First Annual Diabetic Review Test Results Freak Out!

[SheilaCanning]

So back in May I posted this:

I was diagnosed in February with Type 2 diabetes. I had an HbA1c of 7.7 (60.7) and the diabetic nurse wanted to start me either a weekly Ozempic injection or Dapagliflozin tablets. I initially asked if I could try to get my levels down with diet and exercise and she said no and that she would call me after the weekend to see which medication I would choose. I came here feeling utterly overwhelmed.You gave me the strength to tell her no, I was going to try low carb eating and diet first. She said I would need to lose a stone and get down to 6.5 in 3 months or go on the medication.

I have lost 12 pounds - so nearly a stone which is pretty good going as I also started HRT which can result in weight gain.
And today I got my blood test results - HbA1c 6.2 (44.3).

And last week I went for full blood tests prior to my first annual diabetic review which is in 2 weeks time. I can see my test results online and I was anxious to see them. I relaxed my low carb eating a little bit and I suspected my blood sugar would go up a little but hoped it wouldn't be much. I'm pretty pleased it's 45.4 mmol/mol HbA1c level (DCCT aligned) 6.3 % as it's 6 months on from that initial early burst of enthusiastic and determined dieting and it feels sustainable long term. However, my cholesterol has gone up and is flagged.
Serum cholesterol level 6.32 mmol/L [2.0 - 5.0]
Above high reference limit
Serum triglyceride levels 2.05 mmol/L [0.5 - 2.5]
Serum non high density lipoprotein cholesterol level 5.11 mmol/l
A non HDL cholesterol of 2.5 mmol/L is equivalent
to an LDL cholesterol of 1.8 mmol/L. Aim for at
least a 40% reduction in pre-treatment values.
Serum cholesterol/HDL ratio 5.2
Serum HDL cholesterol level 1.21 mmol/L
Calculated LDL cholesterol level 4.18 mmol/L

And also this is flagged which has sent me into a panic.

Urine albumin/creatinine ratio
Urine albumin level 8.0 mg/L
Urine creatinine level 10.2 mmol/L
Urine albumin/creatinine ratio 0.8 mg/mmol
A1 <3mg/mmol,KDIGO ACR category

Both things are marked borderline. I feel like they are going to offer me medication. They have put (ACEi) to be discussed. I am really spiralling into panic and last time this happened I came here and learnt about low carbing and felt confident to say I could sort it without medication. Any advice or thoughts would be so gratefully received.

Also, for background info, I am perimenopausal and on HRT patches and progesterone tablets. I am still struggling to feel well despite getting grip on the diabetes.

Thank you so much.

 

[Ronancastled]

Firstly great news on the A1c, especially if you've upped the carbs slightly.
I'm no expert on lipids but I'll tag in @bulkbiker as he is more schooled on the levels.

With the kidney function I have to resort to Google.

On the whole, the normal range of urine albumin is around 0-8 mg/dl. So, if a urine sample test displays a reading of 2 mg/dl, it means 1 liter of urine contains 0.02 grams of albumin. When the amount of urine crosses this normal range, it is a symptom of kidney deterioration.

So you've only touched the bottom rung of the allowable there

For Urine creatinine I referred here
https://www.medicineshoppe.ca/en/ar...vels-and-creatinine-clearance-urine-and-blood

• Urine creatinine (women) : 6 - 13 mmol/24 hours

If I'm reading that correctly you're in range.
I think you may have only one raised value which is still only on the edge of the reference zone *

* Please consult a medical professional to corroborate

 

[bulkbiker]

However, my cholesterol has gone up and is flagged.

How long had you fasted before the blood was taken for the test?

Do you have a previous full lipid panel result to compare these results to?

 

[SheilaCanning]

How long had you fasted before the blood was taken for the test?

Do you have a previous full lipid panel result to compare these results to?

I had fasted from 8 pm to 8.45 am when the test was.
I have spent ages going in and out of my online records (you can only search 60 days at a time and I had no clue when I last had full blood work) but some success!

LIVER FUNCTION TEST
Serum total protein level 73 g/L [60.0 - 80.0]
Serum albumin level 41 g/L [35.0 - 50.0]
Serum total bilirubin level 27 umol/L [2.0 - 21.0]
Above high reference limit
Serum alkaline phosphatase level 47 u/L [30.0 - 130.0]
Serum globulin level 32 g/L [20.0 - 35.0]
Serum alanine aminotransferase level 25 u/L [5.0 - 40.0]

Urea and electrolytes
Serum sodium level 140 mmol/L [133.0 - 146.0]
Serum potassium level 4.7 mmol/L [3.5 - 5.3]
Serum chloride level 105 mmol/L [95.0 - 108.0]
Serum urea level 3.4 mmol/L [2.5 - 7.8]
Serum creatinine level 67 umol/L [50.0 - 98.0]
eGFR using creatinine (CKD-EPI) per 1.73 square metres > 90 mL/Min [60.0 - 120.0]

LIPID PROFILE NON FASTING
Serum cholesterol level 6.80 mmol/L [2.0 - 5.0]
Above high reference limit
Serum triglyceride levels 2.00 mmol/L [0.5 - 2.5]
Serum non high density lipoprotein cholesterol level 5.72 mmol/l
A non HDL cholesterol of 2.5 mmol/L is equivalent
to an LDL cholesterol of 1.8 mmol/L. Aim for at
least a 40% reduction in pre-treatment values.
Serum cholesterol/HDL ratio 6.3 [< 5.0]
Above high reference limit
Serum HDL cholesterol level 1.08 mmol/L
Calculated LDL cholesterol level 4.81 mmol/L [< 2.5]
Above high reference limit


So things have actually improved mainly! Not sure about the urine test as can't find any other. But cholesterol should be good enough to say it's going in the right direction? Serum HDL cholesterol level 1.21 mmol/L has gone up a bit but that's all I think.

I'm sorry for being so panicky! I find these things hard to understand. I'm really bloated at the moment and have a pain in my back which I decided might be a liver or kidney issue in the middle of the night. Thanks for your help.

 

[SheilaCanning]

Firstly great news on the A1c, especially if you've upped the carbs slightly.
I'm no expert on lipids but I'll tag in @bulkbiker as he is more schooled on the levels.

With the kidney function I have to resort to Google.

So you've only touched the bottom rung of the allowable there

For Urine creatinine I referred here
https://www.medicineshoppe.ca/en/ar...vels-and-creatinine-clearance-urine-and-blood



If I'm reading that correctly you're in range.
I think you may have only one raised value which is still only on the edge of the reference zone *

* Please consult a medical professional to corroborate

Thank you so much! I was having a big wobble! And google kept leading me to kidney failure relating to diabetes and freaking me out.

 

[bulkbiker]

I had fasted from 8 pm to 8.45 am when the test was.

Ok that's good was it water only?

Just asking because your triglyceride number is a tad high.

HDL up is good

And well done on the HbA1c.

Might I guess you have reduced carbs but not gone full on keto?

 

[Dark Horse]

You

A1 <3mg/mmol,KDIGO ACR category

A1= normal or mildly increased ACR. https://patient.info/doctor/microalbuminuria
Did you have a blood test value for eGFR?

 

[SheilaCanning]

Ok that's good was it water only?

Just asking because your triglyceride number is a tad high.

HDL up is good

And well done on the HbA1c.

Might I guess you have reduced carbs but not gone full on keto?

The fasting? Yes, I only had water with a tablet at about 10 pm and nothing else.
HDL up is good?
What does the triglyceride number refer to?
And yes, I'm low carb not kept.

Thanks for taking the time - it's much appreciated.

 

[SheilaCanning]

You

A1= normal or mildly increased ACR. https://patient.info/doctor/microalbuminuria
Did you have a blood test value for eGFR?

eGFR using creatinine (CKD-EPI) per 1.73 square metres > 90 mL/Min [60.0 - 120.0]

 

[NicoleC1971]

The fasting? Yes, I only had water with a tablet at about 10 pm and nothing else.
HDL up is good?
What does the triglyceride number refer to?
And yes, I'm low carb not kept.

Thanks for taking the time - it's much appreciated.

Hello Sheila and again congratulations on the changes which have seen big improvements in HBA1c and weight loss. We're all works in progress and your team usually don't see many type 2s who improve their health like you've already done so whether or not you get a pat on the back please give yourself one!
The trig/HDL ratio is a good risk predictor for heart disease (better than LDL in fact). Trig are the a good reflection of how carb tolerant you are in that if your body can't store excess carbs as muscles glucose (glycogen) or in your sub cutaneious fat (love handles not belly fat) it turns them into triglycerides in the liver. Your HDL is important because it sweeps up excess triglycerides and small dense lipo proteins (VLDL) that can be damaging to arteries, so if the HDL is lower than trigs it is an indication of your body not quite dealing with the carbs you are eating.
I am not sure if the test is always reliable but your previous results show a similar ratio and ideally being even more careful with the carbs but enjoying protein/non starchy stuff/dairy should help improve the ratio further . Ideally you want HDL above 1.0 and triglycerides below 1.7 or at least equal to or lower than the HDL.
If you can continue to lower both waist (to be half your height) size and glucose levels (hba1c) then this will be a good sign of improving liver health too because you will be losing the dangerous fat that accumulates around your liver and pancreas.
Its up to you re meds (stains and metformin may be offered) so have a good think about the pros and cons and have questions before you see the team. How is your BP btw?

 

[Dark Horse]

eGFR using creatinine (CKD-EPI) per 1.73 square metres > 90 mL/Min [60.0 - 120.0]

So your GFR is normal and your ACR is normal, I don't see why your kidney function has been flagged up.

 

[SheilaCanning]

Hello Sheila and again congratulations on the changes which have seen big improvements in HBA1c and weight loss. We're all works in progress and your team usually don't see many type 2s who improve their health like you've already done so whether or not you get a pat on the back please give yourself one!
The trig/HDL ratio is a good risk predictor for heart disease (better than LDL in fact). Trig are the a good reflection of how carb tolerant you are in that if your body can't store excess carbs as muscles glucose (glycogen) or in your sub cutaneious fat (love handles not belly fat) it turns them into triglycerides in the liver. Your HDL is important because it sweeps up excess triglycerides and small dense lipo proteins (VLDL) that can be damaging to arteries, so if the HDL is lower than trigs it is an indication of your body not quite dealing with the carbs you are eating.
I am not sure if the test is always reliable but your previous results show a similar ratio and ideally being even more careful with the carbs but enjoying protein/non starchy stuff/dairy should help improve the ratio further . Ideally you want HDL above 1.0 and triglycerides below 1.7 or at least equal to or lower than the HDL.
If you can continue to lower both waist (to be half your height) size and glucose levels (hba1c) then this will be a good sign of improving liver health too because you will be losing the dangerous fat that accumulates around your liver and pancreas.
Its up to you re meds (stains and metformin may be offered) so have a good think about the pros and cons and have questions before you see the team. How is your BP btw?

Thank you so much! Yes, I definitely want to continue with this diet and need to get back to exercising more often too. I really would like to manage as much as possible without medication as side effects are always tricky and I'm already struggling with HRT. I think they have marked things as borderline and to be discussed so I'll ahve to wait a couple of weeks to hear what they say. I'm feeling pretty down because one of my main symptoms of illness was extreme bloating but since low carbing that had gone but now it's back with a vengeance. I'm so tired of blaming myself for everything that goes wrong - thinking oh I did eat a potato and have a glass or two of wine, but that shouldn't kick things off so badly. I had to speak to Occupational Health this week and the nurse was lovely and said I was in a perfect storm of hormones as diabetes is hormonal (which I had no idea about) as is the perimenopause of course.
My blood pressure averaged out over a week at about 132/80 I think which is pre-high blood pressure.
I'm a wreck. Sigh.

 

[bulkbiker]

The fasting? Yes, I only had water with a tablet at about 10 pm and nothing else.
HDL up is good?
What does the triglyceride number refer to?
And yes, I'm low carb not kept.

Thanks for taking the time - it's much appreciated.

The Trig number measures the amount of triglycerides in the blood.
These are thought to be easily influenced by diet (hence the question about what you had eaten before the blood draw).

Current modern thinking is that the ratio of Triglyceride to HDL is one of the more important indicators of possible future heart trouble. Trig/HDL below 0.87 s considered as excellent.

Your most recent level is 2.05/1.21 = 1.69 so needs a bit more work.
Avoiding carbs is the best way to get Trig numbers lower and raise HDL.

Your HDL is going up slowly which is good.

 

[NicoleC1971]

Thank you so much! Yes, I definitely want to continue with this diet and need to get back to exercising more often too. I really would like to manage as much as possible without medication as side effects are always tricky and I'm already struggling with HRT. I think they have marked things as borderline and to be discussed so I'll ahve to wait a couple of weeks to hear what they say. I'm feeling pretty down because one of my main symptoms of illness was extreme bloating but since low carbing that had gone but now it's back with a vengeance. I'm so tired of blaming myself for everything that goes wrong - thinking oh I did eat a potato and have a glass or two of wine, but that shouldn't kick things off so badly. I had to speak to Occupational Health this week and the nurse was lovely and said I was in a perfect storm of hormones as diabetes is hormonal (which I had no idea about) as is the perimenopause of course.
My blood pressure averaged out over a week at about 132/80 I think which is pre-high blood pressure.
I'm a wreck. Sigh.

Expecting that hormone storm myself - sounds fun! Don't blame you for having the odd glass of wine etc....
130/80 is really nothing to write home about (not requiring meds) and all your figures should get better as your diabetic numbers improve via diet. I am a PT so can only agree that building a bit more muscle will help you feel better and stronger!

 

[Outlier]

For those of us who have a bad menopause, it adds a most unwelcome dimension to blood readings whether on HRT or not, and it would be a hot day in Manchester if this were only taken into account by medics treating other issues. We can only steer our way through the storm, and it is absolutely NOT your fault, any of it.

 

[SheilaCanning]

I have just had my annual diabetic review phone consult and I am officially in remission and pre-diabetic which is great. We had a chat about statins and I said my cholesterol has actually come down a bit and I'd like to try without meds for now and see if I can reduce it a bit more. She mentioned I should look at a low lipid diet which I'm not sure about; I am definitely eating more butter and cheese than before but I suspect exercise might help more. I have got out of a proper exercise routine. What do you think?

I also have to go for a foot check.

Overall I'm pleased. It's not fast progress but ut feels solid and sustainable which is important.

Thanks again for all your help.

 

[bulkbiker]

She mentioned I should look at a low lipid diet which I'm not sure about;

Good because it's nonsense.

Your body decides how much cholesterol it needs (we'd die without it) and what you don't eat your liver makes.

 

[Outlier]

I wish my GP knew that.