Medical Emergencies · patient case question
Hemoglobin A1c is also known by which name?
Patient case: Dry Mouth in a Cancer Survivor with Diabetes
Patient: 55-year-old male
Chief Complaint: “My mouth is always dry and food sticks to everything.”
Background: Type 2 diabetes mellitus, most recent HbA1c 8.4%. Prostate adenocarcinoma treated with external beam radiation directed to the pelvis 2 years ago, currently in remission with no evidence of recurrence. History of peptic ulcer disease. No radiation to the head or neck.
Medications: Metformin · Glipizide · Amitriptyline for diabetic neuropathy · Omeprazole
Vital Signs: BP 138/86 mmHg · HR 80 bpm · RR 16 · T 98.4°F
Findings: Dry, sticky mucosa with minimal salivary pooling in the floor of the mouth. Mirror adheres to the buccal mucosa. Multiple new cervical and root surface carious lesions. Fissured, erythematous tongue.
Show answer and explanation
Correct answer: A. Glycated hemoglobin
- A. Correct. Glucose binds non-enzymatically and irreversibly to the N-terminal valine of the hemoglobin beta chain. The proportion of hemoglobin so modified rises in direct relation to ambient glucose concentration over the life of the cell.
- B. Incorrect. C-peptide is released in equimolar amounts with endogenous insulin and is used to assess residual beta cell function, not glycemic control.
- C. Incorrect. Fructosamine measures glycated serum proteins, chiefly albumin, over a 2 to 3 week window. It is useful when hemoglobin A1c is unreliable, such as in hemoglobinopathies.
- D. Incorrect. Fasting plasma glucose is a single point-in-time measurement taken after an overnight fast. It says nothing about long-term control.
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