Until this article in Medscape, I had
not imagined all the potential problems elevated A1c's could cause
for people with diabetes. Yes, we are all aware of the
complications, (retinopathy, neuropathy, nephropathy,
atherosclerosis, deafness, cognitive decline), and how they love
people with elevated A1c's. These complications set up shop quickly
in people that let their blood glucose levels stay consistently
elevated and do their best to take over these people.
New problems keep emerging for people
with unmanaged type 2 diabetes, so I should not have been surprised
when I read this article. In reading this, I did agree because when
I think of hyperbaric oxygen therapy being used for wound healing,
this explains why it is necessary because the blood cannot carry
sufficient oxygen to the cells around the wound to promote healing.
The oxygen saturation (SaO 2) and
partial pressure of oxygen (PO 2) in this trial was measured with
simultaneous monitoring of SpO 2 in 261 type 2 patients during
ventilation or oxygen inhalation. Pulse oximetry is the measuring of
oxygen saturation in the veins by placing a sensor on the finger or
earlobe of an adult or even children. For infants, the sensor is
placed across the foot.
The study showed the relationship of
diabetes that was poorly managed (A1c greater that 7%) to diabetes
that was managed (A1c less than 7%) and the amount of oxygen in the
blood. Those that were highest in oxygen were clearly those with
A1c's less than 7%. However, it was confirmed by using arterial
blood gas analysis (the method used before pulse oximetry became the
standard) that the amount of oxygen in the blood was less than the
pulse oximetry recorded. This raises the concern about those with
A1c's in excess of 7% having enough oxygen in the blood for proper
cell oxygenation.
Therefore, the researchers are correct
in the alerting of treating patients for hypoxemia (inadequate oxygenation of the blood)
that using the pulse oximetry is misleading for type 2 patients with
elevated A1c levels. They recommend using arterial blood gas
analysis for patients with poor blood glucose control during the
treatment of hypoxemia to receive best results.
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