Hemoglobinopathies Points to Remember

• Hemoglobinopathies are inherited hemoglobin variants caused by mutations in the globin genes.


• The people of Africa, the Mediterranean, or Southeast Asian descent are particularly at risk for hemoglobin variants


• Hemoglobin variants can confound the results of the A1C test, which indicates average blood glucose levels in the blood during the last 2-3 months.


• False A1C test results can lead to false diagnosis or over-treatment or under-treatment of diabetes in people with hemoglobinopathies.


• Information to assist in selecting the best assay methods is available from the National Glycohemoglobin Standardization Program (NGSP).


• The most common hemoglobin variants include hemoglobin S, C, and E.


• People who are homozygous for a hemoglobin variant may have a disease condition - for example, those who are homozygous for the hemoglobin S variant have sickle cell anemia. Those who are heterozygous for a variant are said to have a trait or to be carriers and are usually asymptomatic.


• A booklet for people with diabetes about hemoglobin variants and the A1C test

Hemoglobinopathies and Diabetes Effect and Diagnosis

Hemoglobinopathies

Hemoglobin molecules in red blood cells transport and distribute oxygen to cells throughout the body. Hemoglobin is composed of heme - the portion of the molecule holding iron—and globin—a protein made up of amino acid chains.

Hemoglobin variants occur when mutations in the globin genes result in changes in the amino acids of the globin protein. Hundreds of variants have been identified; a small number of variants are common and have clinical significance. Hemoglobin variants are inherited in an autosomal recessive manner.

Effect of Hemoglobinopathies on A1C Test Results

With some assay methods, A1C tests in patients with hemoglobinopathies answer in falsely high outcomes, overestimating actual average blood glucose levels for the previous 2 to 3 months. Physicians may then dicate more aggressive treatments, resulting in increased episodes of hypoglycemia. Some assay methods used with some hemoglobinopathies may result in falsely low outcomes, leading to under-treatment of diabetes. Confirmation with a fasting blood glucose is needed for a diagnosis of diabetes to prevent inappropriate treatment decisions.

When to Suspect that a Patient with Diabetes Has a Hemoglobinopathy

People who contain one gene for a hemoglobinopathy are often unaware. Several situations may show the presence of a hemoglobinopathy:
* when results of self-blood-glucose monitoring have a low correlation with A1C results
* when an A1C result is vary than expected
* when an A1C result is more than 15 percent
* when a patient’s A1C test result is radically different from a previous test result following a change in laboratory A1C methods

Diagnosis of Hemoglobinopathies

Carrier state can easily be found by hemoglobin electrophoresis. Most states now screen for common hemoglobin variants in newborns and report results. In addition, pre-pregnancy genetic testing and prenatal screening are done in some high-risk populations or in women with a family history of a variant. Screening may also be acted in parents of children with identified variants and patients with red blood cell abnormalities, such as unexplained anemia.

Take Steps to Maintain your Mouth Healthy

If you have diabetes problems, follow these steps and Call your dentist notice problem.

* Control your blood glucose.

* Brush and floss every day.

* Visit your dentist regularly. Be sure to tell your dentist that you have diabetes.

* Tell your dentist if your dentures (false teeth) do not fit right, or if your gums are sore.

* Quit smoking. Smoking makes gum illness worse. Your physician or dentist can help you quit.

Take time to check your mouth regularly for any problems. Sometimes people notice that their gums bleed when they brush and floss. Others notice dryness, soreness, white patches, or a bad taste in the mouth. All of these are reasons to visit your dentist.

How can diabetes hurt my teeth and gums?

Tooth and gum issues can happen to anyone. A sticky film full of germs, called plaque, builds up on your teeth. High blood glucose helps germs, also called bacteria, develop. Then you can get red, sore, and swollen gums that little bleed when you brush your teeth.

People with diabetes can have tooth and gum problems more frequently if their blood glucose stays high. High blood glucose can build tooth and gum problems worse. You can still lose your teeth.

Smoking makes it more probable for you to get a bad case of gum disease, particularly if you have diabetes and are age 45 or older.

Red, sore, and bleeding gums are the begin sign of gum disease. These problems can lead to periodontitis. Periodontitis is an infection in the gums and the cram that holds the teeth in place. If the infection gets worse, your gums may pull off from your teeth, making your teeth look long.

Call your local dentist if you think you have problems with your teeth or gums.

How can dentist take responsibility of my teeth and gums?

Your dentist can help you appropriate care of your teeth and gums by

* cleaning and checking your teeth two times a year
* helping you learn the good way to brush and floss your teeth
* telling you if you have problems with your teeth or gums and what to do about them
* making sure your false teeth fitness well

You may be taking a diabetes medicine that can explanation low blood glucose, also called hypoglycemia. Talk with your doctor and dentist previously the visit about the best way to take care of your blood glucose during the dental work. You may require to bring some diabetes medicine and food with you to the dentist’s office.



If your mouth is uncomfortable after the dental work, you might not be able to eat or chew for several hours or days. For guidance on how to accommodate your normal routine while your mouth is healing, ask your doctor

* what foods and drinks you should have
* how you should change your diabetes medicines
* how often you should check your blood glucose