HBa1C Test - Been told to wait

[JenniferM55]

Am I right in thinking the locum Dr we visited today is wrong? At a request for a HBa1C test, my husband was told to wait a few weeks as 18 days ago he had an op for a knee replacement and his body needs to settle down after the anaesthetic. Surely it's what has been going on with his BG during the past 3 months that matter?

Last week he had a PET scan and was asked to fast, he had been fasting for at least 14hrs when one of the medical staff took a BG finger prick reading, the result was 9. mmol/L. Since then he's been on my low carb regime where's BG has been coming down over the past few days, this morning it was 6.5mmol/L.

Am I missing something?

 

[Guilty]

I know the A1c results are supposed to give a 3 month average. But they also are supposed to be more heavily weighted towards the most recent month. So maybe that's the reason to wait?

Also there are things that impact A1c other than diabetes. E.g. blood loss, liver disease, anemia, alcohol abuse etc. etc. Never heard about anaesthetic - but maybe???

 

[ianf0ster]

A knee replacement is certainly the equivalent of an injury - so certain to have raised his BG, as was (I presume) any pain he was having from his knee before the op.

 

[JenniferM55]

Thanks for the replies @Guilty and @ianf0ster, never thought the 'injury' could be a problem. His heart-failure nurse has taken up the 'cause' as she wants to put him on another drug. The new drug is to protect his kidneys and other organs from a heart drug he's already taking. But before he gets put on the new drug she needs to know what his ABa1C is. Apparently this drug could help if he does turn out to be diabetic.

 

[Pipp]

Thanks for the replies @Guilty and @ianf0ster, never thought the 'injury' could be a problem. His heart-failure nurse has taken up the 'cause' as she wants to put him on another drug. The new drug is to protect his kidneys and other organs from a heart drug he's already taking. But before he gets put on the new drug she needs to know what his ABa1C is. Apparently this drug could help if he does turn out to be diabetic.

This nurse could ask for HbA1c, I think. No need to go via GP.

 

[JenniferM55]

This nurse could ask for HbA1c, I think. No need to go via GP.

Yes, she's not based at the surgery, but she's phoning the surgery tomorrow to get it organised. I'm pretty sure we'll need to go to the local small hospital for blood tests, it's now been changed into a 'state of the art central diagnostic centre'. Things appear so complicated these days .

 

[jonathan183]

A decision made on an unreliable test might not be so helpful ... maybe worth waiting if you have been specifically advised to ...

 

[Pipp]

A decision made on an unreliable test might not be so helpful ... maybe worth waiting if you have been specifically advised to ...

Sometimes, when different HCPs give conflicting advice, we have to make our own decisions on who we trust the most.

 

[HSSS]

Sometimes, when different HCPs give conflicting advice, we have to make our own decisions on who we trust the most.

Easier done when you understand the reasoning behind each conflicting opinion. In this case whatever decision is made being aware that the pain/op will likely have raised levels is important to factor into any actions or decisions taken as a result of the test levels.

 

[JenniferM55]

Easier done when you understand the reasoning behind each conflicting opinion. In this case whatever decision is made being aware that the pain/op will likely have raised levels is important to factor into any actions or decisions taken as a result of the test levels.

I didn't appreciate that pain and also possibly painkillers could influence BG, even though the test a1c takes into account weeks of previous BG levels. My husband has lots of health issues (who doesn't when approaching 80), the most serious being Stage 4 Hodgkin's Lymphoma, he has a pacemaker with a defib, and terrible arthritis that has put him in a wheel chair. He has next to no feeling in his feet and hands; we've been told this is most probably nerve damage caused by the chemo he's had. My thoughts were; what if the nerve damage was caused by undiagnosed diabetes?

He's now on my diet. So far no complaints as he sees his morning BG gradually coming down, this morning it was 6.2.

 

[Kernow Debra]

He has next to no feeling in his feet and hands; we've been told this is most probably nerve damage caused by the chemo he's had. My thoughts were; what if the nerve damage was caused by undiagnosed diabetes?

If it helps, my partner had nerve damage to her feet( completely numb) when she was on chemo.
To the point they gave her extra time between chemo sessions to try and recover. 5 years on she still has sporadic neuropathy in both feet.
She is non diabetic.

 

[JenniferM55]

If it helps, my partner had nerve damage to her feet( completely numb) when she was on chemo.
To the point they gave her extra time between chemo sessions to try and recover. 5 years on she still has sporadic neuropathy in both feet.
She is non diabetic.

Thank you. That's good news sounds like your partner's neuropathy has improved quite a bit. My husband was warned, towards the end of his treatment (I suspect) they reduced his chemo dose.

Had a nice chat with his heart failure nurse this morning, she sought advice and is of the opinion that it would be better to wait a couple of weeks for the test. Told her my husband is now eating low carb and she's delighted, saying it's the best thing he could do. She raved about the low carb way of eating, she and her family are on it. She's awesome !

 

[AndBreathe]

Am I right in thinking the locum Dr we visited today is wrong? At a request for a HBa1C test, my husband was told to wait a few weeks as 18 days ago he had an op for a knee replacement and his body needs to settle down after the anaesthetic. Surely it's what has been going on with his BG during the past 3 months that matter?

Last week he had a PET scan and was asked to fast, he had been fasting for at least 14hrs when one of the medical staff took a BG finger prick reading, the result was 9. mmol/L. Since then he's been on my low carb regime where's BG has been coming down over the past few days, this morning it was 6.5mmol/L.

Am I missing something?

Jennifer, this is a copy and paste from the NICE Guideline:

"....

• Note: be aware that severe hyperglycaemia in people with acute infection, trauma, circulatory or other stress may be transitory and is not diagnostic of diabetes....."

I would definitely consider a TKR as a trauma, so provided he isn't symptomatic, in terms of insatiable thirst, weeing several times in the night and so on, waiting a short while is unlikely to be too harmful to him - especially if you have a beady eye on him. I didn't mention feeling tired on the symptom list as he's recovering from some major physical joinery.

Here are the NICE Guidelines - updated October 2023 - at the relevant section: https://cks.nice.org.uk/topics/diabetes-type-2/diagnosis/diagnosis-in-adults/

 

[filly]

Am I right in thinking the locum Dr we visited today is wrong? At a request for a HBa1C test, my husband was told to wait a few weeks as 18 days ago he had an op for a knee replacement and his body needs to settle down after the anaesthetic. Surely it's what has been going on with his BG during the past 3 months that matter?

Last week he had a PET scan and was asked to fast, he had been fasting for at least 14hrs when one of the medical staff took a BG finger prick reading, the result was 9. mmol/L. Since then he's been on my low carb regime where's BG has been coming down over the past few days, this morning it was 6.5mmol/L.

Am I missing something?

When I had my knee replacement in April, I was given Post op steroids by iv and blood thinner. Even though feeling fine I didn't have an Hba1c until a short while ago and still above where I wanted to be. Both surgery and other medications around the op can make Diabetic Blood tests go crazy.

 

[Lakeslover]

Just a thought but steroids do raise blood sugar as well as pain. If he has been on them for the arthritis or with the chemo (which can happen) that might be the culprit…or one of them.

 

[JenniferM55]

Jennifer, this is a copy and paste from the NICE Guideline:

"....

• Note: be aware that severe hyperglycaemia in people with acute infection, trauma, circulatory or other stress may be transitory and is not diagnostic of diabetes....."

I would definitely consider a TKR as a trauma, so provided he isn't symptomatic, in terms of insatiable thirst, weeing several times in the night and so on, waiting a short while is unlikely to be too harmful to him - especially if you have a beady eye on him. I didn't mention feeling tired on the symptom list as he's recovering from some major physical joinery.

Here are the NICE Guidelines - updated October 2023 - at the relevant section: https://cks.nice.org.uk/topics/diabetes-type-2/diagnosis/diagnosis-in-adults/

Brilliant, @AndBreathe, interesting link, thank you. I think he is symptomatic as he is weeing a lot. Not helped by the fact the Epidural seems to have stopped him feeling the urge to go. It's been rather a nightmare.... but this is too much information .He was warned that this could be an issue, but slowly slowly I think he's starting to feel 'the urge' again, so fingers crossed this nightmare is only temporary.

Edited to add, we discovered today that he had an a1c test in 2021, the result was 40.

 

[JenniferM55]

When I had my knee replacement in April, I was given Post op steroids by iv and blood thinner. Even though feeling fine I didn't have an Hba1c until a short while ago and still above where I wanted to be. Both surgery and other medications around the op can make Diabetic Blood tests go crazy.

Thank you, interesting! I know his BP went crazy, so much he needed to stop his heart meds. They're now being slowly reintroduced again.

 

[JenniferM55]

Just a thought but steroids do raise blood sugar as well as pain. If he has been on them for the arthritis or with the chemo (which can happen) that might be the culprit…or one of them.

Yes, this could be a trigger. He finished his chemo, which was nothing short of magic, in July this year having had 16 sessions - a session every 3 weeks. Each session was accompanied by a week on steroids.

 

[AndBreathe]

Brilliant, @AndBreathe, interesting link, thank you. I think he is symptomatic as he is weeing a lot. Not helped by the fact the Epidural seems to have stopped him feeling the urge to go. It's been rather a nightmare.... but this is too much information .He was warned that this could be an issue, but slowly slowly I think he's starting to feel 'the urge' again, so fingers crossed this nightmare is only temporary.

Edited to add, we discovered today that he had an a1c test in 2021, the result was 40.

Jennifer, if your husband has been around the block a couple of times, it will be pretty natural to wee a bit more than in his youth.

Obviously, keep an eye on things, but with all these recent events he likely needs to heal a bit. I'm sure his GP will be happy enough to do an A1c shortly.

 

[JenniferM55]

Just an update, husband had his HBa1c test last Thursday, and we received the results today. The result was 36, so we're more than happy. Although he's been on my low carb diet since the beginning of November, I'm hoping this hasn't screwed up or rather masked any problem.

So for now, we're really happy he doesn't have another health issue to deal with.

Thank you for your replies.