Prediabetes HBA1c = normal, BS = Diabetes. Which is correct?

[Growling Frog]

Hi there.

My test results are

HBA1c 40 mmol. 5.8%

Fasting BS 7.1

I’m confused as to what is my diabetic status.

Anyone got any suggestions?

Thank you

 

[Goonergal]

Hi there @Growling Frog

Your GP or medical professional is the only person who can make a formal diagnosis, but the numbers you have given fall below the threshold for a diagnosis in the UK and a number of other countries. Here an HbA1c of 48 or above is considered diabetic and 42-47 pre-diabetic and anything below that as ‘normal’.

As someone managing type 2 via diet I’d want to keep my HbA1c below 40 if possible and don’t fully agree with the distinction between diabetes and pre-diabetes.

What has your doctor said and what are you worried/concerned about in particular?

 

[MarkMunday]

HBa1c of 5.8% is high-normal. Most non-diabetics have HBA1c of 4.3-4.8%. Fasting blood glucose of 7.1 shows that blood glucose rises above normal in the morning, when insulin needs are the greatest. Discuss it with your doctor. A cautious response would be to preempt a diabetes diagnosis by attending to lifestyle issues - diet and exercise. Hopefully it won't get worse.

 

[Brunneria]

Hi there.

My test results are

HBA1c 40 mmol. 5.8%

Fasting BS 7.1

I’m confused as to what is my diabetic status.

Anyone got any suggestions?

Thank you

Hi and welcome,

Some members here take their fasting blood glucose readings every day, for months at a time, and they quickly learn how variable fasting readings can be. All sorts of things affect it, from sleep patterns or deprivation, stress levels, and so on, not necessarily anything to do with diabetes.

Going back a few years, doctors in the UK used to test people's fasting blood glucose and consider that above 7mmol/l could be indicative of diabetes, but there were always further tests for confirmation, and nowadays the HbA1c is considered a better gauge because it represents an average rather than a one off higher than normal.

At this stage, with those results, I would encourage you to make sensible lifestyle choices (avoid large portions of carby foods like bread, potatoes, sweet fruit, sugar, pasta, rice, etc, and lead a reasonably active lifestyle). Then get yourself checked out by a doc periodically. If you get into a habit of making sensible choices now, then you may well improve your health in the long term, in a way that means your body has better blood glucose readings for the next few decades. But it is important to remember that a few readings that are higher than normal does not mean that you are automatically heading into diabetes. By far the majority of people may have the odd high reading but do not progress into major blood glucose dysregulation.

 

[Daibell]

The HBA1C number is the one to use due to the overnight liver dump affecting fasting readings

 

[Growling Frog]

Thanks everyone for your replies. Very helpful. Appreciate your more experienced perspectives. I guess I was looking to see how drastic I needed to change my lifestyle. But really since the reaults I’ve cut out sugar and all the big carbs. Have gone LC and upped exercise. I was BMI 24 so didn’t have much weight available to shift. But have got to work on visceral fat. Fasting BS is now down to 4.8 so the diagnosis, despite the confusion has done its job of raising awareness to what could lie ahead if I didn’t change my eating and exercise habits. Feel much better for it also.

 

[DCUKMod]

@Growling Frog - what have you actually been diagnosed with? Apologies if I missed it, along the way.

 

[NicoleC1971]

Thanks everyone for your replies. Very helpful. Appreciate your more experienced perspectives. I guess I was looking to see how drastic I needed to change my lifestyle. But really since the reaults I’ve cut out sugar and all the big carbs. Have gone LC and upped exercise. I was BMI 24 so didn’t have much weight available to shift. But have got to work on visceral fat. Fasting BS is now down to 4.8 so the diagnosis, despite the confusion has done its job of raising awareness to what could lie ahead if I didn’t change my eating and exercise habits. Feel much better for it also.

Great that you've taken preventative action given that type 2/insulin resistance is more of a spectrum. The diagnosis is set where it is at 7% hba1c because it is at this point that complications trend upwards sharply but the actual process of becoming insulin resistant will have been going on for a long time before the stage at which the blood sugar rises enough to be diagnosed as type 2 and that matters because insulin resistance is the root cause of the problems with type 2. I am glad that you are feeling a lot better for the changes that you have made and hope that this will just become part of your lifestyle now!

 

[Growling Frog]

@Growling Frog - what have you actually been diagnosed with? Apologies if I missed it, along the way.

No, you haven’t missed anything. It’s a very good question. Initially when my fasting BS came in, doc said diabetic. I don’t remember what the actual figure was. So I went for 2nd BS test + HBA1c. 2nd BS was 7.1 confirming 1st test. And the HBA1c came in at 5.8% which pathology lab said indicated ‘prediabetes’. So I was/an somewhere in limbo. Anyhow it’s just a label really as both require the same permanent diet and exercise changes.

 

[Growling Frog]

Great that you've taken preventative action given that type 2/insulin resistance is more of a spectrum. The diagnosis is set where it is at 7% hba1c because it is at this point that complications trend upwards sharply but the actual process of becoming insulin resistant will have been going on for a long time before the stage at which the blood sugar rises enough to be diagnosed as type 2 and that matters because insulin resistance is the root cause of the problems with type 2. I am glad that you are feeling a lot better for the changes that you have made and hope that this will just become part of your lifestyle now!

Thanks Nicole.

 

[Mbaker]

I would give more weight to the fasting blood glucose if similar numbers are experienced. HbA1c is not a slam dunk, but is a useful indicator. David Bobbet of IHDA (Irish Heart Disease Association) "aced his blood tests" (Ivor Cummins) with a low 5 A1c, but still had diabetes according to Ivor. This was due to extreme post prandial spikes.

A1c in my case is problematic, it has remained around 38 for several years on a hospital assay, 35 ish via Medichecks and 31 A1cNow÷. During these years of testing my finger prick tests show an 90 day average of 4,4 (over 6 meters), 2 proven to be accurate by my surgery. Many Freestyle Libre tests have show a continual improvement in readings with projected A1c's in the 20's. My variance never goes above 2 and is usually 1.4. How has my blood sugar got much lower yet A1c remains similar.

In my case it might be the exercise I do, as I know athletes can have pre-diabetic numbers, but then I would expect meters to show 6"s often, yet I've only seen around 3 in years of meticulous testing. I might be out of step with some views, but I feel optimal all day numbers are 4's and 5's, so having your 7.1 rechecked a few times should tell you where you are - probably insulin resistant; if you can get your triglyceride to HDL ratio, this is a good proxy measure of IR.

 

[Growling Frog]

Yes. I agree with you re the weight one should place on BS and HbA1c results. Since changing my diet I am hitting 4.8 fasting BS and rarely go over mid 5’s post prandial. But I am on the lookout for post prandial spikes and when I discover one will ensure the conditions aren’t repeated. The only issue have there is the acute stress I encounter in my job which can’t be worked around without a career change. But post Covid there’s not been any work so that’s a fight for another dsy. My Tri/HdL ratio is 1.3, which I don’t think is in any danger zone.

 

[Growling Frog]

I got the TG/HDL wrong, was using mmol/L. My actual ratio is 3 so def some insulin resistance. Thanks for the ‘warning’. Something else to ponder during lockdown.

 

[DCUKMod]

No, you haven’t missed anything. It’s a very good question. Initially when my fasting BS came in, doc said diabetic. I don’t remember what the actual figure was. So I went for 2nd BS test + HBA1c. 2nd BS was 7.1 confirming 1st test. And the HBA1c came in at 5.8% which pathology lab said indicated ‘prediabetes’. So I was/an somewhere in limbo. Anyhow it’s just a label really as both require the same permanent diet and exercise changes.

So, going back to the point, are you actually formally diagnosed with anything? It can make a material difference to the appropriateness of any advice of suggestions members might offer you.

It may be "just a label", but it is a materially important label in a health forum.

 

[Growling Frog]

So, going back to the point, are you actually formally diagnosed with anything? It can make a material difference to the appropriateness of any advice of suggestions members might offer you.

It may be "just a label", but it is a materially important label in a health forum.

My apologies for not knowing what is ‘materially important in a health forum’. Perhaps you need to warn people they must know these things before they dare to post. Maybe don’t be so sniffy with people who are new to the forum.

 

[Brunneria]

My apologies for not knowing what is ‘materially important in a health forum’. Perhaps you need to warn people they must know these things before they dare to post. Maybe don’t be so sniffy with people who are new to the forum.

Actually, getting clear information can make a very big difference, depending on the various health conditions, dietary needs, medical histories, medications, and types of diabetes.

Since you are new to the forum you may not realise how many new members we get who arrive and post with incomplete profiles, incomplete questions, and often no mention of whether they have diabetes or not - or what type of diabetes it might be. We (members and moderators alike) often need to ask all sorts of questions in order to get an understanding of how to answer a query.

This forum welcomes people whatever their state of glucose (dys)regulation, and whatever relationship they have to diabetes. So, as a possible prediabetic you are just as welcome as a Type 3c on insulin and Creon. But putting a clear indication on your profile, or giving a clear answer when members ask a question, will save everyone having to clarify things before they venture to respond to you.

 

[Growling Frog]

Actually, getting clear information can make a very big difference, depending on the various health conditions, dietary needs, medical histories, medications, and types of diabetes.

Since you are new to the forum you may not realise how many new members we get who arrive and post with incomplete profiles, incomplete questions, and often no mention of whether they have diabetes or not - or what type of diabetes it might be. We (members and moderators alike) often need to ask all sorts of questions in order to get an understanding of how to answer a query.

This forum welcomes people whatever their state of glucose (dys)regulation, and whatever relationship they have to diabetes. So, as a possible prediabetic you are just as welcome as a Type 3c on insulin and Creon. But putting a clear indication on your profile, or giving a clear answer when members ask a question, will save everyone having to clarify things before they venture to respond to you.

I’ve been as clear as I know how to. I’ve given my results and my question. You now know as much as I do. However there is no need for DCUK MOD giving me a superior and rude attitude. It’s completely unnecessary and unhelpful. Worse. It drives people away.

 

[DCUKMod]

@Growling Frog - Where things are not clear are your profile is marked as T2, but your thread is prefixed Prediabetes, so there is a good deal of room of confusion.

If you haven't been formally diagnosed with diabetes, or pre-diabetes by your Doctor, you have the options to modify your profile.

To do that, in your browser (on a PC/Laptop or on your mobile or handheld device), just hover your cursor over your user name at the top right of the page, then click on Personal Details, and you'll see all the available options there.

If anything Growling Frog, my approach is to try to help member receive the most appropriate information and guidance. If you feel my attitude was "superior and rude", I apologise.

I'll keep out of your hair.

 

[Growling Frog]

@Growling Frog - Where things are not clear are your profile is marked as T2, but your thread is prefixed Prediabetes, so there is a good deal of room of confusion.

View attachment 43171

If you haven't been formally diagnosed with diabetes, or pre-diabetes by your Doctor, you have the options to modify your profile.

To do that, in your browser (on a PC/Laptop or on your mobile or handheld device), just hover your cursor over your user name at the top right of the page, then click on Personal Details, and you'll see all the available options there.

If anything Growling Frog, my approach is to try to help member receive the most appropriate information and guidance. If you feel my attitude was "superior and rude", I apologise.

I'll keep out of your hair.

My apologies. I'd say I was low blood sugar when I responded. I've been quite sensitive and snappy and don't like myself for it. I think I've got that under control now.

I have changed my profile to state, diabetic as that is what the doctor is stating is my diagnosis and he wont budge.

Apologies once again.