatic failure? How likely is it that he will require insulin to control his blood glucose. Any ideas about diet and exercise to improve his numbers?
On 2004-04-19 14:33:04 -0400, [email hidden] (Terri) said:
C-peptide levels are rarely useful. In this case, a c- peptide of 1.4 indicates ongoing pancreatic insulin production. His rising HgbA1C level indicates poor control of his diabetes. Who knows why? I don't have enough information to even guess. A month is not long enough to wait between HgbA1C levels, as HgbA1C measures glycosylated hemoglobin (found on red blood cells), and the lifespan of a red blood cell averages around eight weeks. I generally recheck HgbA1C three months following a change in therapy. If he was "just" put on Amaryl, I'd wait three months before checking it again after that. Once he's maxed out on oral agents, it's time for insulin. I generally start with Lantus at bedtime, but there's lots of room for creativity there. It goes without saying that diet, exercise, and weight loss should be part of his ongoing regimen.
Quoted message said:
A 58 year old male - type II diabetic diagnosed more than 6 years ago, who developed acute pancreatitis which has become chronic over the past 2 years - has been having increasing difficulty maintaining optimum blood glucose levels H1c around 10. He's been taking the maximum therapeutic dose of avandamet for more than a month and has just been put on amaryl. Fasting C-peptide came back 1.4 ng/ml.
He controlled his glucose well up until a few months ago with only diet and exercise. Does this inability to control his BG and the low normal C-peptide suggest increasingly severe pancreatic failure? How likely is it that he will require insulin to control his blood glucose. Any ideas about diet and exercise to improve his numbers?
the lifespan of a red blood cell averages around eight weeks.
I misspoke. RBC lifespan is actually around 120 days; however, the clinical usefulness of the HbA1c assay is such that it correllates with average blood glucose over the preceeding eight week period. Sorry.
