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I am completely confused.

A

artdecomum

Active Member
Messages
27
Type of diabetes
Type 2
Treatment type
Diet only
At end of March and again inApril I had fasting bg and HbA1c level done. The 1st HbA1c came back as 46 and the 2nd as 47 and BG of 7.2. The DNS phoned me up and told me I was 'definately type 2 diabetic' and my cholesterol was high. Then I got a letter from my surgery to say that they had put me forward to attend a diabetic education course for pre-diabetics. (Turned it down as this website is far more useful). Today I got a printout of my bloods and I am totally baffled. My serum cholestrol was 4.7 mmo/l, serum HDL 1.68mmol/l, serum cholesterol/HDL ratio 2.8, serum triglycerides 1.4 mmol/l, serum LDL cholesterol level 2.38 mmol/l and non HDL cholesterol level was 3mmol/l. The nurse said i should definately be taking statins due to my high cholesterol yet when i look online the figures don't seem too high. she also warned me to stick to a low fat diet as eating fat causes high cholesterol. I don't eat much fat as i have highly indignant gall stones already. I'm going to be living on water at this rate.

What is anyone elses opinions please. What with being told definately diabetic and definately pre-diabetic my mind is boggling and all i really want to do after 7 weeks of very low calorie and very low carb is eat a slice of toast and butter and marmite. Any opinions gratefully received.
 
Well - I do LCHF and my cholesterol has gone down.
The gall bladder produces bile, which can stagnate and cause gall stones if there is no reason for it to empty itself - a low fat diet, and bile is produced from cholesterol so eating fat would seem to be one way to lower cholesterol rather than the reverse.
I don't restrict calories, as that has always caused me to shut down in the past, almost to the point of collapse. As I have lost 40 lb or so - it goes up and down a lot just at the moment, I think that going low calorie might be counter productive.
Your Hba1c results are prediabetic, so why the doctor told you you were definitely diabetic I can't fathom - and although eating very low carb is outstandingly effective at lowering the BG of a fully fledged diabetic, as you are prediabetic I'd have thought that simply removing some of the heavy starch and sugary foods from your menu would do the trick for you - personally I would not advise toast, but you could see what your BG levels are and try some once in a while - you not being diabetic, and watching what other things you eat.
 

With 2 HbA1c's of 46 and 47 you are at the high end of pre diabetic (48 or over is the diabetic trigger). pre is 42-47
As for cholesterol in my view your levels are pretty much perfect and your nurse is spouting a load of incorrect bulls**t.
Assuming you are female then higher cholesterol is overall better than lower so taking a pill (that can have horrible side effects) to make something lower when in fact most of the science says it should be higher is crazy.
Then again I have very strong views on that particular subject.
 
I had gallstones years before my Diabetes diagnosis so can sympathise the pain it can cause if you overdo the fat. I had mine removed and more recently was diagnosed with diabetes. Are you going to get your gallbladder (and stones removed)?
In the meantime as your level is prediabetic you could possible go along the lines of Low-Carb and as much fat as you can tolerate to fill you up?
As @bulkbiker says your cholesterol levels look ok to me.
 
Your cholesterol is virtually perfect and your HbA1c results indicate pre-diabetes. Your nurse must need to visit Specsavers, or go for re-training. Or maybe it was an impostor talking to you. Joking aside, although you haven't yet crossed the line to Type 2, if you pretend you are T2 and follow the sensible T2 way of eating, you should easily get back down to normal levels. Carbohydrate and fruit are the problems, so reduce all that, then eat normal levels of fat and protein, you should be fine. Just ditching any low fat products and eating the real thing will be enough.
 
artdecomum said:
I don't eat much fat as i have highly indignant gall stones already. I'm going to be living on water at this rate.
Click to expand...
I do sympathise! Since I realised that I have a problem with my bg, it has often seemed to me that it would be so much simpler just to give up eating altogether!!! I have found that in order to lower my bg to pretty much normal levels I have had to eat very low carb (<30g daily), and also take Metformin To fill the hole left by the disappearance of carbs I did try eating lots of fat, but it made me feel queasy. The respected writer Dr Bernstein suggests rather increasing one's intake of protein, and accepting the fat that tends to come with that naturally. I now eat very low carb with moderate to high protein and fat. I go on what feels OK, not feeling either pogged or starved after a meal.

I am due for a full blood test very soon, but whatever the cholesterol results I am going to continue prioritising my bg. Elevated bg is known to be extremely harmful, whereas the effects of elevated cholesterol are controversial.

As for toast with butter and marmite, I would skip the toast but allow myself lots of butter and, if you like it, grated cheese on vegetables. I also enjoy Hellman's Real Mayonnaise, which is the lowest carb mayonnaise available ready made. And coffee with real double cream (much lower in carbs than milk). Believe me, there are delicious things to eat that are also low carb, and you will be able to find lots of ideas and encouragement right here.

Good luck!
 

Your cholesterol numbers are not bad. Statins r the go to when you are first diagnosed. Lower the carbs and eat less greasy meat. You need some fat to keep the gallbladder working, loading up on carbs will cause you issues with your gallbladder. I have a few stones too, u just have to watch the amounts u eat.
 
Ahum, sorry to say but the nurse was definitely right, according to the American Mayo Clinic:

"A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes."

But so, maybe you should have a second test.
As for cholesterol, according to the guidelines (I checked the Dutch guidelines) your total cholesterol (if you have diabetes) should be below 4.5. So that's why the nurse advised statins.

In general I don't believe in cholesterol as THE BIG cause of cardiovascular disease and I am very wary of statins but I don't know about the value of statins in diabetes.
 

The conclusion can be made that low carb does not work for everyone.

Fat does not cause high cholesterol, that's outdated "knowledge".

If I were you, I'd go back to a moderately low carbohydrate diet with mostly slow carbohydrates. No point in following a difficult to maintain (very) low carb diet if it does nothing for you.
 

Hi, it seems to me that you have three main issues according to your post:
-elevated HbA1c
-? mildly elevated lipids
-gallstones

The first two are a medium to long term management issue, ie, all other things being equal, they don't present any immediate risks to health in, say, the next 6 months.

But the presence of gallstones might. In most cases we are recommended to have our gallbladder removed. I know things are very different in the UK but here in New Zealand, as far as I know, anyone whose ultrasound scan shows gallstones, is offered a referral for surgery, or at least more info to help them decide.

I am waiting for surgery myself. Gallstones that are medium to large in size can block the outlet of the gallbladder and cause severe pain. I have a larger amount of tiny gallstones, which are actually more of a problem, because they can travel and get stuck in the pancreas, which can be life-threatening if not treated in hospital as an emergency. It's rare but if it happens, it's a big deal.

I've had many medical conditions over the years and I've often found that nurses and even doctors can miss something important because they focus too much on other issues.

So just a suggestion... become the squeaky wheel that gets the oil, because your health is too important not to get the treatment you need.
 

We are in the UK, not the USA. Also, the poster had 2 x HbA1c tests, both of them coming in the pre-diabetic range. She only had one blood glucose test, which was slightly inside the diabetes range (over 6.9) but was not followed up, and there was no need to follow it up. In the UK we are diagnosed by the HbA1c only. The FBG test (if done at all - my surgery doesn't do them) is only an indication and is followed up with an HbA1c. It is the HbA1c that counts, not the FBG. Therefore, she is pre-diabetic according to the UK guidelines.

Bryce74 said:
As for cholesterol, according to the guidelines (I checked the Dutch guidelines) your total cholesterol (if you have diabetes) should be below 4.5. So that's why the nurse advised statins.
Click to expand...

In the UK the guidelines for a diabetic's total cholesterol was 4 or less. However, that ridiculous and non-sensible guideline has gone out of the window now as GPs are asked to look at the ratios and the non-HDL. Her total/HDL ratio is 2.8. (should be under 5.) Her non-HDL amount is 3. (should be under 3.4) Whatever one's views on statins, there was no need to prescribe them in this case.
 

As you can read here, it is not that simple:

https://www.diabetes.org.uk/profess...nitoring/new_diagnostic_criteria_for_diabetes

If her raised blood glucose will be confirmed to be at 7 or above, she officially has diabetes, also in the UK.
Note:

"An HbA1c of 48mmol/mol (6.5%) is recommended as the cut off point for diagnosing diabetes. A value of less than 48mmol/mol (6.5%) does not exclude diabetes diagnosed using glucose tests."

Your remark that the "nurse must need to visit Specsavers, or go for re-training." was not smart.
Sure, doctors and nurses can be criticized too, but before you do so, you should be very sure about what you are saying, otherwise you create just more confusion.
 

It was a joke, and I said so in my post. You joined this forum yesterday and so far have not completed any personal information about yourself, in particular your own diabetes status, yet you see fit to criticise comments made by other members.

These, as far as I can gather, are the WHO recommendations: (and I admit nothing is ever simple)

A fasting glucose ≥7 on two separate occasions OR
A random glucose ≥11.1 on two separate occasions OR
An HbA1c ≥6.5% (48mmol/mol) on two separate occasions OR
An HbA1c ≥6.5% AND a single elevated plasma glucose (fasting ≥7 or random ≥11.1)

However, these are for the whole world, including under developed countries with inadequate or non-existent facilities for the HbA1c. I understand that in the UK each individual GP practice can chose which of these to use, and it does vary from what is reported on this forum. I do know that my own surgery chooses 2 x HbA1c tests on separate occasions. It no longer does FBG tests, even for screening on routine non-diabetic health checks. So, the poster was given 2 x HbA1c tests on 2 separate occasions, thus fulfilling the WHO recommendations.

I am now out of this conversation because it is pointless.
 


Lady,

The fact I just joined has nothing to do with this discussion.

The diagnostic criteria the NHS/NICE refers to are those of the International Diabetes Federation:

"Diabetes can be diagnosed on any of the following World Health Organization (WHO) criteria: • Fasting plasma glucose (FPG) ≥ 7.0 mmol/l (126 mg/dl) or, • 75 g oral glucose tolerance test (OGTT) with FPG ≥ 7.0 mmol/l (126 mg/dl) and/or 2 hour plasma glucose ≥ 11.1 mmol/l (200 mg/dl) or, • Glycated haemoglobin (HbA1c) ≥ 6.5% / 48 mmol/mol, or • Random plasma glucose ≥ 11.1 mmol/l (200 mg/dl) in the presence of classical diabetes symptoms • Asymptomatic individuals with a single abnormal test should have the test repeated to confirm the diagnosis unless the result is unequivocally elevated"

https://www.idf.org/component/attachments/attachments.html?id=725&task=download

Her *fasting* plasma glucose is above 7, so she has diabetes (but needs to be confirmed with a second test if she has no symptoms of diabetes).
You are confused with a random (non-fasting) plasma glucose test.

As the other source said: ""An HbA1c of 48mmol/mol (6.5%) is recommended as the cut off point for diagnosing diabetes. A value of less than 48mmol/mol (6.5%) does not exclude diabetes diagnosed using glucose tests."
 
As you like quoting so much here is what NICE actually says..
  • Diabetes is usually diagnosed by an HbA1c of 48 mmol/mol (6.5%) or more. If the use of HbA1c is inappropriate (for example in people with end-stage chronic kidney disease), type 2 diabetes is diagnosed by a fasting plasma glucose level of 7.0 mmol/L or greater.
    • In an asymptomatic person, the diagnosis of diabetes should never be based on a single abnormal HbA1c or fasting plasma glucose level; at least one additional abnormal HbA1c or plasma glucose level is essential. If the second test results are normal, it is prudent to arrange regular review of the person.
Those are my italics
So one elevated FBG as the OP mentioned is not enough and HbA1c is the chosen method here in the UK. As the OP has not mentioned chronic kidney disease I think we can safely assume that HbA1c's should be used.
 
Good grief - my head is exploding with foreign stuff KABOOM! - too late ..........>.
 
Folks, please take it down a notch.

@artdecomum started this thread asking for help because she was confused.
Bickering about different diagnostic criteria in different parts of the world is more likely to drive her away than help her to come to terms with her health situation.

It is prfectly true that different parts of the world view the thresholds of diabetes and pre-diabetes differently, but @artdecomum came here asking for support and helpful advice, so I have this to offer her:


I know exactly how you feel. Being told that normal taken-for-granted foods are suddenly off the table is distressing.

My own view is that toast is doable, so long as the portions are reasonable. One slice instead of three You blood glucose meter can guide you in the finer details.
You can lower the carbs further by choosing one of the lower carb breads such as Burgen or HiLo. They can reduce the blood glucose impact significantly.

Re fat intake and butter... well surely natural butter is better than some Frankenfood margarine or adulterated 'spreadable'?
Butter portion size isn't something I have ever been able to control, but I do know how motivating the threat of imminent agony can be. So I expect you can gauge with precision exactly how much butter you can tolerate!

As for Marmite - have at it! Gorgeous stuff!!!
 
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Hello sorry to hear of confusion, nothing worse, that is one of the main hurdles to get over with diabetes,numbers, and general lots of variations worldwide, and what seems also varied diagnosing, having said that, on the positive side, as seems from your advices, your diabetic and also pre diabetic? perhaps a second opinion on that area may clarify any confusion area? just a suggestion box.

Toast, personally I would recommend something as alternative, seed crackers home made look on www.dietdoctor.com
amazing website with lots of excellent recommendations.

If of an incentive or motivation to you, personally I have turned around my pre diabetes status, medical records as of last week show non pre or diabetic range.

I changed my lifestyle. Changed diet, to eating keto low carb, some fabulous and delicious recipes to explore and try, started exercising more, walking min 5 klm a day, and hopping on the tread mill at home 10 mins after each meal, if you dont have treat, dont worry, just take a short brisk walk, intermitting fasting 3 days and week, by making these small lifestyle changes have reduced not only my sugars, but my A1C 23% in four months, and cholesterol too, may not work for all, but for my body did wonders. In the meantime lost 24 kilos and 23cm off waist, and not taking any form of medications whatsoever. Since informed Pre Diabetic cut out bread potatoes, pasta and rice, this has I feel highly contributed in my reversing and lowering numbers, have super alternatives pasta I use zuchinni and spiralize, rice, grate caulifour, bread, make my own seed crackers low carb, and potatoes, eat pumpkin instead, there you go always a solution for all, well more or less.

Hope this assists, and if confusion continues, ask questions, always better to do this than be confused one question or 100 keep asking, until you get the right answers to take that confusion away.
 
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