Confused about diagnosis and hba1c

[Polo mint]

Hi, first time posting but this forum has been invaluable since I was diagnosed approx 7 months ago.

Apologies for the long post!

First hba1c reading 7 months ago was 50, a week or two later was 48.
Recent hba1c test was 33.
I know that 48 and over is considered diabetic.

I fully admit my diet was not good in the 3 to 4 months prior to my blood tests eating lots of sweets, jellies, biscuits, chocolate etc. I have never previously been told my blood sugar levels were high.

Since my diagnosis I have lost approx 4.5 stone by improving my diet in general and exercising. I have not cut out any foods. I'm still eating lots of fruit, brown bread, potatoes and small amounts of biscuits and chocolate every day.

I have only told one person of my diagnosis and I'm struggling to accept I am now diabetic for life. And in my head, it's my fault for the high hba1c as it was based on the 3 to 4 months of an extremely bad diet. If I had the blood tests taken at any other time the hba1c reading could have been lower .....

In one way, my diagnosis has given me the kick start to improve my lifestyle in general and spurred me on to lose so much weight but I am still struggling to accept the diagnosis.

Is there another test I can ask the doctors to do to confirm I am diabetic? I suppose I'm confused how my hba1c has dropped so low but still eating foods that I shouldn't be eating.

What are your thoughts? Any advice?

Thank you.

 

[Bluetit1802]

If your first two tests were 50 and 48 there is no doubt you are diabetic I'm afraid. Your more recent weight loss and improved diet is what has brought your HbA1c down - so well done for that, but you have to keep it up and maintain that lovely result for your next test, and every one after that.

 

[AloeSvea]

Hi @Polo mint. Great that you here on the forum!

I am the last poster to say that was a long post! . Not at all.

But I will say - I hope you stop saying your blood glucose levels are your fault! Assigning fault and blame when it comes to bodily breakdowns and disease is a ghastly thing, imho. (I do joke with my super-ager parents about blaming them for the ribena in my baby bottle and my current blood glucose status - but I laugh when I do it! And I don't mind giving them a little cause for pause.) (And I am far more forgiving about the brandy in the bottle! .)

But to your question. Firstly, the 'for life' thing is one of the most controversial ideas about T2 diabetes! You can have a lot of fun for a very long time reading the arguments for and against in this forum alone. .

And, the cut off points for diabetes proper, and prediabetes, have a 'random' aspect to it, around numbers and borders, especially when you are just over a border as your diabetes diagnosis was. Different countries have different HBA1c markers for the disease, and they change, have changed. I did not know this, but my sister is a diabetes nurse, and she had prediabetic diagnosis, just, (in NZ - an HBA1c of 41, as opposed to 40), but did not choose to identify with it, as she had witnessed them change the blood glucose marker. (And she lowered it, I have no idea what she did.) I think it still indicated that she is high-carb-intolerant - which also applies to your situation, which is the really important thing for you, in order not to get that high again.

I have witnessed folks not with a very high HBA1c make very minor tweaks in their lifestyle and diet, sometimes it is weight, sometimes not, and improve their insulin sensitivity and blood glucose regulation enormously. You are one of these folks! And all the power to you, and this is a very very good thing. Congrats on the HBA1c of 33.

I would say - get HBA1cs tested every three months, or at the very least - every six months, to make sure you keep being diabetes-free. As yes, you are vulnerable to getting diabetes. (I am not one of the people that thinks diabetes is 'for life' even though it might be for me .)

 

[Smallbrit]

Well, I’m going to be one of the odd ones who sympathise with the “if the test were taken at any other time the result would be different” idea because that is actually what happened to me.

The difference was that I’d been hovering around figures close to your initial HBA1C for at least three years but had convinced myself that ‘prediabetes’ was not diabetes or why would it have a different name? And then bad things happened in life and I started eating really very badly and shot up from an HBA1C in the low 40s to 86 in three months. Entirely due to biscuits and chocolate. But the dr didn’t believe me and thought I’d got type 1. And by the time he figured out I hadn’t, I’d returned numbers to prediabetes numbers.

But now I am labelled type 2. And somehow that made it all real, although to be honest, if you discounted six months of bad eating it would all be the same and I’d still think I was “at risk” but didn’t have anything concrete. It does take time to wrap your head around things and be ready to tell yourself and the world that you are diabetic. Be kind and patient with yourself.

 

[Resurgam]

I need to eat low carb - all my adult life I have not been able to eat 'normal' amounts of carbs without gaining weight. It took until I was 65 to be diagnosed as diabetic, by which time I felt old and tired and I was very overweight.
From now on no amount of brainwashing will convince me that I ought to be on the diet which fattened me up to over 264lb - yes, I could eat more carbs, and my blood glucose might stay low for a while, but I'd be piling on the weight again, and I just do not want to head that way again.

 

[Alison Campbell]

Please focus on the amazing improvements you have made @Polo mint . If you can keep this up for a few years your doctor may chose to change your diabetes status to diabetes in remission.

In most cases subtle changes to the body create the environment to possibly develop type 2 diabetes upto 10 years before HBA1C levels start to rise. Sometimes these changes cause a roller coaster of blood sugar levels leaving you tired after eating and then craving more sugar a few hours later (my experience) and others have no symptoms at all. Please don't blame yourself for a few months of bad eating which may have been caused by your body struggling to cope. HBA1C is an average blunt instrument
that sometimes does not reflect health.

This article explains it in so much more detail than I can https://www.bloodsugar101.com/how-blood-sugar-control-works

Pick a different 3 months prior to your HBA1C, and you/your doctor may have missed the warning signs early enough to improve blood sugar levels without needing more drastic dietary and/or medication interventions.

 

[pixie1]

Well done you for changing things around to a fab 33. Adjusting your diet and exercising was enough for you to increase some insulin sensitivity. Depending on what I'm doing, I can have some naughty foods. One time in work, I had a piece of cake, tested 2hrs later, I was 5mmol, I'm bewildered.

 

[Polo mint]

Thanks very much for taking the time to respond.

When I was first diagnosed I decided I needed to lose weight and focused on eating healthier and cutting down on the sugar content on packets (as opposed to carbs) as my DN advised me just to look at the sugar content on the labels. I've still been eating lots of foods that aren't good for diabetics.

Im still eating carbs, fruits high in sugar and small amounts of chocolate/biscuits each day ....but still managed to reduce my hba1c which I suppose has confused me !

One thing that hit me hard, was when I went to a beauty salon recently, I had to complete a form and one of the questions was are you diabetic... it hit home that this affects so much of my life and I don't think I'm ready to accept that yet

My 6 monthly review with the DN was cancelled and hasn't been scheduled until next month.

 

[torchman2]

If your first two tests were 50 and 48 there is no doubt you are diabetic I'm afraid. Your more recent weight loss and improved diet is what has brought your HbA1c down - so well done for that, but you have to keep it up and maintain that lovely result for your next test, and every one after that.

So you don't think that the body can ever change? Once you show diabetic signs, you are diabetic for ever? In this case the guy even says he's not restricting foods and still has good HbA1c numbers, so how is he diabetic?

 

[Mr_Pot]

So you don't think that the body can ever change? Once you show diabetic signs, you are diabetic for ever? In this case the guy even says he's not restricting foods and still has good HbA1c numbers, so how is he diabetic?

At the very least he has shown that he can get up to diabetic levels if he doesn't keep to a sensible diet. If he calls himself diabetic or not does it really matter as long as his levels are ok. I like to keep my diabetic label as I get the annual checkup.

 

[Bluetit1802]

So you don't think that the body can ever change? Once you show diabetic signs, you are diabetic for ever? In this case the guy even says he's not restricting foods and still has good HbA1c numbers, so how is he diabetic?

Of course I think the body can change and insulin sensitivity can return providing action has been taken. That has been proved. However, I also believe that insulin resistance can come back if the diet slips back to how it was. I like to call the time in between as being in remission, but not cured.

She may still be eating some diabetic unfriendly foods but nothing like what she was eating previously, and she does say she is very careful about sugar in foods and looks at the nutrition labels for sugar content. She has also lost a lot of weight, and started exercising. All this has helped. If that slips, so will her next HbA1c.

 

[bulkbiker]

Once you show diabetic signs, you are diabetic for ever?

That is the gospel according to our doctors and diabetes nurses...chronic progressive disease etc etc.. who are we mortals to argue with the (self) appointed?

 

[Polo mint]

Again, thank you for the replies.

While I know my diet was absolutely horrendous in the months prior to my first hba1c results (lots of chocolate, biscuits, jellies etc - pure sugar!!!) this obviously brought me into the diabetic range. If anyone ate like that for a few months, would it bring most people into the diabetic range????

The fact I've brought my hba1c down to such a low level while still eating so many foods that diabetics aren't supposed to eat, I'd love to know if there is a definitive test that would confirm if I am diabetic?

I'm finding it hard to accept that I'm diabetic for life (and having to declare it for so many things like insurance for example), based on a blood test that was taken after a short period of having such a bad diet. If I'd had the blood test at any other time, I might not have been diagnosed with diabetes.

 

[Bluetit1802]

The fact I've brought my hba1c down to such a low level while still eating so many foods that diabetics aren't supposed to eat, I'd love to know if there is a definitive test that would confirm if I am diabetic?

An oral glucose tolerance test might help you. This is a test whereby you fast overnight then attend the surgery. They take your fasting glucose and then give you a pure glucose drink (75g of glucose). They test you at regular intervals for 2 hours, during which time you are supposed to sit quietly, no rushing about or walking too far, nothing to eat or drink. No smoking. Then they decide whether you are non-diabetic, pre-diabetic, or diabetic, depending on the results. This will show you how your body has coped with pure glucose as opposed to a meal with normal carbs, fats and protein.

You can do this test at home. The glucose drink is called Rapilose and you can order it on line. You are supposed to eat normally for 3 days beforehand, with at least 130g carbs per day.

https://www.gpsupplies.com/catalog/...pilose-ogtt-glucose-solution-300ml-pack-of-1/

https://www.diabetes.co.uk/oral-glucose-tolerance-test.html

In addition to the Rapilose you will need your meter and a plentiful supply of strips, plus something to record things on. It is best to test your fasting and every 15 minutes or half an hour after the drink for at least 3 hours.

 

[Alison Campbell]

, would it bring most people into the diabetic range????

No type 2 takes at upto 10 years to develop with subtle changes in only those that have the possibility to develop it. Now matter what they eat most people will not develop type 2.

Quote from https://www.sciencedirect.com/science/article/pii/014067369292814V

The development of type 2 diabetes is preceded by and predicted by defects in both insulin-dependent and insulin-independent glucose uptake; the defects are detectable when the patients are normoglycaemic and in most cases more than a decade before diagnosis of disease.

 

[torchman2]

I'm finding it hard to accept that I'm diabetic for life (and having to declare it for so many things like insurance for example), based on a blood test that was taken after a short period of having such a bad diet. If I'd had the blood test at any other time, I might not have been diagnosed with diabetes.

The beauty of the body is that it is adaptive, and responds to bad periods and good periods. If you see diabetes as an inability to oxidise glucose properly, then there is no reason why someone could not move in and out of a diabetic state, rather than "have diabetes" for life. If you can now eat carbs without high fasting or post-prandial BG, then there is nothing to suggest you have diabetes currently.

All diseases can go into remission. I made another long post here about natural things you can do to improve insulin sensitivity and BG control: https://www.diabetes.co.uk/forum/threads/my-doctor-was-angry-with-me.159019/page-2#post-1940143

I find magnesium has a huge impact on my postprandial and fasting BG for example, and it's incredibly easy to take, without any negative impacts (since the colon clears it in excess).