Blood Work

[Novelty341]

Hello, Everyone.

I hope everyone is well.

I've been a lurker here for years, but need some advice today.

My diabetic nurse tells me that she would measure only my HBA1C from now on and not my cholesterol levels/serum lipids/liver function and renal profile.

She explained that I had to be "medicated" for these to be able to be "eligible" for the tests.

Is that a new change in the NHS guidance regarding blood work for diabetics?

Please can you provide a link or any additional information?

If the above is really the case, can you recommend a private lab where I can check my liver function, may be have C-peptide done, have renal profile and have my serum lipids monitored.

Background: I am a slim diabetic, never had any problems with my weight. My father was a slim diabetic as well, type 2, on Metformin. He developed fatty liver disease on the seventh year post diagnosis that went unnoticed/unchecked. He then developed a liver failure, there was no donor and he passed away. From his side of the family, there are at least 7 diabetics, both type 1 and type 2, that I know of. My brother, my only sibling, is slightly overweight, eats a lot of carbs, older than me and completely healthy. I hope he stays that way!

I have been diagnosed as a diabetic seven years ago, at HBA1C of 56. Since then, I was on 1 tablet Metformin in the morning, 500 mg. My current HBA1C is 44, slightly up from my last one, from October 2020, of 41.

I am on a low carb diet and very active (according to my Apple watch about 850 calories per day of activity).

I am a woman and do not drink.

However, my cholesterol has been going up (last reading of 6.6) and this worries me. The diabetic nurse refused to draw blood for my cholesterol, explaining that I had to be medicated for cholesterol first.

Has anyone else had similar issues with their blood work and diabetic nurse?

What would you recommend I'd do?

Also, any lab that I can go to (I cannot do home tests, they keep failing no matter how much I try; it seems I cannot draw blood from my fingers properly?!) in person for my blood work? I live in the North West.

Any advice is much appreciated.

Thank you in advance for taking the time to respond.
Novelty 341

 

[Mr_Pot]

Hello, Everyone.

I hope everyone is well.

I've been a lurker here for years, but need some advice today.

My diabetic nurse tells me that she would measure only my HBA1C from now on and not my cholesterol levels/serum lipids/liver function and renal profile.

She explained that I had to be "medicated" for these to be able to be "eligible" for the tests.

Is that a new change in the NHS guidance regarding blood work for diabetics?

Please can you provide a link or any additional information?

If the above is really the case, can you recommend a private lab where I can check my liver function, may be have C-peptide done, have renal profile and have my serum lipids monitored.

Background: I am a slim diabetic, never had any problems with my weight. My father was a slim diabetic as well, type 2, on Metformin. He developed fatty liver disease on the seventh year post diagnosis that went unnoticed/unchecked. He then developed a liver failure, there was no donor and he passed away. From his side of the family, there are at least 7 diabetics, both type 1 and type 2, that I know of. My brother, my only sibling, is slightly overweight, eats a lot of carbs, older than me and completely healthy. I hope he stays that way!

I have been diagnosed as a diabetic seven years ago, at HBA1C of 56. Since then, I was on 1 tablet Metformin in the morning, 500 mg. My current HBA1C is 44, slightly up from my last one, from October 2020, of 41.

I am on a low carb diet and very active (according to my Apple watch about 850 calories per day of activity).

I am a woman and do not drink.

However, my cholesterol has been going up (last reading of 6.6) and this worries me. The diabetic nurse refused to draw blood for my cholesterol, explaining that I had to be medicated for cholesterol first.

Has anyone else had similar issues with their blood work and diabetic nurse?

What would you recommend I'd do?

Also, any lab that I can go to (I cannot do home tests, they keep failing no matter how much I try; it seems I cannot draw blood from my fingers properly?!) in person for my blood work? I live in the North West.

Any advice is much appreciated.

Thank you in advance for taking the time to respond.
Novelty 341

I am unmedicated and get the full blood panel twice a year and a review once a year, which I think is the NICE recommendation.

 

[bulkbiker]

The diabetic nurse refused to draw blood for my cholesterol, explaining that I had to be medicated for cholesterol first.

That sounds very odd.. how long ago was it as there was a national shortage of vials for blood tests that is now apparently over according to the Practise Manager at our recent PPG meeting this week. So it might have been that?

 

[Novelty341]

That sounds very odd.. how long ago was it as there was a national shortage of vials for blood tests that is now apparently over according to the Practise Manager at our recent PPG meeting this week. So it might have been that?

I honestly do not think her refusal had anything to do with shortages. She also insisted that I should go off my medication completely as "I probably have tons of medication unused at home...and, anyway, my control was very good'.

No shortages were mentioned. I am sure of it.

 

[Novelty341]

That sounds very odd.. how long ago was it as there was a national shortage of vials for blood tests that is now apparently over according to the Practise Manager at our recent PPG meeting this week. So it might have been that?

I am unmedicated and get the full blood panel twice a year and a review once a year, which I think is the NICE recommendation.

Do you mind asking me which region in England do you live in? Could it be some "postcode lottery" thing? And, can you provide some more information about the NICE Guidance, meaning page, chapter where the recommendation is mentioned, please?

I have my panel only once per year and this is only if I call and request to be seen by the diabetic nurse. I am not provided with blood strips either.

 

[bulkbiker]

Do you mind asking me which region in England do you live in? Could it be some "postcode lottery" thing? And, can you provide some more information about the NICE Guidance, meaning page, chapter where the recommendation is mentioned, please?

I have my panel only once per year and this is only if I call and request to be seen by the diabetic nurse. I am not provided with blood strips either.

I live in Worthing West Sussex.

I reminded my GP about the NICE regs that anyone diagnosed T2 should be checked every 6 months and as a PPG member (which is interestingly noted on my patient record) I seem to get a far better service!

https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#hba1c-measurement-and-targets

 

[Novelty341]

Well, the above extract refers to HBA1C specifically, not to the whole blood panel. I have an issue with "until stable" not being defined better, but, at least regarding HBA1C, she seems to be right.

Re "until stable": How many readings would have to be consistently within the normal range for an HBA1C to be considered "stable"? I mean, I understand it is not a legally binding document, but just a guidance, but still could have been clearer...

Is there anything else about cholesterol and diabetes monitoring anywhere in the text that you are aware of? Meaning that cholesterol has to be monitored if flagged as abnormal in the medical records?

 

[Rokaab]

She explained that I had to be "medicated" for these to be able to be "eligible" for the tests.

And how do you know if you need medication if you don't have the test

Admittedly whether medication is actually needed is beside the point (and is disagreed on by many as well), but yeah how do you know if you don't test

 

[Dr Snoddy]

I am also unmedicated and get full blood panels done each year. This year I also had triglycerides included in the lipid panel. I was however refused B12 and D levels due to the vial shortage.
I take the view that I am cheap to treat and need to make the best of my annual retinopathy and review appointments. I can now be quite assertive if I feel I am being fobbed off as I am much better informed than I was at diagnosis.

 

[NicoleC1971]

Although it sounds as if you are doing a great job being weight stable , active and doing low carb the fact you have a family history of diabetes and fatty liver should be of concern given the connection with fatty liver and type 2. The fatty liver comes first (the long silent scream of the liver as Prof Roy Taylor described it) so along with the lipids you would want to get your GGT done (liver).
The fact that you are slim, as was your father, means that your body will store fat in the wrong places (see TOFI) i.e. around the liver.
In addition to cholesterol keep checking BP and also triglycerides/HDL c ratio to ensure your low carb and exercise routine is keeping you metabolically healthy.
See a GP rather than the nurse to ask for it. The nurse may just be assuming that because you are slim and have an HBA1c not as bad as most patients, though it is still in the pre diabetic which is still essentially diabetic) range.

 

[Mr_Pot]

Do you mind asking me which region in England do you live in? Could it be some "postcode lottery" thing? And, can you provide some more information about the NICE Guidance, meaning page, chapter where the recommendation is mentioned, please?

I have my panel only once per year and this is only if I call and request to be seen by the diabetic nurse. I am not provided with blood strips either.

I am in Berkshire. This might help....
https://www.nhs.uk/conditions/type-2-diabetes/going-regular-check-ups/

 

[Novelty341]

Thanks for your response, Nicole C. Much appreciated.

I agree on all points. This was the reason why I provided the background picture.

Blood pressure is being monitored at home daily, morning and evening with an Omron device. Current average is 117/83. The pulse is a bit high (especially during periods - about 80), but the resting rate following exercises is 63-65 (as per my watch).

I have never been offered any liver scans but at least I had blood panel that included the triglycerides and HDL. I am afraid my LDL is high. Will have to look up the exact numbers.

I completely agree with the fact that diabetic nurses don't seem to be able to see the difference with a slim diabetic. As if they have the 'you should lose weight' tirade ready, and, if this is not the case....Then just silence.

And it is much more nuanced than that.

Just checked my medical records.

Triglycerides (Oct 2020) - 1.03
HDL (Oct 2020) - 2.4
LDL (Oct 2020) - 4.1
Serum cholesterol - 6.6

 

[bulkbiker]

Well, the above extract refers to HBA1C specifically, not to the whole blood panel. I have an issue with "until stable" not being defined better, but, at least regarding HBA1C, she seems to be right.

Re "until stable": How many readings would have to be consistently within the normal range for an HBA1C to be considered "stable"? I mean, I understand it is not a legally binding document, but just a guidance, but still could have been clearer...

Is there anything else about cholesterol and diabetes monitoring anywhere in the text that you are aware of? Meaning that cholesterol has to be monitored if flagged as abnormal in the medical records?

I'm surprised that with a total cholesterol level of 6.6 (even though the number is pretty meaningless on its own) that you aren't getting a full panel as most surgeries would expect a patient with those levels to be recommended statins.

Have you tried talking to a GP or Practise Manager about this as I'd doubt the nurse is in a position to decide on the tests you should get.

As to whether a level of 6.6 is "dangerous" in itself without a full panel breakdown it's impossible to tell.

Maybe push a bit harder for the test especially now the vial shortage is "over".

 

[bulkbiker]

Thanks for your response, Nicole C. Much appreciated.

I agree on all points. This was the reason why I provided the background picture.

Blood pressure is being monitored at home daily, morning and evening with an Omron device. Current average is 117/83. The pulse is a bit high (especially during periods - about 80), but the resting rate following exercises is 63-65 (as per my watch).

I have never been offered any liver scans but at least I had blood panel that included the triglycerides and HDL. I am afraid my LDL is high. Will have to look up the exact numbers.

I completely agree with the fact that diabetic nurses don't seem to be able to see the difference with a slim diabetic. As if they have the 'you should lose weight' tirade ready, and, if this is not the case....Then just silence.

And it is much more nuanced than that.

Just checked my medical records.

Triglycerides (Oct 2020) - 1.03
HDL (Oct 2020) - 2.4
LDL (Oct 2020) - 4.1
Serum cholesterol - 6.6

Ah ok
Your Trig/HDL ratio at 1.03/2.4 0.429 is excellent anything under 0.87 is considered so ..

If your DN is one of the enlightened few it could be that they are aware of that. However it still makes sense to get it regularly tested.