Moved To Uk

[Bluetit1802]

Arguably I am no longer "stabilised". For about a year I was stable at around 30 or 31, but now I've jumped to 37 over a six-month period. It's a perfectly acceptable level but there's no way to tell whether the increase has reached a plateau, or whether it will just go on increasing. It went up 6 units in six months, if that happens in the next six months I'll be at 43 ... and a year from now at 49.....

Some of this increase COULD be down to your new UK lab having different types of machines that measure the HbA1c. Have you considered this? They do vary, and I know this for certain. I personally had an HbA1c measured at my normal lab which I disputed with my GP as it was nowhere near what my other data was telling me (including a home A1cNow test). She contacted the biochemist consultant at the lab who recommended my next lot of bloods were sent to a different lab at Salford Royal Hospital as they use different machinery. This was all arranged straight away. I had one vial of blood drawn, which was tested first at the usual lab then sent to Salford for testing. This same sample of blood produced two HbA1cs that were 4 points different.

 

[Grateful]

Some of this increase COULD be down to your new UK lab having different types of machines that measure the HbA1c.

I agree. This is not really supposed to happen anymore: as I understand it, the measurement of HbA1c was internationally standardised a decade ago. Prior to then, it was apparently not unusual for different labs to produce very different results even if they were top-notch facilities and even if they were using similar testing methods or equipment.

However it is clear that complete standardisation hasn't yet been achieved. I discovered this article on the subject, written (three years ago) from the perspective of the German situation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604529/. Some quotes:

Looking at the results from previous interlaboratory comparisons in Germany ... it is clear not only that some measurement methods are used considerably more frequently than others and that there are apparently several manufacturers and methods ... but also that there are clinically relevant discrepancies in the results, depending on the method: At a target value of 39.1 mmol/mol (5.7%) for sample A, the median of all measurements is 39.6 mmol/mol (5.8%). This appears quite good, but the extremes were 28 mmol/mol (4.7%) and 89 mmol/mol (10.3%)! The acceptable limits in the interlaboratory comparison (18% according to RiliBÄK) are also quite far apart, at 32 mmol/mol to 46.2 mmol/mol (5.08% to 6.38%).

The article goes on to point out the potential dangers:

To get to the point, switching from one HbA1c measurement method to another can lead to an apparently substantial change in the glycemic control of all patients in a specialized diabetes practice, without any concrete change in the treatment. In an extreme case, which is very unrealistic, it would be possible for a patient with a doctor who used HbA1c measurement method A, to have an HbA1c value of 4.7% (27.9 mmol/mol), that is, optimal glycemic control, and for the same patient with a different doctor, who used measurement method B, to have an HbA1c value of 10.3% (89.1 mmol/mol), and for the doctor to initiate extensive adjustments to his or her treatment.

Food for thought.

(Coming back briefly to my case, I think I would be reasonably satisfied if I can get another HbA1c test, at the same clinic, three months from now that shows "stability" at 37. I am more interested in the direction of movement than in the absolute number, at that level.)

 

[Rachox]

I agree. This is not really supposed to happen anymore: as I understand it, the measurement of HbA1c was internationally standardised a decade ago. Prior to then, it was apparently not unusual for different labs to produce very different results even if they were top-notch facilities and even if they were using similar testing methods or equipment.

However it is clear that complete standardisation hasn't yet been achieved. I discovered this article on the subject, written (three years ago) from the perspective of the German situation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604529/. Some quotes:

Looking at the results from previous interlaboratory comparisons in Germany ... it is clear not only that some measurement methods are used considerably more frequently than others and that there are apparently several manufacturers and methods ... but also that there are clinically relevant discrepancies in the results, depending on the method: At a target value of 39.1 mmol/mol (5.7%) for sample A, the median of all measurements is 39.6 mmol/mol (5.8%). This appears quite good, but the extremes were 28 mmol/mol (4.7%) and 89 mmol/mol (10.3%)! The acceptable limits in the interlaboratory comparison (18% according to RiliBÄK) are also quite far apart, at 32 mmol/mol to 46.2 mmol/mol (5.08% to 6.38%).

The article goes on to point out the potential dangers:

To get to the point, switching from one HbA1c measurement method to another can lead to an apparently substantial change in the glycemic control of all patients in a specialized diabetes practice, without any concrete change in the treatment. In an extreme case, which is very unrealistic, it would be possible for a patient with a doctor who used HbA1c measurement method A, to have an HbA1c value of 4.7% (27.9 mmol/mol), that is, optimal glycemic control, and for the same patient with a different doctor, who used measurement method B, to have an HbA1c value of 10.3% (89.1 mmol/mol), and for the doctor to initiate extensive adjustments to his or her treatment.

Food for thought.

(Coming back briefly to my case, I think I would be reasonably satisfied if I can get another HbA1c test, at the same clinic, three months from now that shows "stability" at 37. I am more interested in the direction of movement than in the absolute number, at that level.)

I know you don’t self test, but maybe a bit of testing at this juncture might reassure you which direction your levels are going or indeed that they are staying steady, rather than waiting three months for a repeat HbA1c?

 

[Grateful]

I know you don’t self test, but maybe a bit of testing at this juncture might reassure you which direction your levels are going or indeed that they are staying steady, rather than waiting three months for a repeat HbA1c?

You suggestion is a good one, but I'd still far rather wait for the next lab test. I'm only mildly concerned about the rise in A1c over the past six months, and my NHS doctor seems not concerned at all (to the contrary, when she phoned after the test results came through, she praised me for maintaining control with diet only).

Introducing self-testing at this point would, given my personality type, just be adding stress that I don't need. I realise this may put me in something of a minority on this forum, but that's the way I want to try to keep going. Having said that, if my situation clearly worsened and became hard to control with only the periodic clinical tests, I would of course see the case for self-testing, especially as a way to figure out what foods specifically are spiking the BG.

 

[Rachox]

You suggestion is a good one, but I'd still far rather wait for the next lab test. I'm only mildly concerned about the rise in A1c over the past six months, and my NHS doctor seems not concerned at all (to the contrary, when she phoned after the test results came through, she praised me for maintaining control with diet only).

Introducing self-testing at this point would, given my personality type, just be adding stress that I don't need. I realise this may put me in something of a minority on this forum, but that's the way I want to try to keep going. Having said that, if my situation clearly worsened and became hard to control with only the periodic clinical tests, I would of course see the case for self-testing, especially as a way to figure out what foods specifically are spiking the BG.

That’s fair enough, we each make our choices for our own requirements and personalities, personally I’d find it more stressful to not know for so long. It’d be a boring old world (and Forum) if we were all the same

 

[Grateful]

It’d be a boring old world (and Forum) if we were all the same

Indeed.

 

[donnellysdogs]

Don’t forget in England that a medicated diabetic has to fill in a form with their GP to get free medications... no form, no free meds. GPS can forget to give forms and the next thing is that you get a penalty charge!!

 

[Grateful]

Don’t forget in England that a medicated diabetic has to fill in a form with their GP to get free medications... no form, no free meds. GPS can forget to give forms and the next thing is that you get a penalty charge!!

Thanks. As far as you know, can that wait until actual meds are prescribed (I'm not taking any yet) or should it be done immediately upon registering with the GP, even if one is not taking meds?

Also: I am over 60. As I understand it, all NHS patients over 60 get free prescriptions, and to my knowledge there is no requirement to fill in a form. (I don't know that for sure, but it is what I read somewhere.)

 

[liarsdance]

Hello I find myself agreeing with your 'no-test' approach. I am only 4 months into my T2 journey and tested almost fanatically for about 9 weeks between diagnosis and my first review - where my HbA1c had dropped from 48 to 35. After this result last month I decided to abandon testing until the next review at the end of October and so far I am sticking with this decision. I have found it quite liberating and am increasingly relaxed about not knowing what my BG level is. Of course, should my HbA1c rise come October, I might have to re-evaluate but at the moment I feel fine about not testing - and my fingers feel a lot better too!

 

[DCUKMod]

When you have a big nose, people find it easier to recognize you.... In the previous avatar I was 17 years old, the new photo was taken at my daughter's wedding last month -- I turned 61 earlier that month.



Arguably I am no longer "stabilised". For about a year I was stable at around 30 or 31, but now I've jumped to 37 over a six-month period. It's a perfectly acceptable level but there's no way to tell whether the increase has reached a plateau, or whether it will just go on increasing. It went up 6 units in six months, if that happens in the next six months I'll be at 43 ... and a year from now at 49.....

I am relatively relaxed about the situation because I know that the past six months have been very stressful. Even after the move to the UK (and the subsequent reduction in stress) I have been drinking more alcohol, and mainly carb-high English real ale, which in itself might explain most or all of the HbA1c trend. (There are four pubs within a 10-minute walk, and this country is much less puritanical about alcohol than America). Simply bringing the drinking under control, and continuing to take advantage of the wonderful hiking opportunities in the countryside here, should (in my opinion) be sufficient to reverse the trend.

Sometime in the next couple of weeks I will stroll into the surgery (5-minute walk) and ask what the deal is concerning regular tests.

BTW I was quite surprised that they did not only the HbA1c, but the whole battery of common blood tests. I think that must be because I was new to this country, and it was the first appointment. I was pleased to find that all of those myriad tests were comfortably in the "normal" range.

My BMI has drifted down to 18.5 over the past year, which is perhaps the only cause for concern as it is the edge of the "underweight" band. But I feel great, I'm eating like a horse (this has been the case ever since I went low-carb 1.5 years ago), and I'm a skinny type anyway, so I will say it again: BMI is bunk.

Thank you everyone for the kind words. I will try to get back to the forum more often and offer whatever meager help I can to the newbies or anyone else who might benefit from my experience.

I have never only had an HbA1c done. I usually have the whole raft, or even the whole raft, plus some others!

 

[Grateful]

I have never only had an HbA1c done. I usually have the whole raft, or even the whole raft, plus some others!

Interesting. Back in the USA, they only did the test relevant to the current situation, so for instance most of mine were just HbA1c every three months in the past 1.5 years, except back in February of this year when I had an annual medical so they did the whole battery of tests.

 

[Alexandra100]

So I am slightly puzzled by the NHS so far. Very impressed by local clinic, and doctor. Also cool to have online access to my records (I had this in U.S. too). Classified as diabetic, supposed to be getting the regular checks. But what happens next? I'm not a self-tester, so should I just make an appointment for 3 months from now for the next HbA1C? It seems surprisingly casual as opposed to U.S. where at the end of every appointment, a new appointment was automatically scheduled for 3 months hence.

I had thought European countries were much more keen on "preventive care" than USA but now I am not so sure!

You are very lucky your GP takes you as seriously as s/he does. My latest A1c was also 37, which of course is not even classified as pre-diabetic in the UK. My GPs therefore see me as "worried well". Luckily for me in a way, I have an ongoing problem with low white blood cells, so I get my blood tested at about 3 monthly intervals, and I can just about persuade my GP to throw in an A1c. She is far more worried about my cholesterol than my bg. This is how GPs here are instructed. If you are not pro-active, you will probably be asked to have a blood test annually.

As you say, it is odd that in the case of diabetes preventative care is not a priority. My GP and the dietician she sent me to considered that I should continue eating as normal until my bgs rose enough for me to be considered pre or fully diabetic, when they would prescribe meds to sort me out. Yet I get pressured to have a flu jab. If I said I'd prefer to wait until I actually had the flu before being immunised they'd think me very odd.

Good to hear from you again.

 

[DCUKMod]

Interesting. Back in the USA, they only did the test relevant to the current situation, so for instance most of mine were just HbA1c every three months in the past 1.5 years, except back in February of this year when I had an annual medical so they did the whole battery of tests.

It does seem to vary from surgery to surgery, but in my case, it is as described.

I have had other bloods done, without A1cs, but I feel comfortable the A1c would have been added, had I asked.

 

[Bluetit1802]

Interesting. Back in the USA, they only did the test relevant to the current situation, so for instance most of mine were just HbA1c every three months in the past 1.5 years, except back in February of this year when I had an annual medical so they did the whole battery of tests.

I think it is the norm in the UK to have a full set of tests along with the HbA1c, plus a urine analysis. I have always had the following 6 monthly (3 monthly initially)
HbA1c
Cholesterol and full lipid panel
Liver & Kidney functions
eGFR
Full blood count, white and red cells
Laboratory analysis of urine annually

You should also have a foot check annually and a retinal eye screening annually.

Prescriptions are free of charge to over 60s. No forms to fill in - the GP puts your date of birth on the prescription.