I need a rant

Scandichic · Apr 7, 2014

Aaaaarrrggggg! Just had doc phone me to talk about bs and possibly reducing metformin. He asked me about the hypo on Thursday. I explained that it could have been that I went slightly longer than usual without food or that the weight loss and diet could mean that I'm taking too much metformin. He wants to do the hb1ac test. Apparently it does not need to be fasting?! He wants to look at the results and then we can discuss diet. I pointed out that I have halved my bs and lost 1 stone 10lbs. I will not be changing my diet any time soon. At the end of the day, non of them are diabetic. Let them screw their own bodies up. I reserve the right to do what's best for mine. If I reduce my meds, then less cost to their budget. Isn't that a win win solution for all concerned? My husband thinks that they're not used to people asking questions or questioning their advice, backing up their choice of diet with a logical response. At the end of the day, pasta, rice, bread and potatoes have no nutritional value beyond providing the body with a source of energy. Whenever I point out that carb turns to sugar when it goes into my stomach and is then passed out into my bs, raising the bs. The very thing they've given me meds for to reduce it. This normally provokes one of 2 responses: stony silence or it's the wrong type of energy with no further explanation. Occasionally I get the cholestrol lecture. There! It's off my chest now

sanguine · Apr 7, 2014

They don't like it up them Captain Mainwaring (sorry, Scandi) - they don't like it up them.

I dont think HbA1c needs to be fasting, 'cos you're measuring a haemoglobin combo not a spot BS (says he, coming across all experty (slap). Keep the faith girl, we have the hard objective data they just have their hymn sheet.

Scandichic · Apr 7, 2014

sanguine said:
They don't like it up them Captain Mainwaring (sorry, Scandi) - they don't like it up them.

I dont think HbA1c needs to be fasting, 'cos you're measuring a haemoglobin combo not a spot BS (says he, coming across all experty (slap). Keep the faith girl, we have the hard objective data they just have their hymn sheet.

I love you!

sanguine · Apr 7, 2014

I say steady on ...

Scandichic · Apr 7, 2014

sanguine said:
I say steady on ...

He, he. Have become hysterical now. They're coming to take me away, haha, they're coming to take me away!!!!!!
Have ordered my. Kevlar jacket and riot gear in anticipation of the confrontational appointment to follow tests. Do you know if the hb1ac will look at cholesterol too? Am going to take in print off from southport GP too. Although they're probably too arrogant to read it!

Indy51 · Apr 7, 2014

A1c is just one test, nothing to do with cholesterol unless that's also been ordered by the doc. Cholesterol should be fasting; A1c doesn't need to be.

Yorksman · Apr 7, 2014

Yes, HBA1c dosn't need to be fasting.

Some things in the blood plasma bind easily to haemoglobin and some things don't. Carbon monoxide binds very easily, more easily than oxygen, which is why it is deadly. Over time, the blood cells take up carbon monoxide and have no room left for oxygen and, once bound, it's hard to get rid of. Alcohol on the other hand stays entirely within the plasma, it doesn't bind at all, which is why you get sober again.

Blood glucose is up and down all the time so it's hard to tell what its average is. That's why they want a fasting level. However, glucose in the plasma does not bind easily to haemoglobin, but it still does bind, albeit reluctantly. This makes it a sort of proxy for an average. Since it doesn't bind easily and if you have a lot of it in your haemoglobin, that must mean, on average, you've mostly got too much in your plasma.

Mind you, there are worse things that can get into your red blood cells, like these malarial parasites, but they don't so much 'bind' as 'burrow':

Scandichic · Apr 7, 2014

So if I've understood correctly, they will be looking at my average bs level between 28th of jan this year and tomorrow. I know that this test is meant to be every 3 months. If I have a cup of tea, it won't affect the test? Does the test provide any further info? From the manner and tone of doc, I suspect this could all become quite confrontational, so jokes apart, I'd like to go in well informed. Unlike you guys, I am not remotely scientific or mathematical. Am purely a linguist. Reasonable at humanities. Sport is also an epic fail. Love it but am quite useless. Any advice appreciated.

Yorksman · Apr 7, 2014

If it is just an HBA1c test they are testing for the amount of glycated haemoglobin, that's all. Iron binds to haemoglobin, in the form of ferritin, but to test for iron deficient anaemia, you have to test for that. You wouldn't pick it up 'by accident' looking at the glucose bound to a red blood cell.

Like glucose in the plasma, you can test for iron in the plasma and it is a sort of indication that you are becoming deficient in iron and likely to develop iron deficient anaemia. But, you have to look for it. Most blood plasma analysers do a very wide range of tests but the GP has to tick the relevant box to tell the lab what to test for.

The reason why I added the malarial image above is because Mrs Yorks occasionally gets requests for iron deficiency tests but she checks the patient notes and, if they've been India or Africa recently, she has a quick look under the microscope and looks for the tell tale little dots which are malarial parasites. If they just send back a negative result i.e. iron levels OK, then the GP has to see the patient again, get another blood sample and test for something else. This is what happens usually and it can be months before they get to the bottom of it, test for this, test for that, come back next week etc etc.

Spiker · Apr 7, 2014

The HBa1c is the best measure of your long term control. Apart from the absence of arms and legs falling off. I don't think anyone has concerns that the HBa1c is suspect. The only suspect thing is that the NHS may be too relaxed in letting diabetic patients get away with too high a value for it.

It measures the last 90 days of blood glucose but it is weighted more towards the more recent part of that 90 days. So I can see why you would reasonably think it should be done every 3 months. But no. You get one a year off the NHS.

Scandichic · Apr 7, 2014

Yorksman said:
If it is just an HBA1c test they are testing for the amount of glycated haemoglobin, that's all. Iron binds to haemoglobin, in the form of ferritin, but to test for iron deficient anaemia, you have to test for that. You wouldn't pick it up 'by accident' looking at the glucose bound to a red blood cell.

Like glucose in the plasma, you can test for iron in the plasma and it is a sort of indication that you are becoming deficient in iron and likely to develop iron deficient anaemia. But, you have to look for it. Most blood plasma analysers do a very wide range of tests but the GP has to tick the relevant box to tell the lab what to test for.

The reason why I added the malarial image above is because Mrs Yorks occasionally gets requests for iron deficiency tests but she checks the patient notes and, if they've been India or Africa recently, she has a quick look under the microscope and looks for the tell tale little dots which are malarial parasites. If they just send back a negative result i.e. iron levels OK, then the GP has to see the patient again, get another blood sample and test for something else. This is what happens usually and it can be months before they get to the bottom of it, test for this, test for that, come back next week etc etc.

So they'll be looking at bs?

Spiker · Apr 7, 2014

If the Doc does a cholesterol test make sure it's not a total cholesterol test as the results of a total cholesterol test correlate with exactly nothing at all. It needs to be at least an HDL/LDL ratio test, even that is sketchy. Ideally a full lipid profile or don't bother. Tell the doc this ahead of time and maybe he will order full lipids just to avoid the grief. After all for him it's just a cross in a different check box.

Scandichic · Apr 7, 2014

Spiker said:
The HBa1c is the best measure of your long term control. Apart from the absence of arms and legs falling off. I don't think anyone has concerns that the HBa1c is suspect. The only suspect thing is that the NHS may be too relaxed in letting diabetic patients get away with too high a value for it.

It measures the last 90 days of blood glucose but it is weighted more towards the more recent part of that 90 days. So I can see why you would reasonably think it should be done every 3 months. But no. You get one a year off the NHS.

So if it has come down (79 when diagnosed) then yar boo sucks to them! I love a mature response but am starting to feel increasingly militant and defiant! Lol!

Spiker · Apr 7, 2014

In very basic terms HBa1c measures how much sugar has stuck to your red blood cells. They live for about 90 days. So the test measures how much sugar has been floating around in your blood over the last 90 days.

Spiker · Apr 7, 2014

Scandichic said:
So if it has come down (79 when diagnosed) then yar boo sucks to them! I love a mature response but am starting to feel increasingly militant and defiant! Lol!

Exactly! :-D

If it's come down then they should be asking you how you did it, not giving you advice.

Indy51 · Apr 7, 2014

In my experience, they never ask what you did - they just assume you're following their brilliant advice

Yorksman · Apr 7, 2014

Scandichic said:
So they'll be looking at bs?

Yes but it is not the same BS as your finger prick test which measures the glucose in your blood plasma, it is a measurement of how much glucose has stuck to your red blood cells. This is a sort of 3 month history.

Spiker · Apr 7, 2014

Nice pic @Yorksman

Scandichic · Apr 7, 2014

Yorksman said:
Yes but it is not the same BS as your finger prick test which measures the glucose in your blood plasma, it is a measurement of how much glucose has stuck to your red blood cells. This is a sort of 3 month history.

Thank you for the diagram. So if it has come down then they should be happy? Or not. **** these LCHF followers! They defy our science. Quick lock them up. Let them not expose their evil rationale to the world. They might be right!!!!! He, he!

Yorksman · Apr 7, 2014

Scandichic said:
Thank you for the diagram. So if it has come down then they should be happy?

Yes. Mine came down from 86 to 48 in three months and then I was 36.5 by the end of the year. I don't take medication so I am much less likely to have a hypo. Your body detects when glucose is low and produces more for you by creating it from things like fatty acids in your stores. This is normal and is actually how weight loss works. Metformin is normally safe but any medication which interferes with the way the body works can mess other things up a bit so my guess is that he wants to see if your levels are improving and, if they are, he may want to adjust your meds accordingly.

I need a rant

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