Am I prediabetic, or I have diabetes 2 already?

cristis said:

I've been identified as prediabetic almost two years ago. My 3-6 months checkups came up with a prediabetic BG constantly.

My fasting BG was however high (7-8 mmol/L) every morning over the past weeks. But since I stopped drinking, removed sugar and high carbs, and started to exercised a lot, I brought it (in the past two days anyway) in range for a... healthy person!

I'm prepared to go now for another checkup (last one was 5-6 months ago). But I am pretty sure they will find me in range again, or at least for a prediabetic. Mostly because of the personal changes from these past few days.

How can we say if we have diabetes or not? When we may take such measures and trick the doctors...

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An interesting post: Have diabetes? It depends on what country you're in ["In Michigan, you have diabetes. In Toronto, you don't."] And yes, I live in Canada and I am familiar with the way they diagnose you with diabetes here.

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I get my A1c checked every 6 months. I've been diagnosed pre-diabetic for 13 years. I also eat healthy, and increase exercise 3 months before my check up. This time I'm also doing intermittent fasting for 3 months before the A1c test to see if it makes a difference. The theory is, fasting should improve my insulin sensitivity.

Random to read - I've never done a fasting test through gp only hba1c here in new Zealand - any thing over about 40 is pre-diabetic any thing over 50 is t2 (they prob do fasting but my highest rating was 49 so to gets to 50 don't think they would) - any way there's some random info from my side of the world

cristis said:

Thanks a lot, @jwongcsp!

This proves my point I think. That we can "cheat" the screening tests and never get properly diagnosed as diabetics!

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What would you expect to gain by cheating ?
Remaining untreated for a serious condition ?

cristis said:

3) Another reason why it's important to make a difference, at least in Canada, from my previous link: "Canadian doctors are not even supposed to do the HbA1C test until a person has been fully diagnosed with diabetes by the usual fasting glucose tests. The HbA1C test is used only to track sugar control. It is against current Canadian guidelines to use this as a screening test."

Thanks for your feedback.

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For those interested, here is how they diagnose diabetes 2 in Canada:

[source: http://guidelines.diabetes.ca/browse/chapter4#sec2]

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I see it says clearly FPG AND/OR A1c in all cases. Where do you get the not allowed to use the A1c from?

Sorry - had no

cristis said:

please don't put words in my mouth.

I was talking only about how relative and superficial the distance between prediabetes and diabetes 2 is. When we get diagnosed.

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Sorry - I had no intention of that - was questioning what you meant by the word you did use.

I suppose that pre-diabetes requires self-treatment without the support structure supposedly available the known - declared diabetic.

There is an interesting article on how the boundaries were set at the bloodsugar101.com website http://www.phlaunt.com/diabetes/14046782.php

cristis said:

@EllieM,

1) All my HgA1C tests have been OK so far, but that's a god point: I didn't have one in a while, and the next one should/must better reflect my condition.

2) I know what you say, but It should matter (a lot!) if people are stamped with either prediabetes or diabetes. Prediabetes is said to be just a pre-condition, with increased risk to get diabetes in the next 10 years or so. While diabetes is an actual bad illness with no cure. It's really sad doctors play somehow arbitrarily with these terms and the threshold between them.

3) Another reason why it's important to make a difference, at least in Canada, from my previous link: "Canadian doctors are not even supposed to do the HbA1C test until a person has been fully diagnosed with diabetes by the usual fasting glucose tests. The HbA1C test is used only to track sugar control. It is against current Canadian guidelines to use this as a screening test."

Thanks for your feedback.

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For those interested, here is how they diagnose diabetes 2 in Canada:

[source: http://guidelines.diabetes.ca/browse/chapter4#sec2]

Click to expand...

Interesting - in the UK there is no screening for diabetes, only for the complications of diabetes (diabetic retinopathy).

On the page your link goes to, it says that:-

• Screening for type 2 diabetes using a fasting plasma glucose (FPG) and/or glycated hemoglobin (A1C) should be performed every 3 years in individuals ≥40 years of age or in individuals at high risk using a risk calculator
• More frequent and/or earlier testing with either FPG and/or A1C or 2hPG in a 75 g OGTT should be considered in those ... people with additional risk factors for diabetes [Grade D, Consensus]. These risk factors include ...History of prediabetes (IGT, IFG, or A1C 6.0%–6.4%)

In other words, it seems to be perfectly acceptable for Canadian doctors to screen for diabetes using HbA1c and to screen more often than 3-yearly for people with pre-diabetes. I suspect that the information from Diabetes Canada is more reliable than that from The Globe and Mail.

There is a continuum from normal through 'pre-diabetes' to 'diabetes' so someone has to make an arbitrary decision of where diabetes begins. Pre-diabetes is even harder to define which is probably why it is not a defined condition in the UK. You might like to read the information from the World Health Organisation about the definition and diagnosis of diabetes:-
http://www.who.int/diabetes/publications/Definition and diagnosis of diabetes_new.pdf

cristis said:

How can we say if we have diabetes or not? When we may take such measures and trick the doctors...

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2 points.
1. We are in fact tricking ourselves and not the doctors
2. Perhaps the current metrics for classifying diabetes is inadequate. The current glucose focus metrics is to determine the need/justification for clinical and pharmaceutical intervention, which are mainly glucose lowering agents, not the measure of optimal health. It is treatment to failure, not treatment to optimal health.

We may perhaps consider reframing the diabetes in the context of insulin response instead of glucose response. Then the progression of the condition becomes much clearer.
https://www.diabetes.co.uk/forum/blog-entry/newbie-guide-to-t2d.1858

I have never had an official fasting glucose test. My Hba1cs have all been done at random times.

Resurgam said:

I have never had an official fasting glucose test. My Hba1cs have all been done at random times.

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I don't get them either. I had one on diagnosis plus the HbA1c. I have had one since when the GP added it to some vitamin tests I'd asked for. It wasn't meant to be a fasting test but I fasted anyway as cholesterol was included. It is my nurse that orders my diabetes review tests and she never includes it. She told me the surgery stopped doing them as they are unreliable and superfluous to the HbA1c. Even the over 40 health check MOTs for healthy people don't include them, they just have the HbA1c.

DCUKMod said:

Whilst I take nothing from what you say about whether fasting blood glucose tell us much more than what an individual's fasting blood sugar reading was on a given day, in likely unnatural circumstances - like the blood draw being some time after rising, as opposed to a potential feet on the floor test at home, I'd be willing to wager there are also elements of there being simply not enough Nurse/Phlebotomist slots for fasting tests, thereby ditching fasting tests can help manage backlogs.

That said, I almost always have my blood draws done at the big city university hospital because they have a walk-in clinic 08-16:00, and I just present myself for the 08:00 slot. I'm rarely more than second in the queue, then I get myself back home down the motorway.

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You are quite right, and that is exactly the reason given by NICE when recommending that it isn't necessary to fast before a cholesterol/lipids test. It is clear that in a surgery that invites all healthy over 40s for a blood test and health check as mine does there would be massive backlogs if they were all fasting, similarly with all diabetes reviews.

I am 66 years old and have never had an annual health check, always had to request the annual check of my Thyroxine supplement, which meant calling at the clinic twice and traveling to the hospital after booking an appointment by phone - they don't make it easy.

cristis said:

please don't put words in my mouth.

I was talking only about how relative and superficial the distance between prediabetes and diabetes 2 is. When we get diagnosed.

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Yes, absolutely, I agree. These categories vary according to what country you live in. In America my previous A1c test of 41 makes me pre-diabetic, in the UK not. Many experts now say that pre-diabetes is a nonsense - there is just diabetes, and it should always be taken very seriously. What counts is blood glucose levels. Damage starts when the A1c is consistently above 31, way below what any doctor will consider problematic. It starts to get more serious at 40-41. But don't panic - with better control bringing down bg, complications can be reversed. There are people here who are labelled diabetic but have excellent A1c results, others only pre but not managing so well. I would describe myself as pre-pre-diabetic, but with all my efforts (and believe me, I try very hard) I can't get my bg down as far as others who were diagnosed diabetic years ago. So I suggest you forget abut the labels but watch your pre and post meal tests on your meter, with an A1c from time to time as another sort of check.

Btw I do know from my own experience that complications start way below an A1c of 41. I had A1cs of 37 in 2014/5, 40 in 2016 and 41 in 2017. It was only in 2017 that I realised what this test meant and began to reduce the carbs in my diet. Suddenly the chronic digestive problems that had tormented me for years, leading to two endoscopies that showed nothing except a small ulcer in the second, were gone! And now, sadly, I am obliged to take a drug that raises bg, my numbers are up, and the reflux is back in a mild form. Similarly, the pain and stiffness in my lower back had much improved, as witnessed by my wonderful physio as well as myself. I fear it is now a little bit worse, but that's harder than reflux to evaluate. I could give more examples. To me, these quite unlooked for changes show both the bad effects of above normal bg and the encouraging fact that often they can be reversed, and speedily.