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Part II Nutrition Assessment, Consequences, and Implications

phenothiazines phenytoin

The following drugs may decrease blood glucose levels (1): ●

● ● ● ● ● ●

acetaminophen alcohol

anabolic steroids clofibrate

disopyramide gemfibrozil insulin

● monamine oxidase inhibitor (MAOI) pentamidine propranolol tolazamide tolbutamide

● ● ● ● Glycosylated Hemoglobin

Normal Values ●

● ➤ ➤ Adults: 4% to 6% (4)

Reasonable goals in older adults with diabetes (4): Healthy, less than 7.5%

Multiple coexisting chronic illnesses, less than 8%

Very complex, poor health, less than 8.5% Nutritional Significance

➤

Glycosylated hemoglobin (HbA1c) is a test that pro- vides an accurate two- to three-month index of average blood glucose levels. This is a valuable test because the sample can be drawn at any time. In addition, recent food intake, exercise, stress, hypoglycemic agents, or patient/resident cooperation do not affect the values. It is used to evaluate the success of diabetic therapy, especially when new strategies for care are implemented. HbA1c has been used to determine the duration of hyperglycemia in newly diagnosed diabet- ics as well as in those with impaired glucose tolerance. It is helpful to differentiate between short-term hyper- glycemia and diabetes (1).

HbA1c levels increase with (1): ● ● ● ● ● ● ●

newly diagnosed or poorly controlled diabetes impaired glucose tolerance hyperglycemia

iron-deficiency anemia hemodialysis

acute stress response corticosteroid therapy

HbA1c levels decrease with (1): ●

●

hemolytic anemia (sickle cell) chronic renal failure

● vitamin E supplementation chronic blood loss

● Hematocrit

Normal Values ●

●

Women: 37% to 47%; 0.37 to 0.47 (SI) (5) ● Men: 42% to 52%; 0.42 to 0.52 (SI) (5)

Older adults: values may be slightly decreased (5) Nutritional Significance

Hematocrit is the percentage of red blood cells in total blood volume and is used, along with hemoglobin, to evaluate iron status. Usually the hematocrit percentage is three times the hemoglobin concentration in grams per deciliter. This will not be the case if the red blood cells are of abnormal size or hemoglobin concentration (1). The hematocrit value is affected by extremely high white blood cell count and hydration status. It should be evaluated in light of other laboratory values. Individuals living in high altitudes often have increased values. It is common for individuals older than 50 years to have slightly lower levels than younger adults. Individuals with anemia of chronic disease will not be able to main- tain normal hematocrit levels because the body lacks the ability to use stored iron (1).

● ● ● ● ● ● ●

Hematocrit levels increase with (1): dehydration

erythrocytosis shock

surgery trauma burns

high altitudes

Hematocrit levels decrease with (1): ●

●

acute blood loss overhydration

● anemias ●

● ● iron deficiency

● anemia of chronic disease pernicious anemia

megaloblastic anemia ● bone marrow failure hyperthyroidism

●

● Hodgkin’s disease leukemia

●