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Diagnosed type 2 5/6 yrs ago but am I?

S

saudidave

Active Member
Messages
31
Hi

I had a type 2 diagnosis about 5/6 yrs ago when I was 57 yrs old, based upon two fasting glucose readings of 7.0 & 7.1. (See my posts in 2011) Prior to that for several yrs I had been 6.5 ish. I would add that when I was 29 yrs old and a 5ft 8", 11 stone marathon runner, I'd been told after a job medical that I had exceptionally high fasting blood sugar.
Anyway, post diagnosis I took heed, lost weight, increased my physical activity and was eminently sensible. I went from 15 st to 12. After a series of personal stress events two years ago (A close friend died, my wife had breast cancer & I fractured my spine in a fall), I wobbled a bit, lost heart, gained weight and generally slobbed about and drank too much.
Bottom line: post diagnosis I have constantly maintained an hba1c of 37-39mmol/mol, irrespective of weight, stress or lifestyle. I've never once gone beyond 39. I would appear to have had a high fasting glucose level as a superfit 29 yr old, so perhaps I've always been that way. This last 6 months I really have been ignoring my weight, diet and alcohol intake due to massive work stress and I've dropped from 39 to 37, despite gaining 20lbs and taking zero exercise! I've no symptoms of diabetes at all and have never been prescribed medication for it.
Am I really a type 2 or am I in some other category? My diabetic nurse said this morning she didn't think I was based on my hba1c's, as did my GP last week. My current main concern is the astronomic cost of renewing my life insurance and health care cover due to having to put type 2 diabetes on the form! I am getting my act back together on diet and exercise too by the way.
The reason for this post is basically to take the opinions and advice of other forum members who may have researched this better than I - am I type 2 or not?. I fully understand the seriousness of diabetes and whilst I've had a mixed personal response to the challenge of it I can't help but think I've had a box ticked and been placed in to a medical category to which I don't fully belong and as a result of that I'm being financially penalised. I've always felt that and the hba1c's appear to be confirming it. The diagnosis cost me a job a few years ago and continues to cost me money when the hba1C says I shouldn't have had the box ticked.

Dave
 
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In the US, it would depend on the wording of the question It varies from, have you ever been diagnosed with (yes), tested for (yes), has it been suggested you have (yes), do you currently have (?), have you had in the past X years (?).

There are severe penalties for inaccurately answering the questions (although less severe post ACA).

As an aside, in the US it has been illegal since 1990 to terminate your employment for simple Type 2 diabetes. (I can envision some circumstances in which it might be legal to exclude individuals with Type 1, or Type 2 taking certain medications, because of the risk of hypos occurring at unpredictable times in jobs in which having a hypo at an inopportune time could be life-threatening.)
 
Thanks. I was excluded from a job because of it, by the way, I didn't lose one I had already. That would be illegal. My point is that I would appear to have had a predisposition to relatively high fasting glucose for a long time, possibly all my adult life and that test (fasting glucose) has put me in to a type 2 box that a more accurate ( and expensive test, hba1c) would suggest I shouldn't be in. I took some care intially to correct my diet based on a type 2 diagnosis but my lifestyle wouldn't appear to be having any effect on my hba1c readings over a 5 year period. I've been fat, thin, exercised, a slob, eater of green veg and consumer of sticky toffee in that 5 years and it's made no difference to the readings, nor have the readings related to those changes.. Two and a half years of being thin and cycling followed by two years gaining the weight back and slobbing haven't affected it. If I were diabetic in the sense I understand it, I would have expected a fall followed by a rise in glucose levels, i.e. tracking my dietary changes, not an unrelated variation as I appear to have had
 
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Have you got your own glucose meter? If not, perhaps you should buy one. If you have, try testing at different times of the day, particularly between an hour and 2 hours after meals, and also when you go to bed. You may get a better idea of what your blood glucose is doing.
 
Bluetit1802 said:
Have you got your own glucose meter? If not, perhaps you should buy one. If you have, try testing at different times of the day, particularly between an hour and 2 hours after meals, and also when you go to bed. You may get a better idea of what your blood glucose is doing.
Click to expand...
 
I've done that after my diagnosis and I concluded then that it was acting in a relatively "normal" manner pre and post prandial but that it does "rest" at a relatively high level. The hba1c's are, as I stated in my initial post, showing a non diabetic level (37-39mmol/mol) over a 5 year period and unless I'm mistaken that's an average over the timescale, thus I'm not diabetic as such, as my diabetic nurse and GP conclude also. What I'm asking the forum is, is the fasting glucose test that was used to diagnose me, and tick the box, a reliable way of concluding the condition? I would have thought that if it was the NHS wouldn't bother with all the expense of hba1c monitoring thereafter. Would I have been diagnosed and had the box ticked if theNHS had monitored me via hba1c tests over say, a year? I doubt it somehow.
 
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Hi. First I don't understand the units you are using for your HBa1C, but aside from that, the fasting test is not a reliable test by itself whereas the HBa1C is so I would challenge any diagnosis based solely on a fasting test (my diagnosis was based solely on a urine stick!)
 
Daibell said:
Hi. First I don't understand the units you are using for your HBa1C, but aside from that, the fasting test is not a reliable test by itself whereas the HBa1C is so I would challenge any diagnosis based solely on a fasting test (my diagnosis was based solely on a urine stick!)
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My sincere apologies, I got the units completely wrong as it's a long time since I looked at this in depth. My Hba1C has varied from 37-39 mmol/mol over the past 5 years since my original diagnosis!
 
If you are happy you are not diabetic, then ask your doctor to confirm this and take you off the register. Simples!
My DN offered to take me off the register last month after being stable for 18 months and not on any meds, yet my HbA1c has ranged from 46 to 42 in that time. I haven't even been below the pre-diabetic threshold. There are plenty of people on this forum that have been offered the option to come off the register. I declined her offer.
 
Thank you. My DN told me today that i couldn't be take off the register, hence my post. I can't be type 2 if I've got an hba1c averaging 38 over the past 5 years, my BMI is over 30, I've not exercised for months and I like beer and sticky buns. It's nonsense
 
What reason did your DN give you, and did you query it?

I would also do some post meal testing, just to make sure you aren't a low glycator. HbA1c tests can be higher or lower than expected due to the way your red blood cells glycate. A high glycator will get HbA1c results higher than expected from regular finger prick tests, and a low glycator will get HbA1c results lower than expected. Most people fall in the middle, but some don't. Like with anything else, one size does not fit all. Likewise, people with certain blood conditions such as anaemia will have skewed HbA1c results.

http://care.diabetesjournals.org/content/30/10/2756.full
 
Bluetit1802 said:
What reason did your DN give you, and did you query it?

I would also do some post meal testing, just to make sure you aren't a low glycator. HbA1c tests can be higher or lower than expected due to the way your red blood cells glycate. A high glycator will get HbA1c results higher than expected from regular finger prick tests, and a low glycator will get HbA1c results lower than expected. Most people fall in the middle, but some don't. Like with anything else, one size does not fit all. Likewise, people with certain blood conditions such as anaemia will have skewed HbA1c results.

http://care.diabetesjournals.org/content/30/10/2756.full
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I didn't really think about it too deeply until after I'd left and was chatting about it to my daughter who is a 4th yr trainee doctor. My daughter and her boyfriend who is also just completing a medical degree as well, are both convinced my diagnosis was wrong given my lifestyle, weight, diet, & constant 5 year Hba1C's that are not even pre diabetic threshold. The flipside is of course that at the moment I'm getting regular and free 6 monthly checks for not only diabetes but liver function, kidney function and all other stats - cholesterol etc. I also get a yearly heart scan and ecg because my father died from cardiomyopathy and I have the early stages, stopped dead in its tracks by medication (pun intended!)
At 63 years old I'm being very carefully monitored and I'm a bit loathe to walk away from all this free testing!
 
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saudidave said:
I've done that after my diagnosis and I concluded then that it was acting in a relatively "normal" manner pre and post prandial but that it does "rest" at a relatively high level. The hba1c's are, as I stated in my initial post, showing a non diabetic level (37-39mmol/mol) over a 5 year period and unless I'm mistaken that's an average over the timescale, thus I'm not diabetic as such, as my diabetic nurse and GP conclude also. What I'm asking the forum is, is the fasting glucose test that was used to diagnose me, and tick the box, a reliable way of concluding the condition? I would have thought that if it was the NHS wouldn't bother with all the expense of hba1c monitoring thereafter. Would I have been diagnosed and had the box ticked if theNHS had monitored me via hba1c tests over say, a year? I doubt it somehow.
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In many countries, there are multiple paths to diagnosis.

A1C is one (6.5% or above)
Fasting blood glucose levels are a second (7 or above on one confirmed test, or two independent tests in the US).
OGTT is a third (200 mg/dl or above)

I don't know whether they are reliable or not - but they are the standard.
 
Neohdiver said:
In many countries, there are multiple paths to diagnosis.

A1C is one (6.5% or above)
Fasting blood glucose levels are a second (7 or above on one confirmed test, or two independent tests in the US).
OGTT is a third (200 mg/dl or above)

I don't know whether they are reliable or not - but they are the standard.
Click to expand...

Thank you for the response. I've concluded the folllowing;

Random blood testing after my diagnosis would suggest that my reaction to glucose is following a "relatively" normal pattern and my own fasting glucose tests indicated I wasn't in the prediabetic range, but the upper end of normal. Five years of six monthly Hba1c's have shown an average 38mmol/mol, with a low of 37 and a max of 39. This combination is conclusive as far as I'm concerned, the Hba1c's are showing that I'm 100% consistently in the normal range, in a narrow band that is not even prediabetic, over a 5 year period where my eating and drinking habits, my weight and exercise levels have varied across a wide spectrum. The random fasting glucose tests I took back that up.

I therefore conclude that I'm in the upper range of normality (and probably always have been) but I'm not diabetic.

All that remains is to consider whether I want to stay registered as diabetic and I think I shall. The reason for that is that the insurance companies will jump at the chance to stuff up the premiums because I have been previously registered and if I remain registered I'll get free monitoring for life. I'm back on a diet and exercise routine now and once I have my BMI down to somewhere close to a recommended level I'll enjoy the odd treacle tart and double cream, accompanied by a bottle of Sauvignon if the fancy takes me.

Dave
 
saudidave said:
Thank you for the response. I've concluded the folllowing;

Random blood testing after my diagnosis would suggest that my reaction to glucose is following a "relatively" normal pattern and my own fasting glucose tests indicated I wasn't in the prediabetic range, but the upper end of normal. Five years of six monthly Hba1c's have shown an average 38mmol/mol, with a low of 37 and a max of 39. This combination is conclusive as far as I'm concerned, the Hba1c's are showing that I'm 100% consistently in the normal range, in a narrow band that is not even prediabetic, over a 5 year period where my eating and drinking habits, my weight and exercise levels have varied across a wide spectrum. The random fasting glucose tests I took back that up.

I therefore conclude that I'm in the upper range of normality (and probably always have been) but I'm not diabetic.

All that remains is to consider whether I want to stay registered as diabetic and I think I shall. The reason for that is that the insurance companies will jump at the chance to stuff up the premiums because I have been previously registered and if I remain registered I'll get free monitoring for life. I'm back on a diet and exercise routine now and once I have my BMI down to somewhere close to a recommended level I'll enjoy the odd treacle tart and double cream, accompanied by a bottle of Sauvignon if the fancy takes me.

Dave
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Thank you to all who responded and on second thoughts I shall do some further blood testing before I throw caution completely to the wind. My meter is an Accu -Chek Compact plus that's now 5 yrs old. Are these still up to it or has technology moved on to something more accurate?
 
I am no expert but going on your results over the last 5 years I would say you are not diabetic
 
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