I don’t understand why I wasn’t diagnosed with diabetes?

[Lonelycat]

I am in America.

I have had Prediabetes for 6 years. My a1c last November was 6.0. I go to Kaiser and they don’t use fasting glucose. I had an a1c of 6.5 in October and my endocrinologist told me it was borderline (on the cusp of diabetes) and ordered a 2nd a1c in 1 month for diabetes diagnosis.

According to her 2 a1cs of 6.5 or above is diabetes. I did the test in a MONTH and lowered it to 6.0 with low carb diet, weight loss, and exercise (age 32 weight was 285, female 5’8”) with metabolic syndrome, and they confirmed prediabetes.

She stated I DID NOT have diabetes to begin with and I’m confused why I wasn’t diagnosed the first time.

I had a fasting glucose of 126-132 everyday for 3 weeks during that time on a low carb diet on my glucometer and my endo said it was higher due to stress (I’m always stressed out) but I’m not sure if I believe that.

 

[JoKalsbeek]

If I was tested today and a month from now, with no previous test results, I'd not be diagnosed a diabetic. I am in the normal range, but I am most certainly a diabetic...! Give me a wonder bread cheese sandwich and be amazed at the resulting glucose spike. But I've been low carbing for these past 7,5 years, so my blood sugars are non-diabetic.... Doesn't mean I am not diabetic though, not by a long shot, as I still can;t handle carbs as other people with a normal metabolism would. You've started treating your high-ish blood sugars with a low carb diet, and the treatment is obviously working.

We can't diagnose on here, but I can advise something: go from the assumption that you are quite insulin-resistant/insensitive, which is basically an assumption you can make after 6 years of prediabetes, and keep up the low carbing from here on in. Your body'll thank you for it.

As for your fasting glucose, anything can up glucose, not just foods. Stress can indeed have an impact, as can a sleepless or restless, nightmare-filled night, a flu jab, an infection, and.... Waking up. When you wake up, your liver starts dumping glucose into your system to help give you energy to start the day. So fasting blood sugars in the morning can even be your highest numbers of the day, sometimes. It's called Dawn Phenomenon or Feet-On-The-Ground. Let it go, and focus more on what you can influence in the short term: keep your blood sugars relatively low around your meals. Eventually, in the long term, that'll make your liver dump less in the morning, though it takes just about forever to show up in the test.

Good luck,
Jo

 

[KennyA]

I am in America.

I have had Prediabetes for 6 years. My a1c last November was 6.0. I go to Kaiser and they don’t use fasting glucose. I had an a1c of 6.5 in October and my endocrinologist told me it was borderline (on the cusp of diabetes) and ordered a 2nd a1c in 1 month for diabetes diagnosis.

According to her 2 a1cs of 6.5 or above is diabetes. I did the test in a MONTH and lowered it to 6.0 with low carb diet, weight loss, and exercise (age 32 weight was 285, female 5’8”) with metabolic syndrome, and they confirmed prediabetes.

She stated I DID NOT have diabetes to begin with and I’m confused why I wasn’t diagnosed the first time.

I had a fasting glucose of 126-132 everyday for 3 weeks during that time on a low carb diet on my glucometer and my endo said it was higher due to stress (I’m always stressed out) but I’m not sure if I believe that.

Hi and welcome. Not sure what view Kaiser takes of this but in the UK it's accepted that there is a bit of error in the HbA1c test - 5% is allowable. So if you're on the borderline, the health system here will usually ask for a confirmatory second test. When I was formally diagnosed I had one test come in at 50mmol/mol and the second at 49mmol/mol (roughly the same as 6.5% on the DCCT scale).

Personally, I would have chosen to avoid a formal diagnosis if I could and I'd known then what I know now. Once diagnosed, you're always going to be "diabetic" because a) it's an incurable condition b) health systems don't look at what your current BG level is, just the diagnosis and c) it can affect things like life and travel insurance.

Lots of other things (other than food) will affect your current blood glucose level, because your liver keeps adjusting the amount of glucose in your blood in line with what the liver thinks you need. For me, stress, exercise, higher ambient temperature, and illness will all tend to increase my current BG.

Incidentally, you seem to be doing well on low carb so far. My view is that once we're out of normal BG range, we have a problem - whether that gets a label that says "prediabetes" or "diabetes" doesn't change much.

 

[Lonelycat]

Hi and welcome. Not sure what view Kaiser takes of this but in the UK it's accepted that there is a bit of error in the HbA1c test - 5% is allowable. So if you're on the borderline, the health system here will usually ask for a confirmatory second test. When I was formally diagnosed I had one test come in at 50mmol/mol and the second at 49mmol/mol (roughly the same as 6.5% on the DCCT scale).

Personally, I would have chosen to avoid a formal diagnosis if I could and I'd known then what I know now. Once diagnosed, you're always going to be "diabetic" because a) it's an incurable condition b) health systems don't look at what your current BG level is, just the diagnosis and c) it can affect things like life and travel insurance.

Lots of other things (other than food) will affect your current blood glucose level, because your liver keeps adjusting the amount of glucose in your blood in line with what the liver thinks you need. For me, stress, exercise, higher ambient temperature, and illness will all tend to increase my current BG.

Incidentally, you seem to be doing well on low carb so far. My view is that once we're out of normal BG range, we have a problem - whether that gets a label that says "prediabetes" or "diabetes" doesn't change much.

Hi KennyA,

Thanks for your detailed response. Sorry for the delay. How long did they take to test your 2nd a1c?

 

[KennyA]

Hi KennyA,

Thanks for your detailed response. Sorry for the delay. How long did they take to test your 2nd a1c?

I got the result of my first test (50) Dec 9th 2019. The second (49) was mid January 2020 - I think it might have been sooner had it not been for Christmas/New Year. I insisted on being tested again in April 2020 - result was 36. A win for low carb.

The HbA1c test looks back about three months, with a big skew towrds the recent month. This is because it counts glycated red blood cells and they live around three months. So two tests a couple of weeks apart are really testing much the same thing, and you might not learn a lot. To see the impact of significant changes (eg to see response to a diet or medication change) I'd suggest waiting at least three months between tests.

I have a growing feeling that media and officialdom in the UK is increasingly using "diabetic" as a shorhand euphemism for "overweight, high blood glucose, and generally unhealthy". It's really unhelpful.

 

[Lonelycat]

I got the result of my first test (50) Dec 9th 2019. The second (49) was mid January 2020 - I think it might have been sooner had it not been for Christmas/New Year. I insisted on being tested again in April 2020 - result was 36. A win for low carb.

The HbA1c test looks back about three months, with a big skew towrds the recent month. This is because it counts glycated red blood cells and they live around three months. So two tests a couple of weeks apart are really testing much the same thing, and you might not learn a lot. To see the impact of significant changes (eg to see response to a diet or medication change) I'd suggest waiting at least three months between tests.

I have a growing feeling that media and officialdom in the UK is increasingly using "diabetic" as a shorhand euphemism for "overweight, high blood glucose, and generally unhealthy". It's really unhelpful.

I see. And you were officially diagnosed at the 2nd a1c of 49? What did they tell you on the first a1c of 50?

 

[KennyA]

I see. And you were officially diagnosed at the 2nd a1c of 49? What did they tell you on the first a1c of 50?

No, after the initial result my GP said something about my BG level, and I said "So that means I HAVE got diabetes"? and he said "yes, I'm afraid so".

This was good news for me, as they'd spent the previous ten years telling me I hadn't got diabetes despite the wide range of diabetic symptoms I'd been having - my symptoms start at HbA1c levels of 43 or 44, possibly lower. At no point did anyone tell me my blood glucose was steadily rising year on year. I only found out after diagnosis when I went back through my test results. Thanks to having found this forum I knew there was something I could do about T2 diabetes, if in fact I had it - the alternative diagnosis would have been out of my control.

Nobody mentioned a second confirmatory test, but when I went to see the Diabetic Nurse (Jan 2020) she did a second test - my practice has the capability of processing tests themselves, so I got the result straight away.