fasting finger prick test of 6.2. Should I be concerned?

[Gardengnome]

I had an HbA1c done as part of the NHS health check and it was 41 mmol/mol. I had it repeated after 12 months and despite having lost weight and altered my lifestyle thanks to a diagnosis of hypertension, it was still 41 mmol. The GP said [unhelpfully] that I was prediabetic as he would have expected the number to drop. He also said my numbers would rise in time and I'd need medication. This was almost 2 years ago now and although with the same practice I changed the GP that I see and a year ago she dismissed the suggestion that I have another test, she thought i was worrying unnecessarily. I do have my own finger prick tester and when I tested in the early morning after fasting it was 6.2. How relevant is this? Should I ask for another HbA1c? My BMI is less than 19 so no weight issues and no other significant markers that I can report other than blurred vision at times. Before I had the health check I had a healthy disregard for my health: I ate well and didn't smoke or drink to excess, was active and exercised. My age is now almost 73. Now I feel that the health check has made a patient out of a healthy person and I wish I'd never had it done.

 

[Shar67]

6.2 is within normal range if it is above 7.7 then your GP should check.

 

[ButtterflyLady]

Current best practice is for everyone over 40 to have a health check every 5 years, including HbA1c, blood pressure, kidney function etc. If the person has any risk factors then the interval is 6 months, 1 year or 2 years. It is wise to have health checks as it means you can pick up things before they become a problem.

Since you have hypertension, you would need your blood pressure checked at least every 6 months, and possible every 3 months. It is because of hypertension that you need at least annual HbA1c tests (hypertension and diabetes are related). It's possible that if you had never had the health check done, you would have had uncontrolled hypertension, which increases the risk of stroke. You did the right thing by having the check.

The prediabetic range is 42-47 HbA1c, so technically you are in the normal range, and not quite prediabetic. If you reduce your carb intake, you can stop it progressing to prediabetes and you won't need medication. You might even be able to reduce your HbA1c so it is further inside the normal range. For example, mine is 37, after reducing carbs and losing weight.

For the fasting blood glucose test, the prediabetic range is 6.1-6.9 but please note that only lab test results are used for diagnosis. Your meter could be slightly out.

I think you have enough information from the fasting blood glucose test and the previous HbA1c tests to adopt a different eating pattern based on what you would do if you were prediabetic, without necessarily having another HbA1c test. However, it might be fun to be able to say to a doctor what your HbA1c was when you started eating differently, and what it is after say 3 or 6 months.

IMO your doctor should be checking your HbA1c every year because you have hypertension. Just as well you are an informed and motivated patient, isn't it?

I encourage you to read threads on this forum about low carb higher fat eating to reduce blood glucose, so you can avoid your levels getting worse and going into prediabetes then diabetes.

 

[Gardengnome]

Thank you CatladyNZ and Shar67. My hypertension is well controlled with just the very lowest dose of Losartan but of course just the fact you take the meds gives you a higher risk score and the next step will be a statin which I don't want. My risk at present is 16% and they say a statin is indicated above 10%. My average BP readings taken twice a day are in the region of <20%> so not a problem. They do give me a blood test for kidney function annually.

All that is of course not the issue here.The dr said I was prediabetic with a HbA1c of 41% because I had made many dietary changes and the number had stayed the same. He said it would rise and he 'Would have the Metformin ready' and to 'Watch your diet'. He didn't exactly say what to do about the diet though although I did read up on the high fat and low carb plan which many people here use. I never knew whether this was said to frighten me or because he believes that patients don't adhere to life changes so it's best to medicate them. Call me an old cynic but I do feel that is the case with many drs and that is why I changed the one I see.

As it's so long since I last had an A1c test and I am due for an annual revue of the hypertension meds next month I wondered if I should ask for one and also for a cholesterol test which was borderline high last time at 5.9. I wasn't sure about the finger prick testing so it's good to know the numbers are still within the normal range.

Thank you for your time in replying.

 

[ButtterflyLady]

Thank you CatladyNZ and Shar67. My hypertension is well controlled with just the very lowest dose of Losartan but of course just the fact you take the meds gives you a higher risk score and the next step will be a statin which I don't want. My risk at present is 16% and they say a statin is indicated above 10%. My average BP readings taken twice a day are in the region of <20%> so not a problem. They do give me a blood test for kidney function annually.

All that is of course not the issue here.The dr said I was prediabetic with a HbA1c of 41% because I had made many dietary changes and the number had stayed the same. He said it would rise and he 'Would have the Metformin ready' and to 'Watch your diet'. He didn't exactly say what to do about the diet though although I did read up on the high fat and low carb plan which many people here use. I never knew whether this was said to frighten me or because he believes that patients don't adhere to life changes so it's best to medicate them. Call me an old cynic but I do feel that is the case with many drs and that is why I changed the one I see.

As it's so long since I last had an A1c test and I am due for an annual revue of the hypertension meds next month I wondered if I should ask for one and also for a cholesterol test which was borderline high last time at 5.9. I wasn't sure about the finger prick testing so it's good to know the numbers are still within the normal range.

Thank you for your time in replying.

I too have well controlled hypertension on the lowest dose of Quinapril (an ACE inhibitor). The "next step" for you is not necessarily a statin. There may not need to be a next step, if your lipid levels don't rise significantly.

I think your previous doctor is one of those people who likes to be "right", and that is more important to him than being caring or positive towards a patient who is doing the right things for their health.

"I never knew whether this was said to frighten me or because he believes that patients don't adhere to life changes so it's best to medicate them."

I would say: both He must think that frightening patients is a way to motivate them. It isn't. Clearly you are one of the minority of patients who can adhere to lifestyle changes, but that didn't interest him because then it would mean he was wrong.

I recommend asking for HbA1c and lipid tests, along with kidney function. If your cardiovascular risk score is 16% then of course you should be having annual lipid tests. Remember you need to know not just your total cholesterol, but your HDL, LDL and triglycerides as that gives a clearer picture.

This is where I get my info about cardiovascular risk scores and monitoring of BP, HbA1c and lipids:
https://www.health.govt.nz/system/files/documents/publications/nz-primary-care-handbook-2012.pdf

There will be an equivalent guideline for the UK, but it sounds like your current GP is not too concerned about the HbA1c side of things, at least.

 

[Gardengnome]

Thank you CatladyNZ. Re-reading what I last wrote I should have said my BP is in the region of <120/75> not writing it as a % I think you are spot on when you talk of the previous dr being of the type who doesn't believe people can stick to life style changes preferring to put patients on pills and dismiss any potential side effects. Thankfully the dr I now see is an old school friend of my daughter and is just lovely. When I saw her 6 months ago she said I could [indeed should] have a cholesterol test again but as I had already refused a statin there was no point. I asked if she would take one given my 'risks' at that time of 14% and she said no. Looks like I should revise my thinking perhaps and ask again. However I checked the link you gave and my risk there is given as 5-10%. In the UK they use the Qrisk2 which is possibly more specific. The problem for many people here is that last year NICE [the NHS body that rations drugs] recommended people with a risk factor of 10%> be offered a statin, this was a reduction from 20% and many GPs were against this.

 

[JTL]

No so stop worrying.
This modern world makes people worry.
The science of finding out what's wrong with us is pretty good but the science of fixing most things is pretty rubbish .... here take some tablets.
Your readings are fine and remember we're all different.
I discovered I was allergic to statins but got my blood pressure and cholesterol and glucose levels as near normal as it's ever going to be in my sixties by eating porridge with coconut oil and having lots of full fat dairy and olive oil and nuts and tinned fish.
My surgery are amazed with my results but unhappy about how I achieved them.
I don't care that they're unhappy!

 

[ButtterflyLady]

Thank you CatladyNZ. Re-reading what I last wrote I should have said my BP is in the region of <120/75> not writing it as a % I think you are spot on when you talk of the previous dr being of the type who doesn't believe people can stick to life style changes preferring to put patients on pills and dismiss any potential side effects. Thankfully the dr I now see is an old school friend of my daughter and is just lovely. When I saw her 6 months ago she said I could [indeed should] have a cholesterol test again but as I had already refused a statin there was no point. I asked if she would take one given my 'risks' at that time of 14% and she said no. Looks like I should revise my thinking perhaps and ask again. However I checked the link you gave and my risk there is given as 5-10%. In the UK they use the Qrisk2 which is possibly more specific. The problem for many people here is that last year NICE [the NHS body that rations drugs] recommended people with a risk factor of 10%> be offered a statin, this was a reduction from 20% and many GPs were against this.

I can see why the GPs would be against it, and so would I. I think even though you are not on a statin it is wise to monitor lipids annually, because if they were to increase significantly, you might want to reconsider a statin... also in the future there way be lipid-lowering drugs that don't carry the same risks as statins. I have no intention of ever taking a statin, and my lipid levels are only slightly higher than normal but that is all the more reason to monitor them, because I will get early warning if they start creeping up, and can do other things to reduce them.

 

[ButtterflyLady]

No so stop worrying.
This modern world makes people worry.
The science of finding out what's wrong with us is pretty good but the science of fixing most things is pretty rubbish .... here take some tablets.
Your readings are fine and remember we're all different.
I discovered I was allergic to statins but got my blood pressure and cholesterol and glucose levels as near normal as it's ever going to be in my sixties by eating porridge with coconut oil and having lots of full fat dairy and olive oil and nuts and tinned fish.
My surgery are amazed with my results but unhappy about how I achieved them.
I don't care that they're unhappy!

Which readings are fine? gardengnome has slightly higher BP, HbA1c and lipids than desirable and IMO he is right to keep a bit of an eye on them to reduce risk and prevent illness.

 

[JTL]

Sorry I was referring only to his 6'2 blood reading.

 

[ButtterflyLady]

Sorry I was referring only to his 6'2 blood reading.

So was I, because 6.2 is in the prediabetic range, and it's important to monitor that so it doesn't become diabetes.

 

[JTL]

So was I, because 6.2 is in the prediabetic range, and it's important to monitor that so it doesn't become diabetes.

Yes but it's not something to be worrying about when he's already working on it.

 

[Daphne917]

@gardengnome at 120/75 your BP seems OK as I believe that 140/80 is the high end of normal. Your hba1c of 41 is just within the non-diabetic range (pre-diabetes is, i believe, 42) but has stayed the same for 2 years and maybe a few 'tweaks' will help to reduce it further. Re your 6.2 fasting blood level most meters have a % variance so the reading may not be entirely accurate. Like @JTL I took statins for a short while but they managed to raise my hba1c from 48 to 54 and made me feel terrible so I am no longer taking them and my cholesterol is 4.8 (LDL of 2.3) - I would advise anyone to research them prior to taking them and not blindly accept the medical professions assertion that they will be of benefit! For reassurance and if not already offered I would request an hba1c test every year or sooner if you notice your BG levels increasing.

 

[ButtterflyLady]

@gardengnome at 120/75 your BP seems OK as I believe that 140/80 is the high end of normal. Your hba1c of 41 is just within the non-diabetic range (pre-diabetes is, i believe, 42) but has stayed the same for 2 years and maybe a few 'tweaks' will help to reduce it further. Re your 6.2 fasting blood level most meters have a % variance so the reading may not be entirely accurate. Like @JTL I took statins for a short while but they managed to raise my hba1c from 48 to 54 and made me feel terrible so I am no longer taking them and my cholesterol is 4.8 (LDL of 2.3) - I would advise anyone to research them prior to taking them and not blindly accept the medical professions assertion that they will be of benefit! For reassurance and if not already offered I would request an hba1c test every year or sooner if you notice your BG levels increasing.

A BP of 140/90 is the high end of normal for non-diabetics; for diabetics it should be under 130/80.

 

[Bluetit1802]

Which readings are fine? gardengnome has slightly higher BP, HbA1c and lipids than desirable and IMO he is right to keep a bit of an eye on them to reduce risk and prevent illness.

The OP stated her BP is 120/75, which is perfect.

.

 

[noblehead]

People with diabetes are advised to keep their bp below 130/80:

Blood pressure (hypertension)
Blood pressure is a measurement of the force of blood flow inside your arteries. Your blood pressure is stated as two figures, e.g.130/80mmHg (millimetres of mercury). The first figure is known as the systolic pressure and relates to the pressure as the heart contracts and pushes blood through the arteries. The other figure is the diastolic pressure measured when the heart relaxes to refill with blood.

• For someone without diabetes the blood pressure should be no higher than 140/85 but when you have diabetes (or if you have had a heart attack, stroke or coronary heart disease) your blood pressure should be no higher than 130/80.
• It is important to have your blood pressure checked at least once a year as part of your annual review for diabetes. This helps to ensure that it is in the target range and not increasing your risk of developing diabetes complications.

Note:
Your healthcare team will help you to aim towards a target level of 130/80mmHg or less. High blood pressure usually has no signs or symptoms – occasionally people with very high blood pressure say they experience headaches – so the only way to know if you have high blood pressure is to have yours measured. High blood pressure can lead to heart attack, stroke or kidney failure. If your blood vessels are narrowed or clogged, extra strain is put on your heart as it has to work harder to pump blood around your body.

https://www.diabetes.org.uk/Guide-to-diabetes/Monitoring/Testing/

 

[ButtterflyLady]

The OP stated her BP is 120/75, which is perfect.

.

Yes I know that, Bluetit, thank you. I was responding to JTL who said not to worry about anything, whereas when someone has had a diagnosis of hypertension and it is now controlled with meds, they still need checks, particularly when HbA1c and cholesterol are also elevated, albeit only slightly.

 

[KeithT 2]

I had an HbA1c done as part of the NHS health check and it was 41 mmol/mol. I had it repeated after 12 months and despite having lost weight and altered my lifestyle thanks to a diagnosis of hypertension, it was still 41 mmol. The GP said [unhelpfully] that I was prediabetic as he would have expected the number to drop. He also said my numbers would rise in time and I'd need medication. This was almost 2 years ago now and although with the same practice I changed the GP that I see and a year ago she dismissed the suggestion that I have another test, she thought i was worrying unnecessarily. I do have my own finger prick tester and when I tested in the early morning after fasting it was 6.2. How relevant is this? Should I ask for another HbA1c? My BMI is less than 19 so no weight issues and no other significant markers that I can report other than blurred vision at times. Before I had the health check I had a healthy disregard for my health: I ate well and didn't smoke or drink to excess, was active and exercised. My age is now almost 73. Now I feel that the health check has made a patient out of a healthy person and I wish I'd never had it done.

My meds were recently reduced because they were putting me at risk of a hypo after weight loss. Since then my post prandial before bed is between 5.4 and 7 and on waking (fasting) they have usually been a tad higher, but normally around 6.2. These numbers are considered to be within the normal range. I would suggest that for a few weeks you test before a meal and two hours after just to see what foods affect your BS the most. Keep notes and try to reduce the starchy foods as much as you can bear. Carbs hold all the danger for diabetics but I wouldn't recommend cutting them out completely as there are essential vitamins and minerals in them that the body needs and are more tasty than supplements. I hate it when my numbers go above 7 mmol/L but it's the double numbers or numbers below 4 that ring alarm bells for me and will need treating with extra medication or in the case of low numbers (unlikely if you are type 2 on Metformin but likely if you are taking Gliclazide) some kind glucose intake needs to be taken to increase them back to a safe position. It's about self-management mostly. Your doctor will take a look at the A1c numbers and determine if you need another test. If you keep a record of your finger prick tests you can get some idea of your BG stability over a period of time. If they settle down with an average of below 7 over say 4 weeks then I think you can safely say you have your "diabetes" under control.

 

[Guzzler]

My meds were recently reduced because they were putting me at risk of a hypo after weight loss. Since then my post prandial before bed is between 5.4 and 7 and on waking (fasting) they have usually been a tad higher, but normally around 6.2. These numbers are considered to be within the normal range. I would suggest that for a few weeks you test before a meal and two hours after just to see what foods affect your BS the most. Keep notes and try to reduce the starchy foods as much as you can bear. Carbs hold all the danger for diabetics but I wouldn't recommend cutting them out completely as there are essential vitamins and minerals in them that the body needs and are more tasty than supplements. I hate it when my numbers go above 7 mmol/L but it's the double numbers or numbers below 4 that ring alarm bells for me and will need treating with extra medication or in the case of low numbers (unlikely if you are type 2 on Metformin but likely if you are taking Gliclazide) some kind glucose intake needs to be taken to increase them back to a safe position. It's about self-management mostly. Your doctor will take a look at the A1c numbers and determine if you need another test. If you keep a record of your finger prick tests you can get some idea of your BG stability over a period of time. If they settle down with an average of below 7 over say 4 weeks then I think you can safely say you have your "diabetes" under control.

This thread is three years old. It is possible that the OP has things in order by now.