Is it Prediabetes?

KennyA said:

Hi and welcome

Your measurements are given in the old DCCT units of mg/dl and percentage. The UK uses IFCC units in mmol/mol and mmol/litre. I'm going to attach a conversion chart which might be of some help. There's only a read-across between mg/dl and mmol/litre (for fingerprick testing etc) and percentage and mmol/mol (for HbA1c) You really can't dependably read across from fingerprick blood test results to HbA1c - the tests measure different things in different ways.

The UK uses an HbA1c result of 42mmol/mol as the end of what "normal blood glucose" is. Non-diabetic BG results cluster around 38mmol/ mol - see the graph.

So your HbA1c of 5.9% would translate to an HbA1c in mmol/mol of about 41 - normal in the UK. There's some inaccuracy in the tests, as in all testing, but the result should be close to what you've been told. To understand any one result, I would want to know more about what my previous tests had shown - is this what you get all the time, or has it risen or fallen? Where's it heading, if anywhere?

My experience leads me to believe that we can have problems caused by high glucose even when the glucose is not all that high and only just out of normal range. In my case, I had symptoms almost as soon as I went out of normal, and some nasty ones starting with a BG of 43 or 44. So the other question is, do you have any symptoms?

And finally, based on what your view on the other questions is, do you want or need to do anything at this point?

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Lamont D said:

Hi, @Home79 and welcome to the forum.
In my personal experience, I would consider the results to be in normal levels.
However, lowering your carb intake would not harm with lowering your hba1c levels, to a healthier outcome.I

Best wishes.

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KennyA said:

My honest answer is I don't know, but I think the "reverse completely" bit is unlikely for most, maybe all, people.

I notice now that if I have small amounts of carbs it neither hits my BG badly nor does it knock me out of ketosis. Bear in mind that a normal day's carb is around 20g for me, and I'm talking about a day of maybe 40g or 50g. That might indicate that my insulin response system is coping a bit better with glucose in late 2024 than it was in late 2019, thanks to taking the strain off it for the last five years. But that's not saying much.

I think of my present insulin system a bit like a vintage car. It still runs, I need to take care of it, and it needs maintenance every day. I can stress it a bit more every so often, when the wind's in the right direction. But I can't use it as a general daily runabout to do the shopping in, to take stuff to the tip or set off to drive to the Italian Riviera in it - because it would break down. Maybe not in the first day or week, but soon. And it might not be repairable then.

So for me - I don't expect

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KennyA said:

5.9% is 41 mmol/mol, which is technically "normal" BG in the UK. There is a standard acceptable error in HbA1c tests, which can be whatever the authority setting it thinks is OK. It's usually somewhere around 3-5% - so at 5% a BG value of 50mmol/mol could return an HbA1c of anywhere between 47.5 and 52.5 and be OK. In the UK if your result is that close to the automatic diagnosis figure they will invariably repeat it for confirmation.

Although all countries will automatically diagnose T2 diabetes with an HbA1c-tested BG level of 6.5%/48mmol/mol, there is no such agreement on what constitutes "normal" or "pre-diabetes" (which isn't a diagnosis). Pre-diabetes just means not normal BG levels, but not yet at automatic diagnosis levels. There's nothing to stop a T2 diagnosis being made sooner, but the practice in the UK now seems to be to only diagnose T2 by HbA1c of >48.

Some countries have also fairly recently decided arbitrarily to change their definitions of what "normal" blood glucose is. I've not seen any explanation for this, other than it being part of the general over-medicalisation of normality. The graph above shows the BGs of non-diabetic people and where the "normal" line gets crossed isn't obvious. I suspect they originally just went with normal/end of normal/start of T2 at 5.5%/6.0%/6.5% because the figures were neat. They don't translate exactly into mmol/mol either, so there's a bit of wriggle.

But it also depends on your doctor. Some people (I'm one of them) say that their doctor didn't mention that blood glucose was rising and was no longer in normal range. Other doctors (maybe more recently) seem to intervene earlier and recommend (eg) carb reduction, exercise, etc.

What you do is your decision. Many people have/had absolutely no symptoms when BG goes out of normal range and having to reduce it can seem a bit pointless. I got bad symptoms very early on (BG 43/44ish) but was firmly and wrongly told it wasn't diabetes. If your BG is rising, you might want to do something to stop it rising further. If it's actually stable around 39/40/41 (ie within test error margins) and you're just one of those people on the right side of the graph, you might come to a different decision.

Best of luck.

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