How do they diagnose diabetes

[TuTusweet]

I ask because my GP said during World Diabetes Week in 2013 "I think you have diabetes and want to give you tablets". This seemed to be based on a blood test that showed a high A1c ( 6.2 % ) that was very similar to 7 previous blood tests over the previous 4.5 years that she had ignored. Maybe there was a new car on offer for the GP with the most new diabetics.

The point I'm nearly arrived at is that I had no other tests or anything. What did mystify me was she said "take one of these tablets per day and come back and see me in a year" So she didn't seem too concerned and anyway got the dose wrong. The manufacturers say it is essential that two are taken 12 hours apart. She said nothing about kidney and liver function tests to check monthly for organ damage.(Manufacturers recommendation).
I refused to take the tablets ---they seem to be excessively powerful for a beginner and told her I would exercise and lose weight .
She shrugged and said carry on.

Conclusion--I don't think I ever had diabetes and had nothing done to confirm or refute the slap dash statement by my GP. I'm getting sick of thinking of myself as a diabetic. I'm going to drop the label. Do you think I am justified?
OR at worst I was pre diabetic and my diet and weight loss (3.5 stone) has caught it.

[BG on waking between 5.6 and 6.4 (Direct correlation with previous day's carb intake) no drugs at all ,could still do more exercise very low carb diet.]

 

[urbanracer]

I ask because my GP said during World Diabetes Week in 2013 "I think you have diabetes and want to give you tablets". This seemed to be based on a blood test that showed a high A1c ( 6.2 % ) that was very similar to 7 previous blood tests over the previous 4.5 years that she had ignored. Maybe there was a new car on offer for the GP with the most new diabetics.

The point I'm nearly arrived at is that I had no other tests or anything. What did mystify me was she said "take one of these tablets per day and come back and see me in a year" So she didn't seem too concerned and anyway got the dose wrong. The manufacturers say it is essential that two are taken 12 hours apart. She said nothing about kidney and liver function tests to check monthly for organ damage.(Manufacturers recommendation).
I refused to take the tablets ---they seem to be excessively powerful for a beginner and told her I would exercise and lose weight .
She shrugged and said carry on.

Conclusion--I don't think I ever had diabetes and had nothing done to confirm or refute the slap dash statement by my GP. I'm getting sick of thinking of myself as a diabetic. I'm going to drop the label. Do you think I am justified?
OR at worst I was pre diabetic and my diet and weight loss (3.5 stone) has caught it.

[BG on waking between 5.6 and 6.4 (Direct correlation with previous day's carb intake) no drugs at all ,could still do more exercise very low carb diet.]

Not sure where you are. I'm in the UK and was told by my endo' that here we diagnose diabetes with an a1c of 6.5%. So your story sounds a little strange and I would think a little too soon to be on meds. But will be interested to read what others have to say. Your doc may be trying to pre-empt a worse situation.

Do you test your blood glucose after meals?

 

[Daibell]

One cynical answer is guesswork like my GP did for me. The HBa1C test is a good test overall but the marginal level of 6.2'ish is a bit arbitrary and depends on the individual. Whether your bs spikes over the magic number of 8.5mmol 2 hours after a meal with this HBa1C is also a useful measure. A lower-carb diet is the first thing to try as it avoids any unnecessary medication, then Metformin which is very safe if needed. What drug did you take?

 

[tim2000s]

I was going to respond "badly", but didn't think it would be all that helpful...

 

[DavidGrahamJones]

I ask because my GP said during World Diabetes Week in 2013 "I think you have diabetes and want to give you tablets". This seemed to be based on a blood test that showed a high A1c ( 6.2 % ) that was very similar to 7 previous blood tests over the previous 4.5 years that she had ignored. Maybe there was a new car on offer for the GP with the most new diabetics.

Other blood tests would confirm her "guess". You might like to look for another GP. Just a thought.

The point I'm nearly arrived at is that I had no other tests or anything. What did mystify me was she said "take one of these tablets per day and come back and see me in a year" So she didn't seem too concerned and anyway got the dose wrong. The manufacturers say it is essential that two are taken 12 hours apart. She said nothing about kidney and liver function tests to check monthly for organ damage.(Manufacturers recommendation).
I refused to take the tablets ---they seem to be excessively powerful for a beginner and told her I would exercise and lose weight .
She shrugged and said carry on.

I can only guess that you were prescribed Metformin as this is quite often the first line of treatment for somebody who has been diagnosed as being type II diabetic. However, not all manufacturers say that it is essential to take two tablets 12 hours apart although this is quite often what happens. I'd be interested to learn what manufacturers recommend monthly blood tests for liver and kidney function. Mine used to be twice a year along with the HbA1c now only once a year.

Conclusion--I don't think I ever had diabetes and had nothing done to confirm or refute the slap dash statement by my GP. I'm getting sick of thinking of myself as a diabetic. I'm going to drop the label. Do you think I am justified?

I'm diabetic and the "label" has never bothered me, probably because I don't think of it as a label, just describes a condition that I have.

OR at worst I was pre diabetic and my diet and weight loss (3.5 stone) has caught it.

[BG on waking between 5.6 and 6.4 (Direct correlation with previous day's carb intake) no drugs at all ,could still do more exercise very low carb diet.][/QUOTE
Well done on the weight loss, low carb will help a lot.

 

[micksmixxx]

Dear TuTusweet,

Your HbA1c level of 6.2% indicates that you are pre-diabetic. A non-diabetic's HbA1c level would be 5.6% or lower. Between 5.7% and 6.4% indicates pre-diabetes, and 6.5% or higher indicates diabetes.

A fasting (after not eating and drinking overnight) blood glucose level should be below 5.5 mmol/l (millimoles per litre) for a non-diabetic.

Two hours post prandial (after eating), a non-diabetic's blood glucose level would rarely, if ever, be above 7.8 mmol/l. I say rarely as there are occasions when it could be higher, such as if the person being tested had one or more comorbid medical condition(s) that are known to cause raised blood glucose levels; if the person being tested was undergoing extreme stress at the time of being tested; or if the person being tested was taking certain types of medication which are known to cause a rise in blood glucose levels. (These medications include those that contain steroids, such as the types used in the treatment of asthma, or for the treatment of certain specific types of infection.)

Although your doctor took, in my humble opinion, far too long before starting you on medication, it's a good job that she did. This is because type 2 diabetes is a 'progressive' condition, which means that it's LIKELY to get 'worse' over a period of time ... that's worse in that the medication that you were started on PROBABLY won't be sufficient to keep your blood glucose levels under control. This occurs because the body's cells become more insulin resistant, which means that your pancreas would be called upon to produce larger and larger quantities of insulin. We all require insulin to survive. It acts as a sort of 'key' that unlocks the body's cells so that glucose, which we get primarily from the breakdown of carbohydrates and starches during the digestive process, into the body's cells where it is used to create energy, thereby keeping us alive.

You don't state which specific tablet it was that your doctor prescribed for you, but I wouldn't be at all surprised if it was Metformin (Glucophage). This is one of the more common medications to start a type 2 diabetic, or a pre-diabetic on. This type of medication, however, does NOT stimulate the pancreas to work more efficiently ... or produce more insulin. It works in a different manner. (It inhibits absorption of glucose through the walls of the intestines; it inhibits production of glucose by the liver; and it MAY help to reduce insulin resistance.)

Sadly, Metformin does have a rather 'strong effect' on giving gastrointestinal upsets. i.e. it MAY give you the 'trots', and it MAY make you feel nauseus or even make you vomit. This does NOT occur with all diabetics that take it. (Often, SOME doctors give the wrong advice on when to take Metformin, giving advice to take it immediately prior to eating or after eating, when, in fact, taking it at the same time as eating has proven to be more beneficial in cutting back on the gastro intestinal side-effects that some diabetics experience from taking it.)

It's sad that your doctor didn't follow up with kidney and liver functioning tests as diabetes, in itself, can cause diabetes-related problems 'further down the road' when blood glucose levels aren't kept at a 'normal' level. You MAY well have heard of some diabetics that have had to have amputations of toes/feet/legs, needing to go onto renal (kidney) dialysis, going blind, having strokes, etc. Unfortunately, the chances of these complications occurring is higher when blood glucose levels aren't controlled. (There are a number of other complications, too, which can occur, such as different types of neuropathy (nerve-ending damage), loss of sexual function, bowel and bladder problems, teeth and gum problems, blood pressure control, and a whole host more.)

Please don't be frightened about what I've said with regards to diabetes-related complications as these, generally, take many years to develop. They are NOT something that suddenly occurs overnight.

Even though you, apparently, have made wonderful strides since refusing to take the medication offered to you, by losing weight and exercising more, this does NOT mean that your blood glucose levels won't rise again in the future. As I said earlier, it's a progressive condition, so you MAY well find that you'll need to go onto medication at some point in the future. There remains the risk factors as to why you developed hyperglycaemia (higher than 'normal') blood glucose levels in the first place. Hopefully, your dietary and exercise regime will 'prevent' you from getting much higher blood glucose levels than you're already getting, though, to be honest, you MAY still need some help in that.

I wish you well, TuTusweet.

 

[micksmixxx]

Oops! TuTusweet,

Please forgive me, but I forgot to add that measuring HbA1c levels and giving a reading in % terms is old news these days. Things have progressed in the UK and we now use mmol/mol (millimoles per mole) ... that's in IFCC (International Federation of Clinical Chemistry) units, and has been this way since 2011 in the UK.

There's actually a conversion chart that you can use on the following webpage that will convert from the older DCCT (Diabetes Control and Complications Trial) units to the newer IFCC units.

http://www.diabetes.co.uk/hba1c-units-converter.html

I also forgot to mention that the HbA1c blood test that you received gives a rough 'average' of what your blood glucose levels have been doing over the previous 3 months ... with a slight bias towards the latter 6 to 8 weeks of that time. (It's determined by how much glucose is attached to the red blood cells within your bloodstream. The reason it offers an 'average' over this length of time is that it's because that's how long red blood cells survive for before they die off and are replaced. (Obviously, they don't all die at the same time. Their lifespan is supposedly between 90 and 120 days long.))

 

[Prem51]

Although your doctor took, in my humble opinion, far too long before starting you on medication, it's a good job that she did. This is because type 2 diabetes is a 'progressive' condition, which means that it's LIKELY to get 'worse' over a period of time ... .

Even though you, apparently, have made wonderful strides since refusing to take the medication offered to you, by losing weight and exercising more, this does NOT mean that your blood glucose levels won't rise again in the future. As I said earlier, it's a progressive condition, so you MAY well find that you'll need to go onto medication at some point in the future.

@micksmixxx Although I agree with the majority of your helpful post, I felt I needed to say that diabetes is not necessarily progressive. The condition can be controlled by modifying your approach to eating, exercise, and if necessary, medication.
I know that you have qualified your comment by saying that it is 'LIKELY' to get worse, but I think that is accepting that we can't do anything to prevent ourselves getting worse.

 

[Oldvatr]

@micksmixxx Although I agree with the majority of your helpful post, I felt I needed to say that diabetes is not necessarily progressive. The condition can be controlled by modifying your approach to eating, exercise, and if necessary, medication.
I know that you have qualified your comment by saying that it is 'LIKELY' to get worse, but I think that is accepting that we can't do anything to prevent ourselves getting worse.

I agree. There are a load of succcess stories on this forum where people have successfully bought their glucose levels back from quite high levels (e.g. HbA1c of 100+) down to almost normal levels of around 40. It is not a cure, but I prefer the term remission rather than reversal. However, it does seem that diabetes can be controlled a lot better than it used to be in my mothers time, and it does seem to be sustainable, not progressive,

 

[urbanracer]

Oops! TuTusweet,

Please forgive me, but I forgot to add that measuring HbA1c levels and giving a reading in % terms is old news these days. Things have progressed in the UK and we now use mmol/mol (millimoles per mole) ... that's in IFCC (International Federation of Clinical Chemistry) units, and has been this way since 2011 in the UK.

There's actually a conversion chart that you can use on the following webpage that will convert from the older DCCT (Diabetes Control and Complications Trial) units to the newer IFCC units.

http://www.diabetes.co.uk/hba1c-units-converter.html

I also forgot to mention that the HbA1c blood test that you received gives a rough 'average' of what your blood glucose levels have been doing over the previous 3 months ... with a slight bias towards the latter 6 to 8 weeks of that time. (It's determined by how much glucose is attached to the red blood cells within your bloodstream. The reason it offers an 'average' over this length of time is that it's because that's how long red blood cells survive for before they die off and are replaced. (Obviously, they don't all die at the same time. Their lifespan is supposedly between 90 and 120 days long.))

Minor point, I am aware of the supposed change over from % to mmol, but both the general hospital I attend and my local GP are still working in % for a1c.

 

[Betes-dave]

Oops! TuTusweet,

Please forgive me, but I forgot to add that measuring HbA1c levels and giving a reading in % terms is old news these days. Things have progressed in the UK and we now use mmol/mol (millimoles per mole) ... that's in IFCC (International Federation of Clinical Chemistry) units, and has been this way since 2011 in the UK.

There's actually a conversion chart that you can use on the following webpage that will convert from the older DCCT (Diabetes Control and Complications Trial) units to the newer IFCC units.

http://www.diabetes.co.uk/hba1c-units-converter.html

I also forgot to mention that the HbA1c blood test that you received gives a rough 'average' of what your blood glucose levels have been doing over the previous 3 months ... with a slight bias towards the latter 6 to 8 weeks of that time. (It's determined by how much glucose is attached to the red blood cells within your bloodstream. The reason it offers an 'average' over this length of time is that it's because that's how long red blood cells survive for before they die off and are replaced. (Obviously, they don't all die at the same time. Their lifespan is supposedly between 90 and 120 days long.))

=========================================================================================

Hello Mickmixxx, u quote some very interesting figures at the start of the large reply to TuTuSweet, r u involved in the diabetes world , ie; nurse, Doctor. Is there a set figure on been diabetic ( u say 6.5 ) has this been changed, as my Doc said 6.3. I was classed as diabetic in 2013, my morning BC is 5.5-5.8 & that is with drinking sugar free orange juice 2-4 times in the night, during the day between 6.3-8.7 depending what I`ve eaton , then calms down to 5.5 - 7.0.

 

[micksmixxx]

Hi Betes-dave,

I am NOT a medically qualified person, but I've been a type 1 diabetic for more than 35 years now, and have spent my time learning about it. I consider myself very lucky in that I have a personal relationship with my endocrinologist who will spend time discussing things with me, even when we speak on the various diabetes-related websites that we are both members on. (I'm especially lucky as I have his home phone number and email addresses as I've repaired a number of his computers over the years.)

I can assure you that the level of 6.5% (48 mmol/mol) has been in use for a considerable number of years now.

Thw WHO (World Health Organization) states:

"Although HbA1c testing is mainly used for monitoring blood sugar control in patients with diabetes, the World Health Organization (WHO) now recommends that HbA1c can be used as a diagnostic test for diabetes, provided that stringent quality assurance tests are in place and assays are standardised to criteria aligned to the international reference values. An HbA1c of 48 mmol/mol (6.5%) is recommended as the cut-off point for diagnosing diabetes. A value less than 48 mmol/mol (6.5%) does not exclude diabetes diagnosed using glucose tests. One advantage of using HbA1c for diagnosis is that the test does not require a fasting blood sample."

You can see this on the following webpage:

http://patient.info/doctor/glycated-haemoglobin-hba1c

Diabetes UK state:

"For most adults with diabetes, the HbA1c target is below 48 mmol/mol, since evidence shows that this can reduce the risk of developing complications, such as nerve damage, eye disease, kidney disease and heart disease. Individuals at risk of severe hypoglycaemia should aim for an HbA1c of less than 58 mmol/mol. However, any reduction in HbA1c levels (and therefore, any improvement in control), is still considered to have beneficial effects on the onset and progression of complications."

You can see this on the following webpage:

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

Diabetes.co.uk, which is NOT the same organisation as Diabetes UK, states that diabetes is:

Diabetes 48 mmol/mol or over 6.5% or over.

You can see this on the following webpage:

http://www.diabetes.co.uk/what-is-hba1c.html

 

[micksmixxx]

@micksmixxx Although I agree with the majority of your helpful post, I felt I needed to say that diabetes is not necessarily progressive. The condition can be controlled by modifying your approach to eating, exercise, and if necessary, medication.
I know that you have qualified your comment by saying that it is 'LIKELY' to get worse, but I think that is accepting that we can't do anything to prevent ourselves getting worse.

Dear Prem51,

I do agree with you, to a great extent, that SOME type 2 diabetics MAY well be able to control their blood glucose levels to such an extent that the chances of them going on to develop diabetes-related complications is greatly minimised, but I attend a diabetes centre and diabetes support group where I've witnessed many type 2 diabetics that have gone on to develop complications, some of whom require renal (kidney) dialysis on a regular basis, some who've had to have amputations, and some that have become severely visually impaired, with two that I know of who have gone blind.

 

[micksmixxx]

Minor point, I am aware of the supposed change over from % to mmol, but both the general hospital I attend and my local GP are still working in % for a1c.

Dear urbanracer,

I hear what you say, sir.

I do know that when my own hospital changed over from the % readings to mmol/mol it caused an immense amount of confusion for SOME people that had been used to dealing in % terms for a good number of years so the hospital were issuing readings in both % terms AND mmol/mol terms. They've now stopped this and only give readings in mmol/mol.

I well recall a similar situation when they first introduced U100 insulins in this country (UK) as, up until that time there used to be U40 and U80 strenth insulins that were commonly prescribed. SOME people seemed to have difficulty in comprehending how much easier it would be to have a 'standard' strength insulin, how it would be less likely to cause SOME people to overdose or underdose when/if their pharmacy dispensed the 'wrong' strength insulin.

 

[micksmixxx]

I agree. There are a load of succcess stories on this forum where people have successfully bought their glucose levels back from quite high levels (e.g. HbA1c of 100+) down to almost normal levels of around 40. It is not a cure, but I prefer the term remission rather than reversal. However, it does seem that diabetes can be controlled a lot better than it used to be in my mothers time, and it does seem to be sustainable, not progressive,

Dear Oldvatr,

I wouldn't disagree with you that MANY people ARE able to reduce their blood glucose levels to either the 'normal' range or the near 'normal' range, but I'm afraid that is not true for all type 2 diabetics. I can't tell you of the number of type 2 diabetics that I've spoken with over the years that can't understand why their blood sugars (glucose levels) haven't "come down" ... until I've asked them about what they're doing, which medication(s) they're taking, if they are, in fact, taking medications ... and realised that they aren't actually doing what they believe are the things they should be doing to reduce their blood glucose levels.

To me, it's really the people that are motivated to want to do something to help their condition that are the ones who are more likely to follow some of the excellent advice that's offered here. I wish ALL diabetics would learn to do the best for themselves that they could.

 

[Oldvatr]

.
To me, it's really the people that are motivated to want to do something to help their condition that are the ones who are more likely to follow some of the excellent advice that's offered here. I wish ALL diabetics would learn to do the best for themselves that they could.

I was one of those until recently. I only took up rhe challenge when I finally persuaded my GP to support self monitoring, Up till then I was blindfolded and helpless without the tools to find out how to control my condition. I started in Sep 2015, and started to see real improvement simply by altering my medications, then cutting out the high carb hitters. Gradually i lost my fear of going LCHF and did the research. Now I really see it working for me, and feel confident to share my experiences here on the forum. i hope to provide inspiration by my story so that others can take positive control for themselves.

But we do need to bring about a sea change [SEA not SEX] in the way NHS dictates the old dogma and practices that stifle self exploration, We can help by supporting this forum.

 

[micksmixxx]

I was one of those until recently. I only took up rhe challenge when I finally persuaded my GP to support self monitoring, Up till then I was blindfolded and helpless without the tools to find out how to control my condition. I started in Sep 2015, and started to see real improvement simply by altering my medications, then cutting out the high carb hitters. Gradually i lost my fear of going LCHF and did the research. Now I really see it working for me, and feel confident to share my experiences here on the forum. i hope to provide inspiration by my story so that others can take positive control for themselves.

But we do need to bring about a sea change [SEA not SEX] in the way NHS dictates the old dogma and practices that stifle self exploration, We can help by supporting this forum.

Congratulations, Oldvatr, on taking the leap in trying the LCHF diet. I may not know you personally, but I'm truly glad that you find it working for you.

You SHOULD feel confidant in sharing your experiences here. You experience and knowledge is as good as anyone else's. What you say here, indoubtedly, has a positive impact on people, offering them the inspiration to try things, and/or work through things for themself.

You'd get no argument from me about bringing about a sea change in the way the NHS spouts the same old dogma and practices that stifle self-exploration AND experimentation.

 

[Prem51]

Dear Prem51,

I do agree with you, to a great extent, that SOME type 2 diabetics MAY well be able to control their blood glucose levels to such an extent that the chances of them going on to develop diabetes-related complications is greatly minimised, but I attend a diabetes centre and diabetes support group where I've witnessed many type 2 diabetics that have gone on to develop complications, some of whom require renal (kidney) dialysis on a regular basis, some who've had to have amputations, and some that have become severely visually impaired, with two that I know of who have gone blind.

I know many Type 2 diabetics do go on to develop complications unfortunately. But having read some of the success stories on this forum I can't help thinking that the NHS approach to diabetes leads to people getting worse not better.
It's a great pity that more T2s don't find this forum and get more information about an LCHF approach to controlling their condition.