Diabetes Classification - Changing the goal posts

[JamieKershaw]

I've been diagnosed as being borderline Type 2 Diabetic for a couple of years now.

When having a general discussion with my Doctor, he said that five years ago with my readings I wouldn't have been classed as being diabetic, but the government moved the goal posts; I assume that this was done for general preventative measures.

What I can't get my head round is that because the government decides to reclassify things, I now have Diabetes, whereas five years ago I wouldn't fall into this category. Surely diagnosis should be based on more tangible measures rather than what the government decides at a certain point in time.

Jamie

 

[Bluetit1802]

Hi Jamie and welcome.

What were all your readings?

Edit - what goal posts changed, and from what to what?

 

[Scandichic]

I've been diagnosed as being borderline Type 2 Diabetic for a couple of years now.

When having a general discussion with my Doctor, he said that five years ago with my readings I wouldn't have been classed as being diabetic, but the government moved the goal posts; I assume that this was done for general preventative measures.

What I can't get my head round is that because the government decides to reclassify things, I now have Diabetes, whereas five years ago I wouldn't fall into this category. Surely diagnosis should be based on more tangible measures rather than what the government decides at a certain point in time.

Jamie

I didn't know this. You've made a good point! The question is, what are you going to do about your condition? I read lots on here and follow a LCHF diet. A member here referred me to this website. It's written by a Swedish doc who specialises in diabetes and obesity. It lowers bs more or less immediately and You can lose weight or not through it. Depends on whether you need to. http://www.dietdoctor.com/lchf
Good luck!

 

[JamieKershaw]

Hi Jamie and welcome.

What were all your readings?

Edit - what goal posts changed, and from what to what?

Hi Jamie and welcome.

What were all your readings?

Edit - what goal posts changed, and from what to what?

My HBA1C was last read as 46; which is deemed good control (13th August 14)
My last Blood/Sugar reading (fasted) was 7.3 (13th August 14)

My doctor told me that the government changed the Diabetes classifications about five years ago, so that now more people are diagnosed as having the condition. This is a preventative measure apparently; probably to save money in the long run for the NHS.

 

[JamieKershaw]

I didn't know this. You've made a good point! The question is, what are you going to do about your condition? I read lots on here and follow a LCHF diet. A member here referred me to this website. It's written by a Swedish doc who specialises in diabetes and obesity. It lowers bs more or less immediately and You can lose weight or not through it. Depends on whether you need to. http://www.dietdoctor.com/lchf
Good luck!

Well done. Keep up the good work.

I have a new baby so I want to be around long enough to see him grow up.

 

[Bluetit1802]

My HBA1C was last read as 46; which is deemed good control (13th August 14)
My last Blood/Sugar reading (fasted) was 7.3 (13th August 14)

My doctor told me that the government changed the Diabetes classifications about five years ago, so that now more people are diagnosed as having the condition. This is a preventative measure apparently; probably to save money in the long run for the NHS.

With an HbA1c of 46 you are not yet diabetic. You are in the pre-diabetic range.
However, the fasting glucose is not so good, but as these vary so much depending on several factors often outside your control, they are not normally used for diagnostic purposes. It is the HbA1c that counts.

These are the current guidelines for type 2 diagnosis as per NICE.
Non diabetics 20 to 41
Diabetics 48 and above
Between 42 and 47 is the pre-diabetic range.

http://www.diabetes.co.uk/what-is-hba1c.html

 

[phoenix]

The committee that recommend how diabetes is diagnosed is international not governmental( ie the World Health Organisation) The UK authorities have just accepted the advice.
Before 2011 the most usual method was to do 2 fasting glucose tests on different occasions, sometimes people may have had a glucose challenge test . If people had symptoms only one fasting test or a random glucose level of over 11mmol/l was necessary

What has happened in the last few years is that there has been an introduction of the HbA1c to diagnose diabetes. This test reflects your glucose levels over the last three months. Hba1c wasn''t used for diagnosis because Internationally ,the lab methods weren't completely standardised and tested.
This has now been done and the committee decided that either the older criteria or the HbA1c can be used. (or a mixture)
Your Hba1c was very slightly under the Hba1c criteria but the criteria also says
Patients whose HbA1c is under 48 mmol/mol (6.5%)

• These patients may still fulfil WHO glucose criteria for the diagnosis of diabetes.
• Use WHO glucose testing in patients with symptoms of diabetes or clinically at very high risk of diabetes
• The use of such glucose tests is not recommended routinely in this situation.

The level for fasting glucose used for diagnosing diabetes was(is ) 7mmol/l or above (and this has been the same since the late 1990s).
http://www.diabetes.org.uk/About_us...vention/New_diagnostic_criteria_for_diabetes/
From my reading it seems that perhaps , if you didn't have symptoms then you should have a second fasting test (it's not totally clear) However with an HbA1c near the cut off it isn't going to make much difference in treatment. It's certainly better to do something about it rather than wait.

.

 

[JamieKershaw]

With an HbA1c of 46 you are not yet diabetic. You are in the pre-diabetic range.
However, the fasting glucose is not so good, but as these vary so much depending on several factors often outside your control, they are not normally used for diagnostic purposes. It is the HbA1c that counts.

These are the current guidelines for type 2 diagnosis as per NICE.
Non diabetics 20 to 41
Diabetics 48 and above
Between 42 and 47 is the pre-diabetic range.

http://www.diabetes.co.uk/what-is-hba1c.html

Thanks for your information.

Readings taken over the past few years have been the following:

21st June 2011: HbA1C = 50
16th January 2012: HbA1C (Fasting) = 50, Blood Sugar = 7.3
23rd April 2012: HbA1C (Fasting) = 41, Blood Sugar = 8.4
16th November 2012 (Fasting): HbA1C = 40, Blood Sugar = 6.5
22nd April 2013: HbA1C (Non Fasting) = 44, Blood Sugar = 10.1
23rd May 2014: HbA1C (Fasting) = 50, Blood Sugar = 7.3
13th August 2014: HbA1C (Fasting) = 46, Blood Sugar = 7.3

How would you describe my situation with these results?

Any feedback would be appreciated.

Thanks

Jamie

 

[JamieKershaw]

The committee that recommend how diabetes is diagnosed is international not governmental( ie the World Health Organisation) The UK authorities have just accepted the advice.
Before 2011 the most usual method was to do 2 fasting glucose tests on different occasions, sometimes people may have had a glucose challenge test . If people had symptoms only one fasting test or a random glucose level of over 11mmol/l was necessary

What has happened in the last few years is that there has been an introduction of the HbA1c to diagnose diabetes. This test reflects your glucose levels over the last three months. Hba1c wasn''t used for diagnosis because Internationally ,the lab methods weren't completely standardised and tested.
This has now been done and the committee decided that either the older criteria or the HbA1c can be used. (or a mixture)
Your Hba1c was very slightly under the Hba1c criteria but the criteria also says
Patients whose HbA1c is under 48 mmol/mol (6.5%)

• These patients may still fulfil WHO glucose criteria for the diagnosis of diabetes.
• Use WHO glucose testing in patients with symptoms of diabetes or clinically at very high risk of diabetes
• The use of such glucose tests is not recommended routinely in this situation.

The level for fasting glucose used for diagnosing diabetes was(is ) 7mmol/l or above (and this has been the same since the late 1990s).
http://www.diabetes.org.uk/About_us...vention/New_diagnostic_criteria_for_diabetes/
From my reading it seems that perhaps , if you didn't have symptoms then you should have a second fasting test (it's not totally clear) However with an HbA1c near the cut off it isn't going to make much difference in treatment. It's certainly better to do something about it rather than wait.

.

Thanks for your detailed information; much appreciated.

My readings taken over the past few years have been the following:

21st June 2011: HbA1C = 50
16th January 2012: HbA1C (Fasting) = 50, Blood Sugar = 7.3
23rd April 2012: HbA1C (Fasting) = 41, Blood Sugar = 8.4
16th November 2012 (Fasting): HbA1C = 40, Blood Sugar = 6.5
22nd April 2013: HbA1C (Non Fasting) = 44, Blood Sugar = 10.1
23rd May 2014: HbA1C (Fasting) = 50, Blood Sugar = 7.3
13th August 2014: HbA1C (Fasting) = 46, Blood Sugar = 7.3

How would you describe my situation with these results?

Any feedback would be appreciated.

Thanks

Jamie

 

[Bluetit1802]

This is my opinion. I am not a doctor.

In 2011 you were a diabetic. The HbA1c is evidence of this as it is over 47.
By April 2012 you had your levels under control on average.
By April 2013 you were slipping and continued to slip.
By May 2014 your levels were back to diabetic levels.
Your latest HbA1c showed some improvement.

You are diabetic but clearly have found a way to keep your levels down on average. The HbA1c is an average of the previous 2 to 3 months. It is an average, and therefore there are times when you are high. It looks like your fasting levels are letting you down.

Do you have a home meter? If not, I suggest you buy one so you can test yourself at home and find out where your peaks and troughs are so you can work on them. The morning fasting level has too many variables to be wholly relied on, such as a disturbed night, stress, dawn phenomenon, and routine activities between getting up and getting to the surgery.

 

[JamieKershaw]

This is my opinion. I am not a doctor.

In 2011 you were a diabetic. The HbA1c is evidence of this as it is over 47.
By April 2012 you had your levels under control on average.
By April 2013 you were slipping and continued to slip.
By May 2014 your levels were back to diabetic levels.
Your latest HbA1c showed some improvement.

You are diabetic but clearly have found a way to keep your levels down on average. The HbA1c is an average of the previous 2 to 3 months. It is an average, and therefore there are times when you are high. It looks like your fasting levels are letting you down.

Do you have a home meter? If not, I suggest you buy one so you can test yourself at home and find out where your peaks and troughs are so you can work on them. The morning fasting level has too many variables to be wholly relied on, such as a disturbed night, stress, dawn phenomenon, and routine activities between getting up and getting to the surgery.

Thanks for the information...

Is there any way (or any activity) that will help cure my diabetic situation at the moment?

Someone said that the 5:2 diet might help kick-start the Pancreas into working normally again. Have you heard this?

JK

 

[Bluetit1802]

Thanks for the information...

Is there any way (or any activity) that will help cure my diabetic situation at the moment?

Someone said that the 5:2 diet might help kick-start the Pancreas into working normally again. Have you heard this?

JK

There are several threads on the forum relating to whether or not diabetes can be cured. Certainly some people have found it possible, but on the whole it is perhaps best to regard it as "in remission". I suggest you have a read round.

I know nothing about the 5:2 diet. Have you got any weight to lose?

During 2012 your levels were under control. What were you doing different that year, and what have you been doing since then to cause the slippage? A suitable diet and added exercise are the keys to good control.

 

[AndBreathe]

Thanks for the information...

Is there any way (or any activity) that will help cure my diabetic situation at the moment?

Someone said that the 5:2 diet might help kick-start the Pancreas into working normally again. Have you heard this?

JK

Do you carry any excess poundage at all Jamie?

At diagnosis, I was told that one of the best things I could do, if I wanted to give myself the best chances of remaining medication free, was to trim away any excess weight. Excess weight, particularly any carried around the mid-section is likely to impacting on insulin sensitivity/resistance.

For me, I did the trimming up, and got skinny, and am now routinely run in the non-diabetic range. My numbers are in my signature, below.

 

[Scandichic]

You can't cure it. But you can get it under control. If your doc won't give you a meter (yyou get the strips on prescription but some docs refuse for financial reasons. They will tell you you don't need one. This is bulls*t - it's cost!). Then an sd code free has the cheapest strips. I have included the link.
A food diary and testing 2 hours after your meal will indicate what you can and can't tolerate. You should be under 7.5 after a meal. Have a look at the website I sent you. Many of us eat this diet. If you don't like it then you could try low GI which works for some people too for example @catherinecherub @douglas99
I think @AnnieC does low fat too.

 

[JamieKershaw]

You can't cure it. But you can get it under control. If your doc won't give you a meter (yyou get the strips on prescription but some docs refuse for financial reasons. They will tell you you don't need one. This is bulls*t - it's cost!). Then an sd code free has the cheapest strips. I have included the link.
A food diary and testing 2 hours after your meal will indicate what you can and can't tolerate. You should be under 7.5 after a meal. Have a look at the website I sent you. Many of us eat this diet. If you don't like it then you could try low GI which works for some people too for example @catherinecherub @douglas99
I think @AnnieC does low fat too.

Thanks

Sorry, I can't find the link to the testing strips you recommended

Do you find it necessary to regularly test after meals?

 

[JamieKershaw]

Do you carry any excess poundage at all Jamie?

At diagnosis, I was told that one of the best things I could do, if I wanted to give myself the best chances of remaining medication free, was to trim away any excess weight. Excess weight, particularly any carried around the mid-section is likely to impacting on insulin sensitivity/resistance.

For me, I did the trimming up, and got skinny, and am now routinely run in the non-diabetic range. My numbers are in my signature, below.

--

Well done for keeping your numbers down.

Yes, I'm carrying a little weight (!). I'm 5foot11.5inches and weight about 15stone5lbs. BMI is currently 29.

What did you do to trim up?

 

[Bluetit1802]

The idea of testing for type 2's is to discover which foods might be causing high levels. If you test before you eat, then again 2 hours after your first bite, you can look at the rise in levels and decide if it is acceptable or not. Keep a food diary and record your levels next to each meal. If you are spiking too high, one or more of the foods in that meal is not doing you any favours, so you need to try the test again but with smaller portions of those foods. You may well find you need to cut those foods out altogether, or stick to much smaller portions.

 

[douglas99]

to be honest, I'd rather be diagnosed diabetic, with lower BS, than not being diagnosed, but with higher BS.
So, this time, it appears the NHS have done the right thing, by bringing the criteria down.

 

[JamieKershaw]

There are several threads on the forum relating to whether or not diabetes can be cured. Certainly some people have found it possible, but on the whole it is perhaps best to regard it as "in remission". I suggest you have a read round.

I know nothing about the 5:2 diet. Have you got any weight to lose?

During 2012 your levels were under control. What were you doing different that year, and what have you been doing since then to cause the slippage? A suitable diet and added exercise are the keys to good control.

Yes, I'm carrying a little weight (!). I'm 5foot11.5inches and weight about 15stone5lbs. BMI is currently 29.

I've had a few things to deal with over the past few years (company politics in old job, got a new job, a lot of overseas travel for business, IVF, work on house for impending arrival of new baby, help for elderly parents regarding their business/ house etc etc), so needless to say all of this has helped take my focus off eating right and keeping fit. I appreciate that these are probably just excuses for not doing what I should have done to safeguard my health.

 

[AndBreathe]

--

Well done for keeping your numbers down.

Yes, I'm carrying a little weight (!). I'm 5foot11.5inches and weight about 15stone5lbs. BMI is currently 29.

What did you do to trim up?

Put simply, I ate less and moved a bit more. But, to add context, I reduced the carbs I ate too. I'm not a true low carber, but I dropped the major carbs and the weight disappeared. The only things I completely eliminated for a while, aside from the obvious sugar, cakes and biscuits, were pastry, pasta and pizza. I hadn't realised the alliteration in that before now!

I must say, I actually found that bit easy. Reducing the carbs, started the weight loss, which spurred me on.

I also set myself a programme of self-testing, as part of my education requirements. Do you test? If not, I strongly recommend you do.