What is going on - confused!

[pandauk]

Short history, changed GP's recently. Was diagnosed pre-diabetic years ago but never had any treatment or even any follow ups.

New GP required a battery of tests including HBA1c, fasting glucose, kidney function etc

First HBA1c came back at 54. Fasting glucose was 7.5 Started low carbing in earnest, and testing at home. I realised that the fasting reading of the day was always my highest - I think its called the dawn phenomena.

The repeat of the HBA1c came back at 47 - just under the threshold for diagnosis - or so I thought. My fasting blood glucose was again raised down to the dawn phenomena.

I got the results from the GPs receptionist who said the doctor wanted a routine appontment with me to discuss the HBA1c - she booked for next week.

This morning I had a letter arrive from the diabetic screening service asking me to make an appointment for a diabetic eye screening!

So it appears the GP has decided I am diabetic after all - even with an HBA1c under the cut off point and has put me on the diabetic register. To say I am shocked and upset at learning about the diagnosis this way is an understatement

Those fasting readings are always the highest of the day - ironically if I eat they come down. I usually sit in the 6s and 7s all day so I am confused !!

 

[ianf0ster]

Hi @pandauk and welcome to the forum.
Personally I think you have been lucky because you have reduced your HbA1C quickly (before the test for confirmation) and your GP has still listed you as diabetic (since you are very narrowly just in the 'pre-diabetic range'). This means that you get the diabetic eye screening and the diabetic foot check.
Note that diabetic complications such as retinopathy and neuropathy don't only occur when an average such as HbA1C is 48 or above, it is a case of increasing risk as the Blood Glucose levels get higher.

 

[ianf0ster]

It seems you have read a little about 'Dawn Phenomenon' but have not seen that in many (including me) what happens is that the liver puts glucose into the blood stream in order to give us an energy boost so we could hunt/gather our breakfast. This was vital for people in the days before agriculture.
So a meal tends to stop it doing that, since if we have found food we no longer are in hunt/gather mode. Now if there is relatively little carbohydrate in that meal our blood glucose will either stay the same or go down as we produce insulin or use up energy. However if that meal is high in carbs then those will digest into glucose such that the overall Blood Glucose will spike up after the meal.

 

[pandauk]

It seems you have read a little about 'Dawn Phenomenon' but have not seen that in many (including me) what happens is that the liver puts glucose into the blood stream in order to give us an energy boost so we could hunt/gather our breakfast. This was vital for people in the days before agriculture.
So a meal tends to stop it doing that, since if we have found food we no longer are in hunt/gather mode. Now if there is relatively little carbohydrate in that meal our blood glucose will either stay the same or go down as we produce insulin or use up energy. However if that meal is high in carbs then those will digest into glucose such that the overall Blood Glucose will spike up after the meal.

Thank you - that makes sense! And thanks for the warm welcome

 

[catinahat]

Welcome @pandauk
You're not alone in thinking the Dr has made a mistake when first diagnosed. I know my diagnosis came with a whole bag full of emotions. Denial, anger, self loathing, fear and probably a few others I've forgotten about.
You have had one hba1c result firmly in the diabetic range, the second one after "low carbing in earnest" is still on the very border of pre and full blown diabetes. Add to those results your high fasting levels and I would think your Dr has got it right.

Those fasting readings are always the highest of the day

The strangely named Dawn phenomenon is just our bodies getting us ready to face the day by releasing some stored glucose, it happens to everyone so I can't think why it's call a phenomenon?
Anyway in people who don't have diabetes, their insulin mops up this little gift of glucose and uses it to fuel their bodies, any rise in blood sugar levels will be very short lived.
For people with T2, although we still produce plenty of insulin our insulin doesn't work as well as it should, it has become inefficient at its main job of taking glucose out of the blood and into our cells to be used as fuel. This means that our levels remain high until our insulin finally manages to get the job done.
The official diagnosis means that now you will get regular blood tests, eye checks and the usual health check by you practice nurse, at least one a year.

 

[pandauk]

Thank you @catinahat - I know you are probably right regarding my GP but I have been avoiding a firm diagnosis for so long it feels like I have finally been "caught". I know logically the GP is acting in my best interests but the rebel in me still says but it was 47 not 48 so its not really true The way our minds work haha

 

[catinahat]

You're right, if you tell yourself something loud enough and often enough you can make yourself believe anything.
For me it was only when I eventually accepted the diagnosis that I was able to focus my energies on working towards remission and improving my lifestyle.
As far as I'm concerned my diagnosis was a blessing in disguise and the kick up the rear I needed.

 

[MrsA2]

@pandauk I'm envious. Mine is a long story where they forgot to put me on the register when I was first diagnosed and so now I miss out on the checks I need and have to fight for them every time, and often don't get.
In my book, I prefer to be diabetic and to control it, then to be in denial, to ignore it and have sudden nasty surprises later down the line.

BTW, I didn't like it at first either, but (apart from the NHS system problems) it's been a blessing in disguise. I'm now thinner, fitter and healthier than I was, and so is my family.

 

[Case_]

First HBA1c came back at 54. Fasting glucose was 7.5 Started low carbing in earnest, and testing at home. I realised that the fasting reading of the day was always my highest - I think its called the dawn phenomena.

The repeat of the HBA1c came back at 47 - just under the threshold for diagnosis - or so I thought. My fasting blood glucose was again raised down to the dawn phenomena.

So it appears the GP has decided I am diabetic after all - even with an HBA1c under the cut off point and has put me on the diabetic register. To say I am shocked and upset at learning about the diagnosis this way is an understatement

Granted, I'm not entirely familiar with current diagnostic criteria in the UK, but a fasting glucose of 7.5 would be considered diabetic (not even pre-diabetic) by healthcare systems in many countries, regardless of your A1C. They would probably repeat the test to make sure, but other than that, a fasting glucose of 7.5 means your glucose metabolism is definitely impaired, even if you manage to keep your HbA1C low (which is of course very good and the goal).

And as many have said before, once you get over the initial shock of that diagnosis, it really is better to be fully diagnosed and under healthcare supervision for potential issues than stay in the grey area of the so-called "pre-diabetes" (especially if you're in the upper part of that range). If your blood sugar is well controlled, nothing really changes for you, you just gained an "insurance policy", so to speak, should your blood sugar control worsen.

 

[Ronancastled]

You are me, my first A1c was 52, the follow up was 48, you get the T2 badge, close but no cigar

So if you'd been told you were per-diabetic would you have changed anything ?
Read my sig, you've won the lottery of life, low diagnostic level & have joined a community that can fix you

Embrace it now, ask away, then teach others down the line