Problems with High A1c for Type 2 Patients

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Until this article in Medscape, I hadnot imagined all the potential problems elevated A1c's could causefor people with diabetes. Yes, we are all aware of thecomplications, (retinopathy, neuropathy, nephropathy,atherosclerosis, deafness, cognitive decline), and how they lovepeople with elevated A1c's. These complications set up shop quicklyin people that let their blood glucose levels stay consistentlyelevated and do their best to take over these people.
New problems keep emerging for peoplewith unmanaged type 2 diabetes, so I should not have been surprisedwhen I read this article. In reading this, I did agree because whenI think of hyperbaric oxygen therapy being used for wound healing,this explains why it is necessary because the blood cannot carrysufficient oxygen to the cells around the wound to promote healing.
The oxygen saturation (SaO 2) andpartial pressure of oxygen (PO 2) in this trial was measured withsimultaneous monitoring of SpO 2 in 261 type 2 patients duringventilation or oxygen inhalation. Pulse oximetry is the measuring ofoxygen saturation in the veins by placing a sensor on the finger orearlobe of an adult or even children. For infants, the sensor isplaced across the foot.
The study showed the relationship ofdiabetes that was poorly managed (A1c greater that 7%) to diabetesthat was managed (A1c less than 7%) and the amount of oxygen in theblood. Those that were highest in oxygen were clearly those withA1c's less than 7%. However, it was confirmed by using arterialblood gas analysis (the method used before pulse oximetry became thestandard) that the amount of oxygen in the blood was less than thepulse oximetry recorded. This raises the concern about those withA1c's in excess of 7% having enough oxygen in the blood for propercell oxygenation.
Therefore, the researchers are correctin the alerting of treating patients for hypoxemia (inadequate oxygenation of the blood)that using the pulse oximetry is misleading for type 2 patients withelevated A1c levels. They recommend using arterial blood gasanalysis for patients with poor blood glucose control during thetreatment of hypoxemia to receive best results.