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Question:

From New York City, New York, USA:

I have been a insulin dependent diabetic for 19 years. I use Humulin R and U three times a day. My question is stimulated by the Lispro or Humalog insulin. I recently had a hypoglycemic seizure in the middle of the night caused by a combination of the Regular's peak and too much exercise that evening. I read that dramatic hypoglycemia causes "adverse CNS [central nervous system] consequences." Is this referring to the standard array of neurological damage, i.e., retinopathy and nerve damage? Or is there other damage of which I am unaware? And is this damage cumulative over the 19 years? I have not been found to have any visible damage or deterioration by my endocrinologist, however all the tests we have done are very basic, crude evaluations.

Secondly, my glycohemoglobin seems fine: 9.1 (range 6.5-8.0) and Hgb A1c: 7.1 (range 5.5-6.4). I exercise a lot and eat what I want to within reason. My questions about this are: Is it more important that the numbers (glycohemoglobin and A1c) are reasonable or how I came to these numbers? I have had many wide swings of high blood sugar readings and many lows that seem to average to a good overall number, but it is not achieved through consistency. I live fairly erratically and I think unpredictably, diabetes follows what I do and not the other way. I have read concerns that the diabetes lifestyle should be as regulated and consistent as possible.

Also, what is the difference between the A1c and glycohemoglobin?

Answer:

The effect of profound and recurrent hypoglycaemia on the nervous system is quite different from the neurological complications of diabetes in the normal sense. Long term sequelae from hypoglycaemia are probably quite rare in any easily measured sense but there has been debate about the subtle effects (on performance and cognitive function) of recurrent hypos. Rarely, profound hypos can result in loss of brain cells and obvious neurological damage but, given the frequency of severe hypos in patients with diabetes, this is very unusual.

About Glycohaemoglobin: I think you are using the term glycohaemoglobin to refer to total haemoglobin A1 as opposed to the subfraction, HbA1c. The latter is a more specific, and therefore better, marker.

KJR

[Editor's comment: Glycohemoglobin terminology is confusing. To start with, hemoglobin is the protein that carries oxygen around the bloodstream. A small percentage of hemoglobin has had glucose hooked irreversibly to it: this sugar-protein is called glycohemoglobin. Then there's an even smaller percentage of the total hemoglobin in the body, which is part of the glycohemoglobin, that is called glycohemoglobin A1c.

In the labs that doctors use for testing, the diabetes test is measured as "A1" and sometimes as "A1c." It's best to compare your results against the normal range, and to get the lab test done in the same lab time after time, so you can see trends as to how you are doing. WWQ]

Original posting 10 Feb 98

  
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Last Updated: Tuesday April 06, 2010 15:08:56
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