Fructosamine Test

[Needing help!]

Hello,
I have just been to see a private nephrologist about excessive fluid loss and high blood sugar spikes (reaching between 14-18 mmol/l pretty much every night around 4am) despite a seemingly normal HbA1c, because my GP is being exceptionally dismissive.
He recommended a fructosamine test as an alternative to HbA1c might help explain high blood sugars if my HbA1c clearly isn't shedding any light on the situation
After a bit of googling it seems the fructosamine test reflects blood protein glycation over the last 2-3 weeks, so will not rely on haemoglobin levels (I am anaemic with low haematocrit so that may be skewing my HbA1c?). It will also give a much more recent picture rather than the 2-3 months of HbA1c.
I was just wondering whether anyone else had ever had this test and if they had any comparisons between their HbA1c and fructosamine test (were they similar for example?), and did the doctor actually take any note of this as google seems to say most doctors don't like using the fructosamine test?
I'm just worried my GP will ignore the result (if it even is abnormal/raised that is) and still go with the HbA1c as it is the more standard and recognised test? Don't want to be paying loads for private tests for the NHS to then not act on them because they weren't ordered by them in the first place!
Thanks!

 

[AndBreathe]

Hello,
I have just been to see a private nephrologist about excessive fluid loss and high blood sugar spikes (reaching between 14-18 mmol/l pretty much every night around 4am) despite a seemingly normal HbA1c, because my GP is being exceptionally dismissive.
He recommended a fructosamine test as an alternative to HbA1c might help explain high blood sugars if my HbA1c clearly isn't shedding any light on the situation
After a bit of googling it seems the fructosamine test reflects blood protein glycation over the last 2-3 weeks, so will not rely on haemoglobin levels (I am anaemic with low haematocrit so that may be skewing my HbA1c?). It will also give a much more recent picture rather than the 2-3 months of HbA1c.
I was just wondering whether anyone else had ever had this test and if they had any comparisons between their HbA1c and fructosamine test (were they similar for example?), and did the doctor actually take any note of this as google seems to say most doctors don't like using the fructosamine test?
I'm just worried my GP will ignore the result (if it even is abnormal/raised that is) and still go with the HbA1c as it is the more standard and recognised test? Don't want to be paying loads for private tests for the NHS to then not act on them because they weren't ordered by them in the first place!
Thanks!

If your nephrologist has concerns, believing a Fructosamine test could be valuable to you, he could ask your GP to run it. That way your GP could not ignore the results.

 

[EllieM]

Fructosamine tests are pretty standard for pregnant women (or were in my pregnant days), just because of the short term measurenent. I don't think my results showed up anything strange but I got the impression that fructosamine results were much less well understood.

I have no idea of the accuracy, but this thread here claims to have a conversion table
Converting Fructosamin values to HbA1c | Diabetes Forum • The Global Diabetes Community

Anaemia is well known (though maybe not to your GP) to skew hba1c results.

I take it your GP is refusing to refer you to anyone because of the normal hba1c???
If I were in your position, I'd definitely push for the test.

 

[Needing help!]

If your nephrologist has concerns, believing a Fructosamine test could be valuable to you, he could ask your GP to run it. That way your GP could not ignore the results.

Thank you for your suggestion - unfortunately, I haven’t had much success so far with trying to merge the private and NHS routes - it seems both like to stick to their own systems and neither seem keen to utilise the other…

 

[Needing help!]

Fructosamine tests are pretty standard for pregnant women (or were in my pregnant days), just because of the short term measurenent. I don't think my results showed up anything strange but I got the impression that fructosamine results were much less well understood.

I have no idea of the accuracy, but this thread here claims to have a conversion table
Converting Fructosamin values to HbA1c | Diabetes Forum • The Global Diabetes Community

Anaemia is well known (though maybe not to your GP) to skew hba1c results.

I take it your GP is refusing to refer you to anyone because of the normal hba1c???
If I were in your position, I'd definitely push for the test.

yes, the GP is refusing to accept there is a problem and is quite close-minded on the whole thing - assuming HbA1c is the answer to everything.
Unfortunately, my relationship with my GP has really broken down over the last couple of months as I keep trying to prove myself as I just know in my body and myself that something isn't right and my body isn’t responding normally at the moment. They are getting increasingly frustrated and insistent that there is nothing they can do to help me, hence why I’ve had to resort to going private.
The problem now is that I just don’t have the money to keep funding this privately and am really getting to end of my tether about what to do anymore

 

[EllieM]

yes, the GP is refusing to accept there is a problem and is quite close-minded on the whole thing - assuming HbA1c is the answer to everything.
Unfortunately, my relationship with my GP has really broken down over the last couple of months as I keep trying to prove myself as I just know in my body and myself that something isn't right and my body isn’t responding normally at the moment. They are getting increasingly frustrated and insistent that there is nothing they can do to help me, hence why I’ve had to resort to going private.
The problem now is that I just don’t have the money to keep funding this privately and am really getting to end of my tether about what to do anymore

Is changing GPs an option?

 

[AndBreathe]

yes, the GP is refusing to accept there is a problem and is quite close-minded on the whole thing - assuming HbA1c is the answer to everything.
Unfortunately, my relationship with my GP has really broken down over the last couple of months as I keep trying to prove myself as I just know in my body and myself that something isn't right and my body isn’t responding normally at the moment. They are getting increasingly frustrated and insistent that there is nothing they can do to help me, hence why I’ve had to resort to going private.
The problem now is that I just don’t have the money to keep funding this privately and am really getting to end of my tether about what to do anymore

But, in my experience the Consultant will write to your GP giving a brief overview of the consultation and any conclcusions he has reached, and any next steps to be taken.

In my personal experience an Endo I was consulting (relating to my wonky thyroid gland) wanted a raft of blood tests done, because of my family history mainly. He just pipped up that he'd ask my GP to order them up. As he is also an NHS consultant he can see the results directly and we'd take it from there.

Those tests revealed nothing - zero, but later GP tests did, and I now see the same Endo as an NHS patient.

Again, in my personal experience, I have striven very hard to maintain decent working relationships with my GP. The btoom line is they are our gateway to any secondary care we need, and if we want to be engaged in our own healthcare, then a cordial working relationship is necessary. I try very VERY hard not to try to tell my GP what's wrong with me in any way that could be described as self-diagnosis, but I will often tell them I've consulted Dr Google (cue rolling of eyes from the other side of the desk), and tell them my findings. That sometimes helps move forward, or it requires them to tell my why my reading or feelings are wrong.

To be clear, that doesn't always mean I agree with them, or that I always accept their decision as final. Sometimes I will adopt a negotiating stance, and end up compromising on my ideal outcome, and sometimes I have to give in - for now.

With out health, we are playing the long game.

Finally, I don't see anywhere where you disclose your ethnicity. The only reason I ask is that for certain racial groups, the A1c test is less robust that it could be, and for those groups the Fructosamine test can results more reflective of the position. Just a thought.

 

[JohnEGreen]

Another condition that can invalidate or skew an A1c test is CKD so if you are having problems with your kidneys then it may be worth pointing that out to your GP though my GP did not take much notice I must admit.

 

[Oldvatr]

Your haematocrit may also skew any glucose meters used for fingerpick testing.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692232/

Low haematocrit can give false highs and vice versa.