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Happy with annual HbA1c result, but need other encouragement please

Discussion in 'Type 2 Diabetes' started by Ryhia, Aug 5, 2020.

  1. Ryhia

    Ryhia Type 2 · Well-Known Member

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    Apologies for the long post but looking for advice and encouragement.

    Had my bloods taken at the beginning of the week and HbA1c has returned 38 one point down on a year ago so I'm happy with that, all other checks look good as well except for cholesterol!. At the beginning of my diabetes journey, test results saw my cholesterol in the 4s, I took up low carb and 6 months later my test came back at 6.7, a bit of a rise. I posted to this forum and was encouraged by what I read and the advice I received it was mentioned that as I was losing weight my cholesterol may been all over the place, that I was probably a hyper responder and that once my weight stabilised it was likely that my cholesterol would as well. I argued at my DN review against statins and continued my low carb way of eating which is keeping my bloods stable without having to take tablets for which I am so thankful.

    I stopped losing weight around December so I was hoping my cholesterol would come back lower this HbA1c but not so! My cholesterol has come back at 10! As you can imagine I got a bit of a shock. I learned of the results when I received a phone call from the practice today, they want me to take another fasting blood test and doc (not my usual doc) wants to see me when I get the results. I had already fasted for this one so the results are unlikely to be different. I got over it when my results were 6.7 but I admit to being quite concerned now they are 10, I think I will have a pretty uncomfortable visit with the doc but I will be asking to try to deal with this by diet but not sure how? How do you lower you cholesterol whilst eating low carb and high fat has anyone done this and can they advise?

    My cholesterol test results are below. As mentioned previously on this forum, I have put them through both Hugh's Calculator https://www.hughcalc.org/chol-si.php and Dave Feldman's checker, https://cholesterolcode.com/report/ but the results are very different, I would be interested if anyone has got any opinion of which calculator is the best one to consider?

    Thanks in advance.

    Results are:
    Serum Cholesterol 10
    Serum Triglycerides 0.9
    HDL Cholesterol 1.9
    LDL 7.69 (I think)

    Dave Feldman's calculator
    Atherogenic Index of Plasma: -0.325 mg/dL = Lowest Risk Third
    Low Risk <––-0.325––•––––––––––•––––––––––> High Risk

    Framingham Offspring: 0.7 Odds Ratio = Low Risk
    Low Risk <–––•0.7•–––•–––•–––•–––•–––•–––•–––•–––•–––> High Risk

    Jeppesen risk tertial: Lowest Risk Third
    Low Risk <––––[X]––––•––––––––––•––––––––––> High Risk
    ------------------------------------------------------------------------------------------

    Hugh's Calc
    Your Total Cholesterol of 10.00 is HIGH RISK
    Your LDL of 7.69 is VERY HIGH RISK
    Your HDL of 1.9 is OPTIMAL
    Your Triglyceride level of 0.89 is NORMAL
     
  2. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    Rhyia - My Total cholesterol is always what my former GP and I agreed is an "inconveniently large number". At first she used to get uptight about it, but as "we" learned more about the breakdown, she changed her views.

    My highest total, to date, since my T2 has been in a good place, was 8.1. At that point, my GP wanted to refer me to the Lipid Clinic, even though she understood my breakdowns were very good,for a specialist opinion and further testing to rule in or our familial hypercholesterolaemia.

    I was just going overseas for a couple of months, so we deferred the referral until I got beck. At that retest, I had trimmed back to a TC of 7.4, which took me out of the bracket where she felt the need to refer me on.

    In your shoes, I would ask for a referral, prior to considering anything further, but how you tackle it is up to you.
     
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  3. HSSS

    HSSS Type 2 · Expert

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    Well your triglycerides are great.! The calculators all agree you aren’t at risk.

    I’d be taking these calculations to your appointment and asking your dr to discuss further before taking any action. Quite possibly asking for a cac scan or particle size test and maybe a referral to a specialist to discuss further. Perhaps your ldl is large and fluffy (protective) rather than small and dense (potentially harmful) as this is common on low carb.
    I understand it’s scary to resist conventional thinking but at the least get strong evidence from them before changing your stance.
     
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  4. ianf0ster

    ianf0ster Type 2 · Well-Known Member

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    Hi, Your LDL number (which isn't actually measured but calculated by one of 2 methods) is unusually high.

    I don't know anything about 'Hugh's Calc', but using the Dave Feldman ratios your numbers are good, as are 2 of the 3 that Dr Paul Mason uses.
    But with a good HDL number and a great Trigs number, I personally wouldn't be accepting statins (unless I wanted to take them) without either an LDL Particle count or a CAC scan.

    I admit the decision is easier for me because my calculated LDL isn't as high as yours, but neither are my Triglycerides anywhere near as good as yours!
     
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  5. Ryhia

    Ryhia Type 2 · Well-Known Member

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    Thanks for your response.. Did you do anything to deliberately lower your cholesterol?
     
  6. Ryhia

    Ryhia Type 2 · Well-Known Member

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    I am hoping that my ldl is the protective type - the doctor who has requested the further test is my named doctor at the practice but I have never seen him (don't even know what he looks like) so I don't know how sympathetic or knowledgeable he is in respect of low carb diets, he is actually the diabetic specialist at the practice but going off previous experience with DNs that means zilch. I may try to see the doc I usually see who is young and quite up to date with modern methods. He also manages to patiently put up with my questioning and contrariness. Whether either of them will think it worthwhile to send me for further tests I am not sure but I will ask.
     
  7. Ryhia

    Ryhia Type 2 · Well-Known Member

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    Thanks for your encouragement, I admit I got a shock at the serum cholesterol level, trigs are slightly better than last time (1.0) and HDL has risen very slightly(1.3 last time) Its only the LDL which seems off the scale. I guess I wont worry until I have the results of the next blood test and then I will see what the doc says at the appointment. I do hope he will let me try to reduce the LDL by diet. I guess the issue is, am I always going to have this problem with cholesterol whilst following a low carb diet? On a very restricted diet already, I would find that to be an added aggravation.
     
  8. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    No. Nothing.

    I was unconcerned - bearing in mind my ratios have always been good. My GP, by her own admission, was just responding to the guidelines. Once the TC lowered, even that bit, she said no need for a referral unless I really wanted one.

    I'll be interested to see where it is next time around, as I finally, after a long struggle seem to be using pretty much the correct regime for managing my wonky thyroid. As the thyroid is a major player in the metabolic process, I'll be interested to see what, if any changes there have been.

    Have you decided on your own tactics yet?
     
  9. Lizzie2

    Lizzie2 Type 2 · Well-Known Member

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    Interesting that you mention thyroid you also have thyroid problems.

    When I had Graves’ disease back in 2012, my cholesterol was incredibly low. Stopped treatment in 2013 and since then my TSH and cholesterol have increased. I took statins years ago but felt really ill, couldn’t walk etc so I stopped and have no intention of starting them again.

    Last time my GP mentioned cholesterol I pointed out that it was funny but when my TSH was really low my cholesterol was low too and now that my TSH is increasing my cholesterol was increasing too and that I was sure there was a link. She smiled and said nothing.

    I’ve since researched and found there is a link between the two.. Bottom line is that I would prefer to lower my cholesterol by bringing my TSH down with some levothyroxine - which isn’t going to happen, my body also felt better when my TSH was around 1 - I’m now nearly 3. Unfortunately I’m still within ‘the range’ so although it’s obviously not in the best place for my body the NHS doesn’t ‘fine tune’. So it’s a kind of stalemate because I don’t want statins ever again and my TSH isn’t going to drop without some levo.
     
  10. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    Our thyroids are at the cornerstone of our metabolic health. It is generally accepted that euthyroid is around 2, so much above this could be considered struggling a bit. However, TSH is in no way enough information to make clinical decisions on, in my view, but sadly, that's often what happens. You really need the breakdown of your TSH, FT4, T3, antibody status, and ideally a few vitamin and mineral levels too, as they're all parts of the thyroid and metabolic jigsaw.

    Anyway, best not derail @Rhyia's thread any further. That wouldn't be fair.
     
  11. HSSS

    HSSS Type 2 · Expert

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    He recommends. You decide. He cannot force you to do anything.
     
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  12. Lizzie2

    Lizzie2 Type 2 · Well-Known Member

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    I’m offended at your final comment - I most definitely wasn't trying to derail the thread - I was just pointing out the link between thyroid and cholesterol especially as she has thyroid problems as well as high cholesterol.

    ThyroidUK consider euthyroid to be around 1 - and yes, I do private testing regularly and I know all about antibody status, TSH, T4, T3, vitamins and minerals etc. I just mentioned TSH on its own as it is the only one most doctors seem to be prepared to test these days.

    I just think doctors should treat one’s body as a whole rather than patch, patch, patch and if @Ryia’S thyroid isn’t in the right place then her cholesterol hasn’t a hope. Hope. You don’t consider I’m still hijacking her post!
     
  13. Ryhia

    Ryhia Type 2 · Well-Known Member

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    It says on my test results Serum TSH level normal : TSH level 1.97 so without knowing any better and seeing the word "normal" makes me assume all looks ok on the thyroid front. All other markers were good apart from the cholesterol. Even BP measured 120/80, although my BP is usually lower at home.
     
    #13 Ryhia, Aug 6, 2020 at 2:49 PM
    Last edited: Aug 6, 2020
  14. Ryhia

    Ryhia Type 2 · Well-Known Member

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    I haven't decided what to do or even which doc to see, I am due my test today so I will look at options after. While I am waiting for the results and the subsequent call back, I will be doing a lot of research on cholesterol and statins so that I have some ammunition and scientific sources to quote. Thank you @bulkbiker for creating the original cholesterol and statins thread, a great source of information. With the high results, I am a little worried in case I have familial hypercholesterolemia as my father died of heart disease and my brother had a heart attack just a few weeks ago. I also have had xanthelasma many years ago over my eyelids which was lasered away but I have noted that a couple of instances of cholesterol spots showing up again. I feel I need further investigative tests. I do not want to take statins but that may be the course I need to consider. I know I will be asking to sort this by diet rather than statins but for my own peace of mind I feel I need to try to get the LDL lower. They might be fluffy protective LDL but then they might not. Whether they will send me for tests is debatable when there is a cheaper statin option. We will see.
     
  15. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    With a TC at 10, plus family history, I would think a referral could be very justifiable.

    There are other cholesterol lowering medications that can be used for FHC.

    Good luck with it all. It must be a bit of a concern, with the family history in play.

    Despite being a thoroughbred Scot, there is, to date, no know cardiac history in our family.
     
  16. Ryhia

    Ryhia Type 2 · Well-Known Member

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    Had a phone appointment with the doc this morning had a good discussion and I believe he is going to refer me to a lipidologist. I have a face to face meeting on Friday. He reckons I have too many markers for future heart issues apparently new to me but I have had higher than normal cholesterol levels since 2003.
     
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