Standard Practice For Diabetic Screening In The Uk

[Jenny15]

Just a quick question for a non UK person (in NZ): If a non diabetic person is worried about possibly having T2 diabetes, what is the standard practice for screening tests in the UK?

In NZ anyone can ask a GP for a lab test and the GP will usually order it, unless I suppose if there are factors strongly suggesting it's not worthwhile. But I get the feeling it's a bit different in the UK?

We also have fingerprick random BG testing available for free in some pharmacies and at community events. If the person has a random BG over 11 (IIRC) I understand they are given a handout recommending they follow up with a GP.

Thanks.

 

[SimonCrox]

In the UK, it seems that the GPs are quite happy to check an HbA1c and random glucose with values above 65 mmol/mol and 11.1 mmol/L or more respectively suggesting diabetes.
Everyone is very much into the HbA1c, but if the diabetes develops rapidly (eg T1DM), or one is elderly, or one has haemolytic anaemia, the HbA1c might not be raised in the presence of diabetes, and conversely other causes of anaemia can falsely raise the HbA1c.
A fasting glucose of 7.0 mmol/L or more also suggests diabetes, but the fasting is a pain for some people and again can be falsely low in the older person.
One can give a load of glucose (75gm) and check the blood glucose level 2 hours later - the glucose tolerance test - and this is regarded by many as the gold standard test, but it is time consuming, hence the other tests
A one off high glucose does not necessarily mean diabetes - one needs confirmatory evidence in terms of symptoms of thirst etc or retinopathy (which is actuall the original gold standard in the Pima Indian studies which led to the modern diagnostic criteria) or another raised glucose level.
best wishes

 

[Jenny15]

In the UK, it seems that the GPs are quite happy to check an HbA1c and random glucose with values above 65 mmol/mol and 11.1 mmol/L or more respectively suggesting diabetes.
Everyone is very much into the HbA1c, but if the diabetes develops rapidly (eg T1DM), or one is elderly, or one has haemolytic anaemia, the HbA1c might not be raised in the presence of diabetes, and conversely other causes of anaemia can falsely raise the HbA1c.
A fasting glucose of 7.0 mmol/L or more also suggests diabetes, but the fasting is a pain for some people and again can be falsely low in the older person.
One can give a load of glucose (75gm) and check the blood glucose level 2 hours later - the glucose tolerance test - and this is regarded by many as the gold standard test, but it is time consuming, hence the other tests
A one off high glucose does not necessarily mean diabetes - one needs confirmatory evidence in terms of symptoms of thirst etc or retinopathy (which is actuall the original gold standard in the Pima Indian studies which led to the modern diagnostic criteria) or another raised glucose level.
best wishes

Although it was 9 years ago so I may have misremembered, I think I was sent for both an HbA1c and an FBG at the lab when diagnosed. I don't know why but I was then sent for an OGT test, which made me feel miserable at the time and for the rest of the day. Because of that, I try to warn people to be prepared for it if having one. My HbA1cs have always been accurate ie I've had no issues like anaemia at the time of the test that would have rendered it unreliable.

I hope I never have to have another OGT test in my life, LOL. I think my body is very sensitive to big BG swings and I'm happiest when it stays within 2-3 points most of the time. The other day I trialed eating some pizza and went from 7.5 to 12.5 or something like that in 2 hours. And felt miserable. No more pizza for me.

Conversely, today I had a cheesy omelette with bacon and in two hours my BG went from 6.1 to 6.1. Imagine having that sort of response all the time! The stuff of dreams, for most of us.

 

[SimonCrox]

Although it was 9 years ago so I may have misremembered, I think I was sent for both an HbA1c and an FBG at the lab when diagnosed. I don't know why but I was then sent for an OGT test, which made me feel miserable at the time and for the rest of the day. Because of that, I try to warn people to be prepared for it if having one. My HbA1cs have always been accurate ie I've had no issues like anaemia at the time of the test that would have rendered it unreliable.

I hope I never have to have another OGT test in my life, LOL. I think my body is very sensitive to big BG swings and I'm happiest when it stays within 2-3 points most of the time. The other day I trialed eating some pizza and went from 7.5 to 12.5 or something like that in 2 hours. And felt miserable. No more pizza for me.

Conversely, today I had a cheesy omelette with bacon and in two hours my BG went from 6.1 to 6.1. Imagine having that sort of response all the time! The stuff of dreams, for most of us.

I used to use Lucozade which was well validated as the glucose load and was generally well tolerated if chilled; but if one used medicinal anhydrous dextrose (basically just pure sugar) folk often felt very sick on it. It may have been that your HbA1c and FBG were not diagnostic of diabetes then, in which case, one might proceed to GTT. ALl the tests have false negatives.
Best wishes

 

[bulkbiker]

Conversely, today I had a cheesy omelette with bacon and in two hours my BG went from 6.1 to 6.1. Imagine having that sort of response all the time! The stuff of dreams, for most of us.

Why do you say that? You have found something that you can eat that doesn't raise your blood sugar.. you just need to find more things like that and eat them. Sounds like a great ketogenic meal to me..

 

[Jenny15]

Why do you say that? You have found something that you can eat that doesn't raise your blood sugar.. you just need to find more things like that and eat them. Sounds like a great ketogenic meal to me..

Because it's the first time I've seen it, and I try not to count my chickens before they're hatched. Initially I had thought this might be a one off, so it's good to hear your view on it.

I didn't find the same kind of outcome when I first started trying to LCHF 9 years ago. The overall results were good - A1cs from mid 50s to low 30s and a lot of weight loss. It's so long ago I don't remember much detail.

I think you're right though, cheesy omelette with bacon will become a daily thing for me now. I usually have mushrooms too but had run out. Absolutely love eating this kind of dish and it made me feel great.

 

[bulkbiker]

Because it's the first time I've seen it, and I try not to count my chickens before they're hatched. Initially I had thought this might be a one off, so it's good to hear your view on it.

I didn't find the same kind of outcome when I first started trying to LCHF 9 years ago. The overall results were good - A1cs from mid 50s to low 30s and a lot of weight loss. It's so long ago I don't remember much detail.

I think you're right though, cheesy omelette with bacon will become a daily thing for me now. I usually have mushrooms too but had run out. Absolutely love eating this kind of dish and it made me feel great.

Just watch out with the insulin.. you don’t want to hypo obviously.. I think this is the difference between low carb which is what you were doing before with your 100g ish per day and keto ... fewer than 20g per day. At least that has been my experience.

 

[Bluetit1802]

Just a quick question for a non UK person (in NZ): If a non diabetic person is worried about possibly having T2 diabetes, what is the standard practice for screening tests in the UK?

In NZ anyone can ask a GP for a lab test and the GP will usually order it, unless I suppose if there are factors strongly suggesting it's not worthwhile. But I get the feeling it's a bit different in the UK?

We also have fingerprick random BG testing available for free in some pharmacies and at community events. If the person has a random BG over 11 (IIRC) I understand they are given a handout recommending they follow up with a GP.

Thanks.

In the UK there is a lot of screening taking place.

Firstly (at least in England) all GP practices have been told to invite all those aged 40 and above (not already having regular health checks) for a full health check, which in most cases includes an HbA1c. Those with no problems are invited back in 5 years, others in 3 years, others annually, and if there are problems these are investigated further.

Secondly, most pharmacies will do a finger prick check for free if asked.

Thirdly, there are pop-up road shows in towns and cities where the public are invited to have a basic diabetes screening, such as a finger prick, waist and height measurements and questions, to determine if they are at risk.

If a person is worried they may have diabetes, a GP will normally agree to an HbA1c.

 

[Jenny15]

In the UK there is a lot of screening taking place.

Firstly (at least in England) all GP practices have been told to invite all those aged 40 and above (not already having regular health checks) for a full health check, which in most cases includes an HbA1c. Those with no problems are invited back in 5 years, others in 3 years, others annually, and if there are problems these are investigated further.

Secondly, most pharmacies will do a finger prick check for free if asked.

Thirdly, there are pop-up road shows in towns and cities where the public are invited to have a basic diabetes screening, such as a finger prick, waist and height measurements and questions, to determine if they are at risk.

If a person is worried they may have diabetes, a GP will normally agree to an HbA1c.

Thanks @bluetit, that's the info I was looking for, because I want to be able to reliably recommend to people what they can do. I assumed there would be services like the above and just wanted to be sure. I realize you say at least in England so I will add that qualifier, too.

AFAIK, the incentive payments for GP practices in NZ are for things like the number of patients receiving the initial 40+ health check rather than prescribing a certain type of drug. I like this approach.

Thanks again for your post.

 

[Jenny15]

Just watch out with the insulin.. you don’t want to hypo obviously.. I think this is the difference between low carb which is what you were doing before with your 100g ish per day and keto ... fewer than 20g per day. At least that has been my experience.

Quite right. 100g ish per day was better than wildly over 250g per day and I didn't find it difficult or unpleasant. I perhaps wasn't motivated enough to try keto, and I was working full time, with a lengthy commute, and dealing with a lot of stress at home. My situation is completely different now, affording me a chance to try things I couldn't before, providing other illnesses are behaving themselves.

So far the lowest BG I've had on insulin was 5.8 and if I approached 4.0 I'd discuss with my DN and we might stop titrating up and even reduce a little. I'm still only on 16u and it's early days yet. My FBGs are still above target. I anticipate not going much higher in dose and likely dropping a bit once my lower carbing beds in a bit. I am eating about 30-50g carbs a day, I think.

I simply don't want to eat many carbs because whenever I do, my BG spikes by more than 2 points and I feel unwell. I would hate to be in the position of having to add carbs to a meal, when I didn't want to, which is what mixed insulin or a non-insulin injectable medication would likely do. Basal or basal/bolus may be the only good options of insulin regime for me. There's every chance I could go off insulin eventually, too. Things are going better than I expected they would.

 

[Jenny15]

I used to use Lucozade which was well validated as the glucose load and was generally well tolerated if chilled; but if one used medicinal anhydrous dextrose (basically just pure sugar) folk often felt very sick on it. It may have been that your HbA1c and FBG were not diagnostic of diabetes then, in which case, one might proceed to GTT. ALl the tests have false negatives.
Best wishes

Thanks, interesting info. I didn't mind the sensation of drinking it, but the effect of rapidly increasing my BGs made me feel a range of symptoms. Probably unavoidable given my clinical state at the time, but I had a hard job convincing staff I felt bad, when my BG itself appeared to be recovering in the hours after the test. I think it was a case of non-diabetics not realising that we can feel bad despite the meter saying we're between, say, 5 and 9.