Test Your Knowledge Answers

Questions appear on page 46.

• 1. B: Because A1C is based on normal hemoglobin, hemoglobinopathies can affect the results in 3 ways: (1) altering the normal process of glycation from HbA to A1C; (2) causing an abnormal peak on chromatography, making the estimation or A1C unreliable; and (3) making the red blood cells more prone to hemolysis, thereby decreasing the time for glycosylation to occur and thereby producing a falsely low A1C. Evidence is lacking to support interference of low-dose aspirin usage with the A1C result. Ingesting large doses of aspirin may, however, impact the A1C result (A). White blood cell count is not related to hemoglobin A1C, which is a measure of the amount of glucose attached to the hemoglobin in the red blood cells (C). Oral contraceptives do not affect the accuracy of A1C result (D).

• 2. A: 30 mg/g is correct. Normal kidney function retains albumin in the plasma. Loss of albumin into the urine at levels >30 mg/g of creatinine suggest kidney damage. Through their mechanism of action, ACE inhibitors and ARBs decrease glomerular pressure through dilation of efferent arterioles and preserve kidney function.

• 3. B: Physical activity increases hepatic glucose production and increases the glucose supply available in the blood. Insulin decreases (A), epinephrine and norepinephrine both increase (C), and growth hormone and cortisol increase (D).

• 4. B: Developing relationships with state legislators is very important for diabetes care and education specialists in order to promote positive changes in public policy. Exchange networks (A), hospital quality improvement teams (C), and community health screenings (D) improve care for people with diabetes but do not directly affect public policy.