Diabetes

Living with diabetes requires diligence and discipline – on the part of patients and physicians. For patients, it means regularly testing their blood glucose levels, and following healthy diets and lifestyles. For physicians, it means ensuring their patients do just that. The more distributor sales reps know about the disease – including how to monitor and manage it – the better they can prepare their physician customers to provide the best care.

There are three types of diabetes:

• Type 1 diabetes, usually diagnosed in children and young adults, is a condition where the body does not produce insulin, a hormone needed to convert sugar, starches and other food into energy. Only 5 percent of people with diabetes have this form of the disease, according to American Diabetes Association.
• Prediabetes is a condition preceding type 2 diabetes, where an individual has high blood glucose before or after meals, or a high average blood glucose level (A1c). However, it is not high enough to be diagnosed as diabetes.
• Type 2 diabetes is a condition where the body does not use insulin properly – commonly referred to as insulin resistance. In the early stages, the pancreas responds by making extra insulin. Over time, however, it isn’t able to keep up and can’t make enough insulin to keep one’s blood glucose at normal levels.

Common symptoms of diabetes include:

• Frequent urination
• Extreme thirst and/or hunger
• Extreme fatigue
• Blurred vision
• Cuts and bruises that are slow to heal
• Inexplicable weight loss (associated with type 1 diabetes)
• Tingling, pain, or numbness in the hands/feet (type 2)

Symptoms associated with type 2 diabetes are sometimes so mild they go unnoticed, making rapid detection of the disease especially important.

Hemoglobin A1c testing
A discussion about diabetes is not complete without ensuring physician customers are equipped with A1c tests. While blood glucose tests enable patients to monitor their daily blood glucose levels, they need an A1c test for a broader picture of how well their diabetes management plan is working. Also referred to as a glycated hemoglobin or HbA1, the A1c test provides an overview of the patient’s average blood glucose control for the previous two or three months.

Diabetics should have their A1c levels measured when they are first diagnosed, and at least twice a year thereafter, according to the American Diabetes Association. In many cases, levels should be measured every three months, particularly when patients begin a new medication or fall short of blood glucose goals.

Hemoglobin, which is found inside red blood cells, carries oxygen from the lungs to all of the cells in the body. Like all proteins, hemoglobin links up with sugars, such as glucose. Patients with uncontrolled diabetes have too much sugar in their bloodstream. The extra glucose enters the red blood cells and links up – or glycates – with molecules of hemoglobin. As excess glucose builds up in the bloodstream, more hemoglobin is glycated. Diabetic patients on medication may find that one week their blood sugar levels are too high, and the next week they return to normal. However, the red blood cells carry a “memory” of the first week’s high blood glucose in the form of extra A1c, according to the American Diabetes Association.

As old blood cells in the body die and new ones with fresh hemoglobin replace them, the record of A1c levels changes. The amount of A1c in the blood reflects blood sugar control for the last 120 days, or the lifespan of the red blood cells. Compared with a non-diabetic patient who has approximately 5 percent of all hemoglobin glycated, a diabetic whose blood glucose levels have been out of control for a long time may have levels as high as 25 percent, according to the American Diabetes Association.

Selling hemoglobin A1c tests
Point-of-care A1c tests are ready to use and require no daily controls, calibration, maintenance or refrigeration for up to four months. By placing a small patient blood sample into a sampler body and shaking well, and then inserting the sampler into a monitor, the physician can read the test results with 99 percent accuracy.

Distributor reps should ask potential physician customers how they are currently getting A1c results for patients. Some good follow-up questions to ask:

• “Doctor, have you done any in-office A1c POC testing in the past, or are you considering doing so?”
• “What do you find effective about the way you currently do A1c testing?”
• “What, if anything, would you change about the way you do A1c testing?”

Despite the quick results from the A1c POC test, some physicians still prefer to send their tests to a lab. Distributor reps should remind customers that rapid test results create an opportunity to provide patients with immediate treatment decisions in the office, as well as educate and counsel them to better manage their disease. There are no follow-up calls to a lab to track down results, no phone-tag trying to connect with patients and no need to schedule follow-up office appointments.

Know your customer
Physicians who may be interested in A1c testing include:

• Pediatricians
• Internists
• General and family practitioners
• Cardiologists
• Endocrinologists

---

Supplemental testing
In addition to administering A1c tests, doctors must monitor their diabetic patients’ blood pressure and cholesterol level. Some necessary tests to monitor the status of diabetic patients include the following:

• Blood glucose. Blood glucose analyzers rely on a precise chemistry methodology, and can help physicians diagnose at-risk patients.
• Urine tests for Ketones. Ketones in the urine are a sign the body is using fat for energy instead of glucose, because not enough insulin is available to use glucose. The ADA does not recommend using urine tests for glucose unless blood testing is not possible.
• Lipids (LDL, Triglycerides, HDL). Lipids tests are important for monitoring patients’ cholesterol levels, which indicate the amount of fat in the blood. Blood vessels leading to the heart can become partially or totally blocked by fatty deposits. A heart attack occurs when the blood supply to the heart is restricted or cut off.
• Echocardiogram. These tests use ultrasound to produce images of the heart and blood vessels on a screen.
• Electrocardiogram (ECG or EKG). These tests provide information on heart rate and rhythm, and show whether there has been damage or injury to the heart muscle.
• Exercise stress test. These tests involve using an ECG in conjunction with a treadmill test and aid in detecting the presence of heart disease that otherwise would only become apparent with cardiac stress or physical exertion.
• Holter monitor. Patients wear Holter monitors for a continual stress test reading after leaving the doctor’s office.
• Blood pressure cuffs. High blood pressure, or hypertension, can lead to heart attack, stroke, eye problems and kidney disease. Since diabetics already are at risk for these complications, they have a lower blood pressure target than the general public.
• Microalbumin test. Albumin is a protein produced in the liver. Although it is present in high concentrations in the blood, when the kidneys are functioning properly, almost no albumin is permitted to leak into urine. Microalbumin tests measure tiny amounts of albumin that the body has begun to release into the urine several years before significant kidney damage becomes apparent.
• Creatinine test. Creatinine is a waste product produced by muscle metabolism. Because healthy kidneys excrete almost all creatinine, blood levels indicate how well – or poorly – the kidneys are functioning.