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[IP] Re: A1c tests

	I did my graduate thesis on glycosylated hemoglobin (believe it or not!
*lol*) - I might be able to remember & relay a few things that may be
helpful to this discussion.  There IS indeed a point in the reaction
(glycation of proteins) when the process is reversible.  I believe that is
called a "Schiff's base".  If blood glucose is brought down to normal levels
at this initial stage of the reaction then the final product of glucose
molecule irreversibly attached to protein (in this case, red blood cell)
does not form.  However, once the reaction is completed, it is not yet
possible to unstick.  At least, it wasn't known to be about 5 yrs ago when I
did this research.  I am unsure how long the "reversible" window is.  But it
certainly does underscore the importance of the frequent self-monitoring &
correction as needed that accompanies pumping.

	This reaction is actually called the "browning reaction" and is the same
process that occurs to carbohydrates (like bread) when we "brown" it.  As we
all know, it is not yet possible to reverse "toast".  ;)  Realize that the
process of glycosylation ("sticking" of sugar to proteins in the body)
happens to some degree in EVERYONE - with & without diabetes.  In fact, it
is the basis of one of the theories of aging.... (which means that I
*SHOULDN'T* be getting CARDED at restaurants anyMORE!, but alas... ;)  -
hence the "normal" range HbA1C (typically 3.9 - 5.7%), with some variability
between labs.  SO, while having lows doesn't cancel out the highs, what this
does mean is that having some degree of lows, particularly sustained, CAN &
does actually have an effect on the "normal range" process of glycosylation.
The problem being that it is, as we all know, quite dangerous... and this
*most definitely* should NOT be our goal.  In essence, having lots of lows
and in turn a lower HbA1c as a result, is not truly representative of what
*we* would consider good self-management then.

  I do also remember that there was (& hopefully still is) much research
ongoing about how to "block" the formation of these final products by
interfering at this "reversible" stage..... thereby blocking the development
of complications!  Anyone know or heard of where this research is?   The
point being, a high that is quickly & correctly addressed may not complete
the glycosylation reaction.  ...... hope this was helpful?

Delaine M. Wright, MS, CDE

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