HbA1c confusion in new diabetic

[lucylocket61]

I was diagnosed as diabetic just over a weeks ago. Type 2. This was based on my fasting blood test result of 7.3

On Friday I had the results of my HbA1c test, it is 6.4

I have been given a diet sheet, told to restrict my carbs to 100g a day, and given a prescription of 1 metformin 500mg tablet to take a day. I will get another HbA1c blood test in 3 months.

I have already had loads of useful info from you on the New Members thread.

My confusion is - with my fasting levels so low and my HbA1c being only 7.3, am I actually a diabetic? Or is my doctor jumping the gun?

I must say, my visit with the practice nurse was very upsetting...but I will ask about that another time.

[borofergie]

No, you're almost certainly diabetic.

A HbA1c of 7.3% is indicative that your average BG over the last few months was about 10 mmol/l.
http://www.diabetes.co.uk/hba1c-to-bloo ... erter.html

It's not as bad as some of us on diagnosis (mine was 10.2%), but it is nowhere near "non-diabetic" (<<5%). Without anything else, a HbA1c of >6.5% is enough to diagnose diabetes.

[Daibell]

Hi. You mentioned two different HbA1c levels in your Post i.e. 6.4 and 7.3. Can you confirm which one is correct. To be given 100gm carb diet advice is fantastic. It indicates you are dealing with health professionals who understand diabetes which is a good start!

[lucylocket61]

My 12 hour fasting blood test (not HbA1c) is 7.3

My HbA1c is 6.4

[Daibell]

Hi. An Hba1c of 6.4 isn't too bad but does indicate your diabetes diagnosis is correct. NICE guidelines suggest you need to be controlled below 7.0 to avoid long-term damage. Try keeping to the 100gm diet where you can and hopefully with the Metformin your levels will stay good. The Metformin can be increased if needed.

[mousemat]

I read on an American website ( don't laugh) that the way that diabetes is now diagnosed is through the HbA1c result.

So if this is under 7, you are not considered diabetic.

I'm not sure why this would be, as surely, in America, they would be keen to define diabetics early , given the amount of medical care that wouldbe needed.

[borofergie]

I read on an American website ( don't laugh) that the way that diabetes is now diagnosed is through the HbA1c result.

So if this is under 7, you are not considered diabetic.

Yay! I've got a 5.2%. I'm Cured! I'M CURED I TELL YOU!

Does it make any difference what the Americans consider non-diabetic? As far as I know, once you are diagnosed in the UK you are in the club for life. You might have to fight with your Doctor to stay on your meds, but they won't ever discharge you.

[lucylocket61]

You mean I will always be considered a diabetic, even if I get my bs under control?

[phoenix]

I read on an American website ( don't laugh) that the way that diabetes is now diagnosed is through the HbA1c result.

So if this is under 7, you are not considered diabetic.

I'm not sure why this would be, as surely, in America, they would be keen to define diabetics early , given the amount of medical care that wouldbe needed.

This is happening in the UK as well but the cut off point (as in the US) is not an HbA1c of 7% but one of 6.5% and those who are between 6 and 6.4% are considered to have impaired glucose tolerance.
"The test is not recommended for diagnosis of type 1 diabetes, and should not be used to diagnose type 2 diabetes in children, or patients with end-stage kidney disease, haemoglobinopathies or anaemia"
http://www.pulsetoday.co.uk/newsarticle ... eload-rise

[Mothman]

So, i was originally diagnosed with an HbA1c of 7.5, got it to 6.5 with considerable effort and hope to get it lower with my next test in a months time. Are you saying that if i reduce below 6.5 i will no longer be diabetic and go back to eating what i like? I can tell you that if i do my figures will skyrocket again. Once a diabetic, always a diabetic but you can control it with what you eat. There will be one hel of a row with my Doctor if she suggests ime 'cured' and can carry on my life as normal.Ive eaten the wrong things and up the sugars go. Its the NHS just trying to save money at the expense of out health and lives.

Andy

[mousemat]

Well that's interesting.

My last two tests were 5.1 and 5.2, so I wondered if there was such a thing as going back to be a borderline diabetic.

Although if I went back to eating sugar,I'm sure it would go higher.

Strangely enough, two years ago, if I ate white rice, my bs would rise to 10 ish. Now it's only around 7.

I'm on a lower medication than before and don't do exercise, so there is no accounting for this.

The only thing that is different is that I am less stressed.

[xyzzy]

Well that's interesting.

My last two tests were 5.1 and 5.2, so I wondered if there was such a thing as going back to be a borderline diabetic.

Although if I went back to eating sugar,I'm sure it would go higher.

Strangely enough, two years ago, if I ate white rice, my bs would rise to 10 ish. Now it's only around 7.

I'm on a lower medication than before and don't do exercise, so there is no accounting for this.

The only thing that is different is that I am less stressed.

Have you lost weight? If you've done that then your insulin resistance may well have dropped.

Diabetes is progressive IF you don't do anything about it so at the point you get diagnosed you will have such an such an insulin resistance that stops your insulin working properly and such and such of your pancreatic insulin production capability left depending on how high and how long your blood sugars have been running at high levels capable of killing off your beta cells.

If you are lucky like "youngfrank" see http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=1&t=27434 then if you still have a decent amount of pancreatic function left and then lose enough weight to shift the majority of your insulin resistance you may well find you can begin to eat more carbs again. The point youngfrank then correctly makes is why do that as it will start you back becoming diabetic again if you readopt your old unhealthy life style and diet.

Of course if it turns out you are one of the 3% (I read somewhere) of Type 2's wrongly diagnosed who should be Type 1.5 then the above doesn't help much because your pancreas is giving out anyway. Likewise if you are true Type 2 and have been running your blood sugars at lethal beta cell levels for a while you also wont have a lot of insulin production left so you wont get the same results.

I have no idea how you go about finding what your insulin resistance is or how much function you still have and I'm sure my surgery wouldn't pay for the tests anyway so the best I can do is lose loads of weight while keeping my blood sugars safe. That way as my insulin resistance drops I might start to recover some carb eating capability at some future date.

[Daibell]

Hi xyzzy. The C-Peptide test does show how much insulin is in the blood at the time of test as c-peptide tracks the level of insulin. I believe there are further tests for pancreatic function but can't remember what they are. Like you have found, the NHS doesn't like doing thse tests due to cost; guessing is much cheaper....

[phoenix]

Mothman:
The change is that HbA1c is being used to diagnose that's all. There are many people who were diagnosed under older criteria that have managed at some time to have lower readings. They are still considered to be diabetic. If a normal amount of carbohydrates causes your glucose levels to rise without taking medication then you are most definitely still diabetic.

I find the Newcastle study interesting though, I think if people were able to pass glucose tolerance tests over a period of time one should at least say that their diabetes is in remission... and what if with a 'healthy diet' they could do it for many years???
I think though that the name diabetes covers a number of conditions sharing a common symptom of high glucose levels.
A Newcastle type of intervention may work with some but most definitely not all. The subjects in that study were quite a select group (overweight and hadn't been diagnosed with T2 for very long) Three months after that study , 3 of the 10 subjects were unable to 'pass' a glucose tolerance test , we don't know what happened at 6months or a year later.

[youngmanfrank]

There is a Newcastle University press release dated 24.6.2011 which quotes one of their trial volunteers and he states that 18 months on he is still off medication,presumably with normal blood sugars.This suggests that the trial took place in 2010 sometime.

http://www.ncl.ac.uk/press.office/press ... 2-diabetes


I do so wish that Newcastle would now do a follow up on all of the successful volunteers and publish their current results.