8/17/2023 0 Comments Ebay watch item![]() An abdominal ultrasound showed surface nodularity in the liver consistent with cirrhosis, ascites and splenomegaly. Possible etiologies that would explain this laboratory “mismatch”, like lab error, hemoglobinopathies or hemolytic anemia, were excluded. This finding was contrast to a previously measured HbA1c 1 year prior to admission that was 13.7% ( Table 2). Despite medical management finger stick readings remained grossly uncontrolled ( Table 1). Metformin was stopped and an insulin regimen of basal glargine and pre-meal aspart was initiated. Iron studies showed iron level of 64 g/dL, iron-binding capacity of 212 g/dL, transferrin saturation of 30.1%, and ferritin level of 661.7 ng/mL. Liver function tests revealed total bilirubin of 0.7 mg/dL, alanine aminotransferase of 74 units/L, aspartate aminotransferase of 98 units/L, alkaline phosphatase of 621 IU/L, haptoglobin of 100 mg/dL, lactate dehydrogenase of 220 IU/L, total protein of 7.3 g/dL, and albumin of 3.2 g/dL. Chemistry panel showed sodium of 132 mmol/L, potassium of 5.6 mmol/l, creatinine of 1.6 mg/dL, blood urea nitrogen of 58 mg/dL, and a glomerular filtration rate of 32.7 mL/h. Laboratory work on admission showed blood glucose of 568 mg/dL, white blood cell count of 5.5 × 10 9/L, hemoglobin of 11.5 mg/dL, hematocrit of 36.5%, MCV of 98.8 fL, platelets of 104,000/μL, prothrombin time of 12.1 s, partial thromboplastin time of 26.9 s, and international normalized ratio of 1.13. Examination of the abdomen revealed a grossly distended abdomen with a positive fluid wave and a protruding, yet reducible umbilical hernia. On physical examination, the patient had pallor, non-icteric sclerae, and poor dentition. Home medications included metformin, levothyroxine, and docusate. Case ReportĪ 61-year-old Caucasian woman, with history of hepatitis C, uncontrolled T2DM, and hypothyroidism presented with shortness of breath and increasing abdominal girth. We present a case of woman with uncontrolled T2DM, acute kidney injury, and liver cirrhosis and discuss the challenges of assessing this patient’s glycemic control in view of the discordance between the patient’s HbA1c and blood glucose measurements. However, there are subsets of patients in whom there will be discordance between HbA1c and blood glucose measurements, rendering it less useful in determining a patient’s glycemic status. Keywords: Low HbA1c Glucose monitoring Liver cirrhosis Fructosamine Glycated albumin Introductionįor decades, hemoglobin A1c (HbA1c) has been the standard measure of long-range glycemic control in patients with diabetes mellitus type 2 (T2DM) even with comorbid liver cirrhosis. In this case, other biomarkers can be used to monitor glycemic control by far frequent finger stick monitoring is the best method. ![]() HbA1c can be falsely low in liver cirrhosis, and can give a false assumption about control of the diabetic disease process. Fructosamine and glycated albumin were high, indicating a hyperglycemic status during the last 3 weeks. Blood work revealed acute kidney injury, anemia of chronic disease, normal albumin level, and low HbA1c. Ultrasound of the abdomen showed liver cirrhosis, ascites, and splenomegaly. ![]() She was found to have blood glucoses greater than 500 mg/dL however, her HbA1c was measured at 5.5%. We present the case of a 61-year-old Caucasian female, with history of hepatitis C and uncontrolled T2DM, who was admitted for evaluation of compensated liver cirrhosis. The objective of this study was to increase awareness about low HbA1c in liver cirrhosis and discuss alternative biomarkers that can be used to measure glycemic control. Inaccuracies of HbA1c in liver cirrhosis are rare, but documented. In a rare subset of patients, this measurement may not be reliable. Hemoglobin A1c (HbA1c) is the gold standard for the measurement of long-range glycemic control in patients with diabetes mellitus type 2 (T2DM).
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