Dr “suspects” my husband is T2 diabetic

[Bittern]

Sorry the conversion is 164 after 1 hour and 2 after 2 hours.

 

[Jersey-Girl]

HbA1c is an "average" of the past 2-3 month blood sugar levels in the blood.

View attachment 50400

From here
https://www.diabetes.co.uk/blog/2020/03/hba1c-and-the-immune-system.html

In the UK it is the primary tool to diagnose T2 diabetes.

Thank you…so how can anyone make Judgement if only done over a period of 3 weeks?

 

[bulkbiker]

Thank you…so how can anyone make Judgement if only done over a period of 3 weeks?

Not sure what you mean ? It's a proxy for 2-3 months of average blood sugar readings.
Depending on the result it could mean elevated blood glucose levels which in turn will mean T2 diabetes.

 

[Jersey-Girl]

Please note I am not medically qualified and cannot diagnose under any circumstances.

Valores de referenca I translate as Reference Values is a column heading at the top of the page and mostly shows two values, the test results should, ideally be between them. In the case of Glicose and Heamoglobina Glicada the test result is outside the range. The value is higher than it ideally should be but but not hugely.

Looking at your diet sheet I would drop all the bread and potatoes and avoid like the plague pasta, rice and bananas they are all carbohydrates which turn to glucose during the digestive process and will raise blood glucose levels and Hba1c.

For meal suggestions try the low carb program on this site and the dietdoctor web site, both have plenty of alternatives, some better than others, to high carbohydrate foods.

Your testing after meals is fine but the better way is to test as you settle to the meal, 1Hr after and then two hours after you are looking for a rise of no more than, I think, than 9mmol at 1 hr and no more than 2 mmol at the two hour point any more and the meal is likely too carbohydrate heavy.

Thank you Bittern, oh my goodness, your guidance is much appreciated. Foods you list are now on the bad list. I will look at the sites you recommend for alternatives as well. I may have more questions as we start this journey, and will up date you all after Wednesdays appointment. Many thanks

 

[Bittern]

Thank you…so how can anyone make Judgement if only done over a period of 3 weeks?

The Hba1c is a measure of the average blood glucose over the three months preceding the test.

So the test taken on 07/07/2021 shows the average blood glucose level, Hba1c, for the preceding 3 months. The first batch of results does not show any Hba1c at all but show a spot glucose test result taken after drinking a specified amount of glucose ie. it shows what the blood glucose is at the instant of test. The two results show different but related things.

For instance if a non diabetic person ate a sweet the spot test would show a very high blood glucose number shortly after because the sweet is mostly glucose. That number would then drop fairly rapidly as the person has a normal insulin response and would stay low until another meal or sweet was eaten when it would rise again.
The Hba1c would, as it is a three month average, not be affected much by one sweet as the blood glucose level, the spot test, has dropped a short time after the sweet has been eaten.

So one spot glucose reading cannot be translated directly into a reliable Hba1c because the Hba1c is an average of all the highs and lows of blood glucose over all of the preceding three months.

So in essence the glucose test in the first set of test results shows an abnormal response to oral glucose and the Hba1c confirms that abnormal response over a period of three months.

Hope that helps.

 

[Jersey-Girl]

This chart might help....
View attachment 50401

Hi Mr Pot, so, I have just gone through all my husbands readings and converted them to mmol. I took his highest reading which converts to 10.3. Which is in the yellow part of this chart. Would you say this is acceptable?

 

[Jersey-Girl]

The Hba1c is a measure of the average blood glucose over the three months preceding the test.

So the test taken on 07/07/2021 shows the average blood glucose level, Hba1c, for the preceding 3 months. The first batch of results does not show any Hba1c at all but show a spot glucose test result taken after drinking a specified amount of glucose ie. it shows what the blood glucose is at the instant of test. The two results show different but related things.

For instance if a non diabetic person ate a sweet the spot test would show a very high blood glucose number shortly after because the sweet is mostly glucose. That number would then drop fairly rapidly as the person has a normal insulin response and would stay low until another meal or sweet was eaten when it would rise again.
The Hba1c would, as it is a three month average, not be affected much by one sweet as the blood glucose level, the spot test, has dropped a short time after the sweet has been eaten.

So one spot glucose reading cannot be translated directly into a reliable Hba1c because the Hba1c is an average of all the highs and lows of blood glucose over all of the preceding three months.

So in essence the glucose test in the first set of test results shows an abnormal response to oral glucose and the Hba1c confirms that abnormal response over a period of three months.

Hope that helps.

Hi Bittern, for someone never having being exposed to this, it’s complicated and a lot to take in so quickly…I have just worked out his highest and average reading in mmol to refer to the chart, his average is 6.3 and his highest was 10.4, so maybe he is prediabetes (fingers crossed) but will know more on Wednesday, thank you again.

 

[Bittern]

As I said previously I cannot diagnose, but have lived with this for some plus 20yrs. and yes it is complicated to start with. It is a slow acting disease and the side effects take time to manifest themselves. Don't overthink it and remember life is good even with diabetes. If you reduce carbohydrates you stand a chance of the disease not progressing and some of us on this forum have put their T2 into remission by carbohydrate reduction, kept it there and have no side effects. Each body is different and you will settle into a regime that suits yours over time. Good luck with the diagnosis and if you have any more questions coming out of your discussion with the doctor just ask someone here will respond and probably someone who has dealt with that particular problem.

 

[Mr_Pot]

Hi Mr Pot, so, I have just gone through all my husbands readings and converted them to mmol. I took his highest reading which converts to 10.3. Which is in the yellow part of this chart. Would you say this is acceptable?

The chart doesn't work like that, you can't use it for individual readings. The figures above the scale are HbA1c which is an indication of average glucose levels over the previous 2-3 months. The figures below the scale are actual average glucose levels which you would get if you took a very large number of finger prick tests at different times of multiple days and averaged them. Because it is very difficult to get a meaningful average from finger prick tests that is why doctors use HbA1c as a proxy. So your husbands HbA1c of 54 mmol/mol equates to an average finger prick test of 8.7 mmol/L (156 mg/dL), which as you can see is in the green/yellow section of the chart and is incidentally nearly the same as mine was. I had non-diabetic numbers in 3 months of a moderately low carb diet and no medication.

 

[Ronancastled]

All the relevant figures are here in the image you posted

Your husbands HbA1c was measured as 7.1% (54 in other units).
Normal would be 4.0% to 5.9% (20 to 41), Pre-Diabetes 6.0% to 6.4% (42-47) & Diabetes >6.4 (47).
Before 2 the hour Oral Glucose Test his fasting glucose was 133mg/dl, not diabetic is normally <100 & pre-diabetic is 100-125 in these units.
2 hours after drinking the glucose drink his blood glucose measured 275mg/dl.
Normal is considered <140, pre-diabetes 140-199 & diabetic >200.

So that's his current situation, there are many factors that can influence his future path but I believe the first doctor was correct.
Although their follow up & advice was very poor.

The 2nd doctors comment on "borderline" is vague as he clearly meets the diagnostic standard on all 3 tests.
Many of us have found the medical profession don't take much interest in their diabetic patients.
They just prefer to keep prescribing ever increasing meds until the inevitable complications arise.

There is another way but your husband will have to embrace major lifestyle changes, low carb eating & self discipline.
You can encourage him but ultimately it's his decision.

 

[Andydragon]

All the relevant figures are here in the image you posted

Your husbands HbA1c was measured as 7.1% (54 in other units).
Normal would be 4.0% to 5.9% (20 to 41), Pre-Diabetes 6.0% to 6.4% (42-47) & Diabetes >6.4 (47).
Before 2 the hour Oral Glucose Test his fasting glucose was 133mg/dl, not diabetic is normally <100 & pre-diabetic is 100-125 in these units.
2 hours after drinking the glucose drink his blood glucose measured 275mg/dl.
Normal is considered <140, pre-diabetes 140-199 & diabetic >200.

So that's his current situation, there are many factors that can influence his future path but I believe the first doctor was correct.
Although their follow up & advice was very poor.

The 2nd doctors comment on "borderline" is vague as he clearly meets the diagnostic standard on all 3 tests.
Many of us have found the medical profession don't take much interest in their diabetic patients.
They just prefer to keep prescribing ever increasing meds until the inevitable complications arise.

There is another way but your husband will have to embrace major lifestyle changes, low carb eating & self discipline.
You can encourage him but ultimately it's his decision.

Remember that @Jersey-Girl mentioned they are in Portugal and criteria for diabetes diagnosis may be different. Quick Google search for Portuguese hospital:

https://www.hospitaldaluz.pt/lisboa.../dedicated-areas/228/diabetes#type-2-diabetes

If I read this correctly hba1c is not used for diagnosis in Portugal? (Happy to be shown otherwise, no knowledge on diagnosis criteria outside the UK )

 

[bulkbiker]

Remember that @Jersey-Girl mentioned they are in Portugal and criteria for diabetes diagnosis may be different. Quick Google search for Portuguese hospital:

https://www.hospitaldaluz.pt/lisboa.../dedicated-areas/228/diabetes#type-2-diabetes

If I read this correctly hba1c is not used for diagnosis in Portugal? (Happy to be shown otherwise, no knowledge on diagnosis criteria outside the UK )

Well with the HbA1c , finger prick tests and OGTT all impyling T2 (or at least a blood glucose problem of some kind) then I guess we can be relatively sure her husband has a problem of the diabetes nature...

 

[LittleGreyCat]

This is the results from last Wednesday 7th JulyView attachment 50396

That seems pretty clear.
HbA1c of 7.1 which is firmly in diabetic territory.

 

[EllieM]

That seems pretty clear.
HbA1c of 7.1 which is firmly in diabetic territory.

Firmly in the diabetes range but at the low end of it. Depending on his current diet, it might be relatively easy to cut out sufficient carbs in order to reduce the levels to normal.

@Jersey-Girl , what sort of things does your husband eat in a typical day? I'm sure the T2s here can make some suggestions as to how to reduce the carbs a bit....

 

[Jersey-Girl]

Firmly in the diabetes range but at the low end of it. Depending on his current diet, it might be relatively easy to cut out sufficient carbs in order to reduce the levels to normal.

@Jersey-Girl , what sort of things does your husband eat in a typical day? I'm sure the T2s here can make some suggestions as to how to reduce the carbs a bit....

Hi EllieM, by my husbands own admission, he does have a sweet tooth, and previously snacked on rubbish throughout the day in between meals (not now I may add!) Since 1st July, he has been eating a sensible diet, he’s not drunk alcohol since October last year, and I have worked out his average reading to be 6.3.

 

[Jersey-Girl]

Hi EllieM, by my husbands own admission, he does have a sweet tooth, and previously snacked on rubbish throughout the day in between meals (not now I may add!) Since 1st July, he has been eating a sensible diet, he’s not drunk alcohol since October last year, and I have worked out his average reading to be 6.3.

I forgot to add, he would love his brown bread & potato’s, very little veg (he doesn’t like it) cheese, chocolate and mini muffins. He is 5’9 and weighs 13st 8

 

[EllieM]

I forgot to add, he would love his brown bread & potato’s, very little veg (he doesn’t like it) cheese, chocolate and mini muffins. He is 5’9 and weighs 13st 8

Well, he'd probably lose any excess weight if he reduced his blood sugar levels to normal, as weight gain is a symptom of T2. I'm going to post a link to @JoKalsbeek's blog, which is in my opinion an excellent intro to T2 and low carbing,
JoKalsbeek's blog | Diabetes Forum • The Global Diabetes Community

But an average reading of 6.3 is pretty good, unless you're missing all the after meal levels.

Good luck.

 

[Jersey-Girl]

Well, he'd probably lose any excess weight if he reduced his blood sugar levels to normal, as weight gain is a symptom of T2. I'm going to post a link to @JoKalsbeek's blog, which is in my opinion an excellent intro to T2 and low carbing,
JoKalsbeek's blog | Diabetes Forum • The Global Diabetes Community

But an average reading of 6.3 is pretty good, unless you're missing all the after meal levels.

Good luck.

Hi EllieM, thank you. Yes, all numbers have been taken into account and he no longer snacks in between meals. Thank you for the link, this is extremely helpful

 

[TriciaWs]

If I ate that amount of carbs my blood sugar would shoot up. In fact I used to have lots of toast, sandwiches, rice and cake before.
Then after I was diagnosed, like lots of other T2 diabetics now, I cut out most of the carbs I used to eat.
When I went low carb I looked around for suggestions for low carb substitutes for my favourite foods.
It took me a while to get used to courgette instead of pasta but that works fine it you barely cook it and have a thicker sauce.
There are lower carb breads, and variations on the 90 second bread made with grounds almonds instead of wheat flour (I like it with a little milled flaxseed added or teaspoon of cream cheese to cut the eggy flavour).
Difficult to find really good alternatives for potato - although a mix of kohlrabi and butternut squash makes a good lower carb mash. Halloumi 'chips' are messy to make but great to dip in eggs.
Cauliflower rice is great - I use the oven method to cook it until it still has a 'bite' then reheat in the microwave or stir fry it.

And I do still have cake some days but made with ground almonds, or almonds and coconut flour, and using a sweetener such as erythritol instead of sugar. Some recipes work out at only 3-5g carbs a slice.

 

[Languagelearner]

The Hemoglobina Glicada IFCC of 54 mmol/mol is the same as HbA1C. yes, that is in the diabetes range, but in the UK the doctors require two readings a month apart to diagnose diabetes, so ideally you would need to confirm with a follow-up test.