ansar test provides answers to the neuropathy question ...

ansar test provides answers to the neuropathy question

ansar test provides answers to the neuropathy question

www.diatribe.us
Kelly L. Close
Editor-in-Chief


Diabetes complications are complicated, even if they’re often referred to by simple acronyms like DAN (diabetic autonomic neuropathy) and CAN (cardiovascular autonomic neuropathy). Neuropathy describes damage to your nerves and because nerves are responsible for exchanging messages between the body and the brain, damage to them should be recognized and treated as quickly as possible.

Both DAN and CAN arise as a result of poor blood glucose control during which extended periods of high blood glucose cause nerve damage. Unfortunately, there are no outward symptoms to let patients know that they are suffering from these complications. Often, by the time these conditions are diagnosed, they have already caused significant damage, which makes testing very important since it predicts your risk of getting this complication. Kelly Close, diaTribe Editor in Chief, got wind of this test from her endocrinologist. The procedure, technically known as autonomic function testing, predicts the risk of complications by examining the autonomic nervous system (ANS). We were happy to hear that she’s in very good shape for avoiding this complication. See details at the end of her account to find out how you can obtain more information about this test that you may share with your healthcare team

The Autonomic Nervous System
Let’s first describe the autonomic nervous system (ANS) - the collection of nerves that we evaluate in autonomic function testing. As the "auto" in autonomic suggests, this system is in charge of many of the processes in our bodies that are not under conscious control. Heart rate, digestion, and sexual arousal are examples of actions controlled by the ANS. The ANS is made up of two components. The sympathetic nervous system of the ANS is in charge of spending energy – for example, hard breathing when running. The parasympathetic nervous system, on the other hand, is more involved in energy conservation and restoration, such as slower breathing during sleep. Both of these branches of the ANS must on average balance each other out for the body to function normally.

As one of the wonderful members of our medical advisory board, Dr. Bill Polonsky, always says, “well-managed diabetes is the leading cause of n-o-t-h-i-n-g!” On the other hand, prolonged high blood sugar and poorly managed diabetes in general are well-established causes of neuropathies, including autonomic neuropathy. Autonomic neuropathy that comes about as a complication of poorly managed diabetes is called diabetic autonomic neuropathy (DAN).

Manifestations of DAN
DAN rears its ugly head in the form of hypoglycemic unawareness and damage to the nerves of the heart and blood vessels leading to cardiovascular autonomic neuropathy (CAN). In addition, DAN can cause abnormal emptying of the stomach, which is specifically relevant to our population because abnormal food digestion can cause wild fluctuations in blood sugar. The eyes, urinary tract and sex organs are also very susceptible to damage with this condition.

Question: How do I know my risk for diabetic neuropathy?
Answer: The ansar Group’s ANX 3.0 Autonomic Nervous System Monitor
From where I stand, I'd rather not wait for nerve damage to show up before taking action so I was particularly pleased when my endocrinologist (and another member of our advisory board), Dr. Nancy Bohannon (St. Luke’s Medical Center, San Francisco, CA) told me about a test for ANS neuropathies: the ansar ANX 3.0. The purpose of this test was to detect ANS dysfunction, which would enable my healthcare team to take action to decrease the danger of neuropathy if it was present.

Nervous anticipation had me a touch on the jittery side. It would be great to have a negative prediction after doing 8-9 fingersticks a day for years, carb counting, lots of insulin corrections and eagerly watching my DexCom continuous glucose monitor. Playing the perpetual optimist, I told myself that even a positive prediction of neuropathy would not be so bad since it meant that I could take action to prevent it from actually happening or at least slow the process.

The nurse sat me down in an ordinary chair and hooked up three wires: two right at the top of my chest, one on either side. The third, she placed on my last rib on my left side. She then placed my left arm in a blood pressure cuff. All the wires fed into a mysterious “black box” which was hooked up to a laptop computer and a printer.

I was told to remain as still and quiet as possible and to breathe freely at my own pace. So I sat there doing just that for about five minutes getting more and more relaxed – note to self: sit quietly and breathe more often. Then we moved to deep breathing exercises which basically consisted of five seconds each of breathing in and breathing out. Then came the interesting part. When the technician operating the monitor told me that we were going to perform the Valsalva maneuver, I was pretty sure I was going to be getting some sort of massage. Not quite. He told me to take a quick breath, hold it, and build pressure in my chest by pushing out my stomach. Not the most comfortable of actions.

I spent about a minute doing regular breathing recovery from the Valsalva procedure. Then I transitioned to the standing challenge – it pretty much explains itself; I stood up as quickly as possible and remained standing for the last five minutes of the test – there were quite a number of repetitions of this. The technician was kind enough to explain that the nurse could usually lend a hand if a patient had difficulty standing quickly. Alternatively, patients unable to stand can lay down for the first portions of the test and sit up for the final part. I was fine, though.

The whole procedure took about 20 minutes. I have to admit, for something that is supposed to be testing the balance of my entire autonomic nervous system, I was expecting to be out of commission for at least two hours.

I sat expectantly for a few minutes while the system chuckled and whirred and the printer eventually spat out five sheets with really impressive-looking graphs. The technician explained to me the overall arrangement of the results. They were broken down into four parts: baseline (regular breathing), deep breathing, Valsalva, and standing. Each of these sections had heart rate and blood pressure information with “normal, low, and high” ratings that gave me a sense of how I “scored” on the test. Needless to say, this is one of those tests where scoring high is NOT the best outcome.

This was what my doctor explained during my follow up visit: I did not have neuropathy and was not at risk of neuropathy anytime soon.

From where I stand, one of the greatest benefits of this evaluation is the concrete feedback it gave me regarding my efforts at good blood sugar management and overall diabetes care. It made me very motivated to keep my glucose numbers under control, that’s for sure!

Reimbursement for the test is good - Blue Cross/Blue Shield covered my test and the company says 90% of tests taken are covered. They also informed us that Medicare reimbursement has been improving over the last seven years.

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