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Confused about numbers/diagnosis

Smallbrit

Smallbrit

Well-Known Member
Messages
284
Location
Cardiff, Wales
Type of diabetes
Type 2
Treatment type
Diet only
This is possibly the most basic question of all, but I don't understand the fasting testing numbers I was told by my GP.
I'm 40 yrs old, 5ft, 51 kg, cholesterol/blood pressure normal, no diabetes symptoms, and UK numbers mean nothing to me, as I'm used to a US system. I have a family history of diabetes.

3 months ago: 89
This time: 76

I used to live in the US, and I had gestational diabetes there, so throughout pregnancy stayed on a low carb diet and glucose tested with a monitor and strips 4 times a day, and had to keep numbers between 100 and 120 there when testing after meals. Had absolutely no follow up after being pregnant (the joys of the US healthcare system!) so didn't think about it for at least 6 years.

Moved back to the UK three years ago, and as soon as I signed up with the GP, got fasting tested and since then have been seen solely by the nurse in a combination of 3-month, 6-month and yearly testing, depending on how "good" or "bad" the numbers were. I never actually asked for numbers, and each time I was told to eat better and exercise more. Except... the last two times, I got diverted to the doctor instead. I saw him yesterday and he is going to do a test for type 1 or type 2 diabetes. He told me to keep doing what I'm doing.

So I'm lost: what do these numbers mean? Why has the dr suddenly got involved instead of nurse check ups? Was 89 an exceptionally high number? Why is he testing between type 1 and type 2? Why am I on this weird plateau of testing every 3 months? Is it okay to stay at these numbers or do I have to change my diet/exercise even more? And how will I know whether it's doing anything before 3 months is up if I have no symptoms?
 
It is probably your HbA1c. A value of average sugar in the blood over the last 3 months.
So yes it is too high and if they decide you are type 2 you need to cut carbs further.
As they Don't appear to be monitoring you more frequently than 3 monthly it does seem they think you are t2.
The tests for t1 are most likely an antibody test and a c-peptide to see how much insulin your body makes.
If t1 you will need to inject insulin.
US numbers to UK on a meter divide by 18. A1c is measured in different units though.
 
Hi. Those numbers look like HBa1C results which use the same units in the UK and USA. We both used to use % for HBA1C but that has been superseded but many of us still use the old ways! If the numbers are USA based fasting finger-prick units then they are very good. If the numbers are HBa1c then they are in the diabetic range and much too high. Your GP may be guessing that T1 is a possibility as you are young and your BMI looks good; both pointers to T1 always being possible instead of T2. He/She may be doing the two tests for T1 i.e. GAD and c-peptide. In the UK the default checks for diabetic patients is annual but if the numbers are too high then it may be 6 months or 3 months. Can you clarify whether the numbers you gave are finger-prick meter tests using USA units or HBA1C? BTW fasting blood sugar checks are not very reliable due to overnight liver dumps of glucose. It's best to check 2 hours after a meal. The HBa1c is not fasting so doesn't matter; it gives you the last 3 months average blood sugar.
 
You need to find out what type of tests they were. If it was an HbA1c, which seems likely, they are high.

up to 41mmol/mol is non-diabetic
42 to 47mmol/mol is pre diabetic
48mmol/l and above is diabetic.

In the UK there is a diabetes care pathway in place. Following a diagnosis we are reviewed every 3 months initially. Once we are seen to be improving and any medication is stable, we may be moved to 6 monthly reviews, and eventually annual reviews. We are also given annual foot checks and an annual retinal eye screening test.

My advice is to ask at your surgery for a print out of the blood tests you have had. These will show you which tests you had, what the results were, and what the standard range is for those tests. If you are in England you can also enquire if your surgery puts test results on-line and how to register for this service. (English surgeries were asked to do this before May 2016 but some aren't doing it)

I believe that in the US the HbA1c is still measured as a percentage rather than in mmol/mol. There is a converter here. http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html Your 76 converts to 9.1% These are only for HbA1c measurements. The measurements we see on finger prick meters is different.
 
Thanks, that's really helpful. I'd only ever done fingerprick tests in the US and just had those 80-120 figures in my head, so all this is like an alien world to me. I'd assume I was improving, and then got worse.

It seems my numbers are really high. I don't really understand, though, how if I was told to "keep doing what I'm doing" would lower them... wouldn't the advice be do more of what you're doing (i.e. cut out more carbs, exercise more)?

I'm in Wales, by the way.
 
When I was diagnosed as a full blown diabetic my Hba1c was 91, and I suspect that the numbers you gave are for Hba1c, which shows your situation over the last few months - my blood glucose at the time of the first test was 17.1 mmol/l which was not good.
Your most recent test showing it has gone down to 76 is good, but it does mean that your blood glucose is still higher than is safe.
I have never had any good advice from nurses or educators and my doctor hasn't wanted to see me since diagnosis and prescribing tablets, so I was fortunate to have already found low carbing, and sticking to low carb foods seems to have done the trick for me.
 
As BG starts to go down, we tend to burn off some of the fat from in our liver, this makes BG go down even more (by reducing insulin resistance). Therefore keeping doing what has decreased BG a little, is likely to result in it decreasing more.

Remember that Hba1c looks at the level of BG over about the last 12 weeks, so if BG is going down, HBa1c will overstate it, and if BG is going up Hba1c will understate it.
 
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