Is it Prediabetes?

[Home79]

Hello, I live in Germany and during my last blood test, I had a fasting blood sugar level of 95 and an HbA1c value of 5.9. In Germany, you are considered to be pre-diabetic with an HbA1c of 5.9. How is it in England? What should I do now? My doctor said my values are fine.

 

[KennyA]

Hello, I live in Germany and during my last blood test, I had a fasting blood sugar level of 95 and an HbA1c value of 5.9. In Germany, you are considered to be pre-diabetic with an HbA1c of 5.9. How is it in England? What should I do now? My doctor said my values are fine.

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?

 

[Lamont D]

Hello, I live in Germany and during my last blood test, I had a fasting blood sugar level of 95 and an HbA1c value of 5.9. In Germany, you are considered to be pre-diabetic with an HbA1c of 5.9. How is it in England? What should I do now? My doctor said my values are fine.

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.

 

[Home79]

Thank you very much for your answers!!

 

[Home79]

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?

Thank you for your explanation. I definitely will change my diet and will start to work out regularly!!!

 

[Home79]

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.

Yes you are right. My aim will BE to lower my A1c

 

[KennyA]

Thank you for your explanation. I definitely will change my diet and will start to work out regularly!!!

What worked for me was a carb target of ~20g/day. I didn't do any exercise for the first couple of years but picked that up once I'd lost enough weight not to injure myself.

I exercise - actually I don't "exercise" - I play football - because I enjoy it, not because of weight loss. In fact, although I'm still losing bodyfat I'm rebuilding muscle which has stopped weight loss.

 

[Home79]

Do you think one can reverse insulin resistance completely? So that one can eat a bit more carbs or sugar once in a while? I watched Videos of Dr. Ekberg who is claiming that. What do you think?

 

[KennyA]

Do you think one can reverse insulin resistance completely? So that one can eat a bit more carbs or sugar once in a while? I watched Videos of Dr. Ekberg who is claiming that. What do you think?

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 it.

 

[Home79]

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

I love this forum. I've learned a lot here.

So, are people with an HbA1c value of 5.9 considered healthy in England? Here in Germany, it is classified as prediabetes.

Do I now have to always follow a low-carb diet in my situation? Do you also make exceptions?

 

[KennyA]

I love this forum. I've learned a lot here.

So, are people with an HbA1c value of 5.9 considered healthy in England? Here in Germany, it is classified as prediabetes.

Do I now have to always follow a low-carb diet in my situation? Do you also make exceptions?

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.

 

[Home79]

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.

Happy New Year to everyone!
I don't want to annoy anyone with my questions, but I would like to hear some opinions on this. I have three questions:

1. If in the UK an HbA1c value of 5.9 is still considered as normal, that means the average blood sugar level must be higher than at 5.6 which is the limit in Germany. This means that the 140 mg/dL threshold will be exceeded more often, two hours after a meal, right?

2. Is it possible for blood sugar to still rise two hours after a meal? Yesterday, I wasn't paying attention and had a lot of dessert (cake), and my blood sugar was 130 two hours after the meal and then 140 half an hour later. How can this be explained? Or ist this a sign for prediabetes?

3. I also read that in healthy people, blood sugar levels can sometimes also be higher two hours after a meal. Is that true?

 

[KennyA]

Happy New Year to everyone!
I don't want to annoy anyone with my questions, but I would like to hear some opinions on this. I have three questions:

1. If in the UK an HbA1c value of 5.9 is still considered as normal, that means the average blood sugar level must be higher than at 5.6 which is the limit in Germany. This means that the 140 mg/dL threshold will be exceeded more often, two hours after a meal, right?

2. Is it possible for blood sugar to still rise two hours after a meal? Yesterday, I wasn't paying attention and had a lot of dessert (cake), and my blood sugar was 130 two hours after the meal and then 140 half an hour later. How can this be explained? Or ist this a sign for prediabetes?

3. I also read that in healthy people, blood sugar levels can sometimes also be higher two hours after a meal. Is that true?

You're not annoying anyone with questions - that's what the forum is here for. I'll have a go at answering:

1. It depends. I am not sure what you mean by the "average blood sugar level". Average over what period, based on what data? All the words are simply labels, there's nothing fixed about them and they can be manipulated. What is considered "normal" this year might not be thought to be normal next year, and this also varies from country to country. It was only in 2008 or so that there was international agreement on a level which everyone would recognise as "a diabetic HbA1c". So don't get hung up on the words - what's normal for you is what matters.

We normally aim for a BG to reduce, by the +2hr point, to not above 7.8mmol/l and within 2mmol/l of where you started. Where did you start?



2. Yes, that's not unusual. 130mg/dl is about 7mmol/l ish and 140 is around 7.8. Those seem to me to be more than OK post meal readings at +2 hours, particularly given what you report eating. We will probably hit peak BG around 45 minutes or so after eating - it just takes around that length of time. And depending on the composition of a meal, the process can be slowed - there's what's often called the "pizza" effect, which some people report when eating carbs with fats - it slows down small intestine carb/glucose absorption maybe because it slows food transit through the gut. As you had a reasonably sugary dessert then you might conclude your system handled that meal reasonably well, on the information you got from those tests. If you had done another test at say three hours it might have confirmed that one way or the other.


3. The blood glucose of non-diabetic people goes up and down all the time, including above BG levels that you are describing as "limits" or "thresholds" - I don't think they are either. I'm attaching a link to a little study done on a small number of non-diabetic people who were fed a variety of meals while wearing CGMs. You'll see that BG rising is a normal response in non-diabetic individuals, particularly following higher carb food.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7296129/

You'll have other questions, fire away.

 

[Home79]

Thank you so much for your reply.
More questions:

1. For example, my values three hours after a meal, when I've eaten a bit more carbohydrates, are not always under 100, but around 120. What could this mean?

2. Is it common for the HbA1c value to be borderline, but the fasting blood sugar level to be normal, i.e., under 100?

3. Is it possible for my values to improve if I lose my weight? I need to lose 20 kg. Could I then eat more carbohydrates?

4. Sometimes before going to bed my bg ist around 100-110. Is that normal?


I just wanna figure out If i am prediabetic.

 

[KennyA]

Whether you're "pre-diabetic" or not depends on not only your HbA1c but also what the current assumptions are wherever you live. If you have an HbA1c od f 41 and the German healthcare system says"that's pre-diabetes" then according to them you are "pre-diabetic". Pre-diabetes isn't a diagnosis. It's used for someone whose HbA1c falls in the gap between normal blood glucose levels and the 48mmol/mol automatic diagnosis point. As I had full blown diabetic symptoms with an A1c of 43/44, it was of exactly no use in my case. Labels don't stack up very well against reality.

Incidentally, as this is a UK forum and we use the UK IFCC system, I'll give answers using that as it's what I'm familiar with.

1. It means that is what your current blood glucose was (given meter accuracy) at the point you tested. What was the difference from the earlier test? Were there any other factors that might have affected your blood glucose - illness, exercise, stress, etc? One reading on its own says nothing about what your HbA1c was or might be. The normal routine is to test before you eat and then again at +2 hrs. You are testing to see how well your system dealt with the carbs in whatever it was you ate. You want your second reading to be under 8.0mmol/l and within 2 mmol/l of the first. If you're eating very carby meals, you might expect to see prolonged BG rises.

2. I don't know what you mean by "borderline" - do you mean around 41, or around 48? HbA1c and fingerprick tests estimate blood glucose by measuring different things in different ways. So it shouldn't be expected that they would read across.

3. I don't know about your values improving. A large number of people on this forum have seen their BG values fall via a low carb lifestyle, I'm one of them. My BG was back in normal range inside four months, long before I'd lost much weight - the weight loss follows rather than causes normal BGs. I did lose a lot of weight afterwards, and it's added up to around 40kg. As I don't want both to regain that and to push my blood glucose up, I have kept my carb intake as it's been, around 20g/day.

4. It depends. What had you eaten? Were there any other factors, as in 1. above? Is this just the one reading, or is this a pattern noticed over many readings?