Understanding the Ups and Downs of Blood Glucose. Irl B. Hirsch, M.D. University of Washington. Question. Who has the greatest risk of proliferative diabetic retinopathy (PDR) over the next 10 years A 55 y/o man with type 2 diabetes for 5 years, on oral agents, A1c = 9.0%
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Irl B. Hirsch, M.D.
University of Washington
Why are the risks of PDR different?
Postprandial hyperglycemia ≠ glycemic variability
Don’t forget about the “ups” and “downs”!
Oxidative Stress =
Imbalance between pro-oxidants (free radicals, reactive oxygen species) and anti-oxidants
Free radicals (reactive oxygen species) are known to fuel diabetic vascular complications
How Does One Measure…? Reactive Oxygen Species
Urinary 8-SO-PGF2 alpha Excretion Rates
0 20 40 60 80 100 120 140 160
MAGE (mg glucose/dL)
JAMA 295:1688-97, 2006
So What T2DMIs The Significance of the Understanding of GV?
Brownlee M, Hirsch IB: JAMA: 295:1707, 2006
Diabetes 55 (Supp 1): A1, 2006
So how do we best measure glycemic variability in our patients with diabetes?
Joe: HbA1c = 6.5%; on CSII with insulin aspart
Mary: HbA1c = 6.5%; on HS glargine and prandial lispro
Mean = 123 mg% Mean = 123 mg%
SD = 51 SD = 63
Standard Deviation T2DM
SD X 2 < MEAN
Increased Oxidative Stress!
Caveats of the SD T2DM
Mean = 81; SD = 29
Mean = 217; SD = 82
After thinking about glycemic variability and oxidative stress
Data comparing these tools to markers of oxidative stress!
A1c is not the only factor contributing to the complications of diabetes