Is There An Error In Determining The Degree Of Diabetes?

Guzzler

Master
Messages
10,577
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Poor grammar, bullying and drunks.
This thought has struck me on many an occasion. I had no classic symptoms on diagnosis even though my A1c was very high and yet I read often of people with much lower numbers having not only symptoms but the early signs of complications and sometimes with complications not easily resolved. For me it is a quandry, was I very lucky to avoid these symptoms/complications even though I may develope them later on or was I unlucky not to have been diagnosed earlier thereby giving me more time to improve prognosis?

It is a question I will never resolve but it does serve to show just how different we all are in the face of this condition.
 
  • Like
Reactions: HICHAM_T2

Guzzler

Master
Messages
10,577
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Poor grammar, bullying and drunks.
The story behind the decision beind the cutoff points is here

https://www.bloodsugar101.com/misdiagnosis-by-design

Wow! I am only halfway down that page and I am gobsmacked! I have always been of the opinion that nothing good ever came out of a committee and I see no reason, after reading this, to change my view. Thank you for posting the link.

Edited to add.

I have just finished reading this piece, the conclusion I have come to is that my glucometer truly is/was the best piece of kit to aquire and the only one at my immediate disposal that will show me any reasonable measure of my management of Diabetes.

On another thread there is a discussion on the supposed accuracy of A1c and A1c Home Use Kits that may interest some members (near the end of the piece).
 
Last edited:

Alexandra100

Well-Known Member
Messages
3,742
Type of diabetes
Prediabetes
Treatment type
Tablets (oral)
This thought has struck me on many an occasion. I had no classic symptoms on diagnosis even though my A1c was very high and yet I read often of people with much lower numbers having not only symptoms but the early signs of complications and sometimes with complications not easily resolved. For me it is a quandry, was I very lucky to avoid these symptoms/complications even though I may develope them later on or was I unlucky not to have been diagnosed earlier thereby giving me more time to improve prognosis?

It is a question I will never resolve but it does serve to show just how different we all are in the face of this condition.
I have never had any of the "classic" symptoms you mention. This is not surprising, since my highest A1c was 41, officially pre-diabetic. However I have a whole string of other health problems that I am convinced are due to raised bgs, particularly damage to my vagal nerve. My troubled digestion (bad enough to win me two gastroposcopies which showed very little) was quickly almost resolved once I began eating LC. I think the poor circulation in my hands is somewhat improved, but that could also be due to the warm summer we are having. I'll never know whether my paroxysmal AF has been put into remission, as I don't dare to stop taking my pills to find out! I am living in hopes that my other problems will resolve over time, and that is one of my motivations in eating as I do.

My numerous health conditions are labelled "idiopathic" ie no doctor has the faintest idea of their causes. I have tried telling various medical professionals about the link with raised bgs, but no-one wants even to consider this. Dr Bernstein says that by the time of diagnosis, virtually all diabetic patients will already have accumulated numerous complications, but that if we can maintain "normal" bgs many of these can be cured or at least improved. The catch is that for many of us "normal" bgs will not be attainable without the insulin he offers his patients. However he also says that near normal bgs will probably win us milder complications that will not cause us too many problems. Jenny Ruhl considers that we will be OK with far higher bgs.

I have given up asking the "why" of my many and varied health problems. Better concentrate on "how" best to manage and live with them.
 

Bluetit1802

Legend
Messages
25,216
Type of diabetes
Treatment type
Diet only
Yes i think i'm getting where you are all coming from. Talk about not even wanting to trust the doctors or the tests. However if it isn't what i want i will try not to be upset about. Don't feel so bad about having it tomorrow now, so thank you everyone.

My HbA1c is always a lot of points above all my other data. I would be happy enough never to have another HbA1c, but they keep my nurse happy and I am happy if the trend is stable or downwards. The trend and line on a graph is all that matters.
 

Guzzler

Master
Messages
10,577
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Poor grammar, bullying and drunks.
I have never had any of the "classic" symptoms you mention. This is not surprising, since my highest A1c was 41, officially pre-diabetic. However I have a whole string of other health problems that I am convinced are due to raised bgs, particularly damage to my vagal nerve. My troubled digestion (bad enough to win me two gastroposcopies which showed very little) was quickly almost resolved once I began eating LC. I think the poor circulation in my hands is somewhat improved, but that could also be due to the warm summer we are having. I'll never know whether my paroxysmal AF has been put into remission, as I don't dare to stop taking my pills to find out! I am living in hopes that my other problems will resolve over time, and that is one of my motivations in eating as I do.

My numerous health conditions are labelled "idiopathic" ie no doctor has the faintest idea of their causes. I have tried telling various medical professionals about the link with raised bgs, but no-one wants even to consider this. Dr Bernstein says that by the time of diagnosis, virtually all diabetic patients will already have accumulated numerous complications, but that if we can maintain "normal" bgs many of these can be cured or at least improved. The catch is that for many of us "normal" bgs will not be attainable without the insulin he offers his patients. However he also says that near normal bgs will probably win us milder complications that will not cause us too many problems. Jenny Ruhl considers that we will be OK with far higher bgs.

I have given up asking the "why" of my many and varied health problems. Better concentrate on "how" best to manage and live with them.

I suggest you read that piece in the link that Bamba posted. It is a fair length but well worth reading in its entirety.
 
M

Moggely

Guest
My HbA1c is always a lot of points above all my other data. I would be happy enough never to have another HbA1c, but they keep my nurse happy and I am happy if the trend is stable or downwards. The trend and line on a graph is all that matters.
@Bluetit802 what do you mean by "all my other data' You mean the finger pricking? The trend and line on a graft and yes i admit i'm daft but have no idea what all that means. Actually the more i seem to learn in here the less i seem to know, i know that doesn't make sense.
 

Bluetit1802

Legend
Messages
25,216
Type of diabetes
Treatment type
Diet only
@Bluetit802 what do you mean by "all my other data' You mean the finger pricking? The trend and line on a graft and yes i admit i'm daft but have no idea what all that means. Actually the more i seem to learn in here the less i seem to know, i know that doesn't make sense.

Please do not worry. We were all beginners at this game once upon a time. It is a long learning curve, and we are all still learning. This forum is the very best place to learn. :)

Yes, I mean finger pricking (and I time my finger pricks to try and catch the peak of any rise rather than sticking rigidly to the 2 hour mark). Plus I am also a part time user of the Libre (a sensor that calculates your blood glucose continuously throughout the day and night for 2 weeks) and I have also done a private home HbA1c test a day or so prior to my official one.

A trend line on a graph is just an expression. It is simply a matter of seeing if your HbA1c is stable, going up or coming down.
 
P

pollensa

Guest
To me it doesn't matter what the cut off is, or what it's called - pre-diabetic, diabetic etc etc etc. I just need to know that I have a problem that can (for now) be controlled by eating very few carbs. Does it matter if the HbA1c is slightly out? If I tried to keep my HbA1c say point one below the 'cut off' then yes it would matter, but I choose to keep my HbA1c well below that! On my DESMOND course we were told to keep our HbA1c below 58 (!!!!!!) I queried this, asking why one would choose to leave it so high and said I was going to lower mine to non-diabetic levels and the response I got was "Well you can try". I don't think the nurses believed it was even possible let alone that I would do it!
Surely it doesn't matter what the 'degree' of diabetes is, the answer for most is to low carb.

How right you are, Low Carb is the way to go, amongst other, along with focusing and target the real cause not lets forget what it is, which is Insulin Resistance re diabetes 2, as I understand the result of this sugars are merely a symptom of the root cause problem Insulin Resistance.

If of any interest re A1C levels, here in spain , same in Canada cut off is below 6% classed normal, just to keep us on our tip toes, where we have to aim for albeit uk 58% Spain 6% Canada 6% the world?????? whatever, we try, diet and low carb and intermittent fasting is of vital importance and wonderful tools to use to keep control.

I agree does it matter if A1C is slightly out, if A1C is up but all other levels majority finger testing are normal, this is where the system breaks down, there has to be some common sense medical sense flexibility if A1C high, all other numbers high, yes there is a problem, but if majority is normal consistent and A1C or other numbers high, surely one should not get worried about this,
if 2hr after eat is normal, random normal, but fasting slightly higher so what??? do we worry about this, same if fasting normal, 2 random normal, 2 hr after eat is slightly higher, personally, I take the majority at all times, and dont worry any further.
 

Alexandra100

Well-Known Member
Messages
3,742
Type of diabetes
Prediabetes
Treatment type
Tablets (oral)
I suggest you read that piece in the link that Bamba posted. It is a fair length but well worth reading in its entirety.
I already read it. Don't forget, I am a disciple of Jenny Ruhl. There are plenty of other exposés on her site and in her books.
 

Guzzler

Master
Messages
10,577
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Poor grammar, bullying and drunks.
I already read it. Don't forget, I am a disciple of Jenny Ruhl. There are plenty of other exposés on her site and in her books.

As I am not a disciple of anyone's I shall keep my eye out for others with views on this particular topic. Experience has taught me that I should not get into bed with a particular boffin so as to avoid ending up married into a particular family.
 

Alexandra100

Well-Known Member
Messages
3,742
Type of diabetes
Prediabetes
Treatment type
Tablets (oral)
As I am not a disciple of anyone's I shall keep my eye out for others with views on this particular topic. Experience has taught me that I should not get into bed with a particular boffin so as to avoid ending up married into a particular family.
Wouldn't you say that you are a member of the low carb family?
 

Guzzler

Master
Messages
10,577
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Poor grammar, bullying and drunks.
Wouldn't you say that you are a member of the low carb family?

No. While I would advocate a LCHF lifestyle to anyone in similar circumstances to mine I would hope that I would always avoid becoming entrenched to the point of ignoring everything else just because it is not low carb. I have no need of cliques or clubs, I gather knowledge and make choices and I find that multiple sources of (reputably gathered) knowledge has always widened my choices.
 

kitedoc

Well-Known Member
Messages
4,783
Type of diabetes
Type 1
Treatment type
Pump
Dislikes
black jelly beans
Hello Kitedoc. Yes, I may pop on and view now and again.
Your info presented, well said. The nonsense of cut offs i.e. vary, irregularity arbitrary set, great concern, again I am minority thinking on this concern and question this situation often. I give example which is a real situation and facts, would be interested anyone out there to hear their views when a situation arises as experienced, as I am sure it must affect many others in the same way yes or no?

British yet residing spain, followed trusted the recommended guidelines UK cut off system, which included what was shown on this informative website, the site, showed
  • Fasting guide level showed to be below 108mg/dl, below this indicates one is normal range. I based my results on this cut off number.
  • In Spain cut off fasting is 70 to 110mg/dl. If one is in this range, you are normal range. I followed the British cut off. For over a year, 108mg/dl guide, resulted my tests fell below this cut off and were indicated normal range.
Suddenly 108mg/dl guide, changed on the website? to show it had lowered from 108mg/dl to now 100mg/dl.

That lowering of number resulted normal results that ranged generally between 89 to 103mg/dl fasting, now if numbers hit range 90mg/dl to say 100mg/dl or 101, 102, 103, now become Pre diabetic range? as I understand.

One year one can be normal, a sudden change lessening of a number 108 to 100mg/dl can make a dramatic change as guideline for one to base their results upon.

However, As my numbers are below 110mg/dl in Spain, of course, I am classified as normal range, compared to now UK nodue to change of cut off level overnight basically, I change from Normal to Pre diabetic, I do not see the good medical sense when such situations are real and facts that are taking place to suddenly become normal range to pre diabetic. I had a great surprise when I saw the 108mg/dl had been reduced to 100mg/dl fasting on the sight, and at first, I felt a typographical error had been in place, on enquiries to clarify, it seemed no error in place explanation presented.

I am not saying UK change guidelines are wrong, they simply follow decisions of recommendations, that differ say to other countries. No one is wrong, all countries follow their own rules criterias accordingly, but results in one becoming victim of these variations of cut off situations inbeween.

My question is, should such situations be in existence that a lowering of a number changes all, no doubt adds anxiety stress and unwarrented worry and disappointment, that one can feel happy due to their efforts to control, and then find overnight, they suddenly become a different category, I cannot see a sound reason as to how such a situation of lowering of number changes by the so called experts can take place with this in mind.

Differences of diagnosing A1C cut offs.

A1C New Zealand to my understanding if I am not mistaken are as follows as I read on their website and differ to other countries for example.

40mmol/mol equal to or less. 5.8%
Virtually excludes diabetes non diabetic range. No need to repeat A1C

41/49 mmol/mol equal to or less 5.9% to 6.6%
Abnormal glucose tolerance pre diabetes range. Recommended diet lifestyle changes and assess manage all CV risk factors. Repeat A1C annually, unless symptomatic in interim.

50mmol/mol equal to or greater 6.7%
Supports diagnosis f diabetes in asymoptomatic people must be confirmed on a second A1C sample after aninterval. Recommended diet lifestyle changes and assess manage CV risk factors, start regular retinal urinary microalbumin, renal function and foot screening

Whether one agrees with these cut offs or NZ is right or wrong in their viewing, at least they explain clearly and simply how their criterias function. i.e.

I find it welcoming personally, New Zealand explanations guides, leaves one with no doubt as to their range, for the fact, they clearly demonstrate and make it clear, "equal" to or less or "equal" to or greater. for example, on their cut off for diabetic, if one is sitting on the 6.7% New Zealand cut off, one would be viewed as Pre Diabetic range, if greater i.e. 6.8% or more, supports diagnosing of diabetes.

At least to indicate equal to less or greater, takes a certain doubt away for persons results, I am not saying NZ are right or wrong, only speaking about how cut off ranges compare and due to this, hence not a doctor, yet feel overall the Diabetes world industry, should perhaps,provide more clearer information readily available re cut off situation, the world should follow one strict guideline cut off for all, perhaps that would be a good start....and make a decision as to what happens if one is actually sitting on the chosen cut off, as to what category they fall into, NZ makes it very clear in their, perhaps also the guideline makers decision makers should a leaf out of the book of New Zealand regards the situation of when one is actually sitting on the cut off number whatever that may be.

Your post of information is excellent surrounding information and comments.

Mallorca.
Thank you @pollensa, and please excuse my belated response. Whilst the lab scientists and doctors might explain the differing standards (figures) for diabetes diagnosis from time to time and country to country as due to continual researching of laboratory error range and new techniques of measurement, I tend to call this activity "changing the position of the goal posts'.
And I am cynical. In Australia the upper limit for safe mercury levels in tuna has increased as consumers become more aware of the risks and tuna sales have fallen. Political, food industry and other interests can be well served by these manipulations.
Lowering of some of the cut-off levels for diabetes /pre-diabetes in certain countries seems counter-intuitive in this regard yet the health professions, drug companies, diet and food industry benefit from an increase in numbers of newly diagnosed diabetics.
Where diagnostic levels have perhaps not budged much, the expense of newly diagnosed diabetics to Government-run health schemes is at least stabilised for the time being. Am I too cynical ??
I agree that NZ has at least clarified who is 'in' and who is 'out', rather than a person being left on the edge. And one can argue that an error range for the test could possibly place one person in and another out if the first argues for the upper error limit as the result to be used and the latter, argues for the lower extreme of the range.
Also who is to say that the test repeated the next week is not going to be different enough to change the diagnosis.?
Absolute figures, ranges, fancy predictions and statistics do not, cannot apply fully to human beings, only perhaps trends apply over time and other variables. Clinicians use a numbered scale to assess and person's level of pain. Pain is an experience which cannot be reduced to a linear scale yet concrete thinking rules the day!
There is not only the fear, worry about being diagnosed in or out of diabetes, there may be some financial benefits or disadvantages to health consumers and then the monitoring or diagnosis by HBA1C is still a crude measure. It is the best we have at the moment but again it has cut offs and by itself provides an average over 3 months, an average of BSLs and an average only on potential damage caused.
And we know that for some that diabetes is reversed, at least for a while. Do the health professions think this is a game of rounders, cricket etc? My premise is that trends, using whatever is the most effective, least interventive, and most economical form of assessment and use of a continuum paradigm better informs management of diabetes.(apologies for repetition of part of last post here).
Clinicians need to be trained to not think in absolutes, nor have Government try to enforce this. In Australia a GP can be fined for pre-emptively prescribing a diabetes medication to reduce insulin resistance for a person who under the guidelines (read cut-offs) is diagnosed as pre-diabetes rather than diabetes. Despite the fact that in one case a pre-diabetic women achieved pregnancy only by being prescribed such a medication before conception.
Health professional training from under-graduate upward needs to include health care consumers who can argue the case for modifying the 'cut off' paradigm. Sadly some doctors still think of healthcare consumers/patients as passive, unintelligent or too under-qualified to discuss things with. The exceptions amongst the profession are to be highly valued.
You have given me added umphh (so descriptive a word, and with no cut-offs attached) to add this to the Health Literacy projects I am working on with a Healthcare Consumer group here in Adelaide. If a change can occur through small group effort, anything is possible. If you see a future newspaper article on Adelaide showing protestors dressed in long trousers and slacks, holding banners labelled " Say NO to cut-offs", "Trends send the right message", "Managing diabetes is not cricket" I will be there.
Best Wishes - May the Trends always be in your favour, and those that appear not, May they be amendable always to change.
 
P

pollensa

Guest
Thank you @pollensa, and please excuse my belated response. Whilst the lab scientists and doctors might explain the differing standards (figures) for diabetes diagnosis from time to time and country to country as due to continual researching of laboratory error range and new techniques of measurement, I tend to call this activity "changing the position of the goal posts'.
And I am cynical. In Australia the upper limit for safe mercury levels in tuna has increased as consumers become more aware of the risks and tuna sales have fallen. Political, food industry and other interests can be well served by these manipulations.
Lowering of some of the cut-off levels for diabetes /pre-diabetes in certain countries seems counter-intuitive in this regard yet the health professions, drug companies, diet and food industry benefit from an increase in numbers of newly diagnosed diabetics.
Where diagnostic levels have perhaps not budged much, the expense of newly diagnosed diabetics to Government-run health schemes is at least stabilised for the time being. Am I too cynical ??
I agree that NZ has at least clarified who is 'in' and who is 'out', rather than a person being left on the edge. And one can argue that an error range for the test could possibly place one person in and another out if the first argues for the upper error limit as the result to be used and the latter, argues for the lower extreme of the range.
Also who is to say that the test repeated the next week is not going to be different enough to change the diagnosis.?
Absolute figures, ranges, fancy predictions and statistics do not, cannot apply fully to human beings, only perhaps trends apply over time and other variables. Clinicians use a numbered scale to assess and person's level of pain. Pain is an experience which cannot be reduced to a linear scale yet concrete thinking rules the day!
There is not only the fear, worry about being diagnosed in or out of diabetes, there may be some financial benefits or disadvantages to health consumers and then the monitoring or diagnosis by HBA1C is still a crude measure. It is the best we have at the moment but again it has cut offs and by itself provides an average over 3 months, an average of BSLs and an average only on potential damage caused.
And we know that for some that diabetes is reversed, at least for a while. Do the health professions think this is a game of rounders, cricket etc? My premise is that trends, using whatever is the most effective, least interventive, and most economical form of assessment and use of a continuum paradigm better informs management of diabetes.(apologies for repetition of part of last post here).
Clinicians need to be trained to not think in absolutes, nor have Government try to enforce this. In Australia a GP can be fined for pre-emptively prescribing a diabetes medication to reduce insulin resistance for a person who under the guidelines (read cut-offs) is diagnosed as pre-diabetes rather than diabetes. Despite the fact that in one case a pre-diabetic women achieved pregnancy only by being prescribed such a medication before conception.
Health professional training from under-graduate upward needs to include health care consumers who can argue the case for modifying the 'cut off' paradigm. Sadly some doctors still think of healthcare consumers/patients as passive, unintelligent or too under-qualified to discuss things with. The exceptions amongst the profession are to be highly valued.
You have given me added umphh (so descriptive a word, and with no cut-offs attached) to add this to the Health Literacy projects I am working on with a Healthcare Consumer group here in Adelaide. If a change can occur through small group effort, anything is possible. If you see a future newspaper article on Adelaide showing protestors dressed in long trousers and slacks, holding banners labelled " Say NO to cut-offs", "Trends send the right message", "Managing diabetes is not cricket" I will be there.
Best Wishes - May the Trends always be in your favour, and those that appear not, May they be amendable always to change.
I cannot resist reply to this so informative post as myself being from Byron Bay Australia, reply thank you, has helped myself regards putting doubts into some perspective, and added more info to the pot, THANK YOU, certainly welcoming interested to hear your involvement in Adelaide overall regards Diabetes, New Zealand I suppose on their approach differences, it could be argued sensitivity is been sacrificed of cases of diabetes missed??? its a valid point of concern I am sure, yet seems they take a pragmatic approach, as I understand, premature or incorrect diagnosis of diabetes can lead to unnecessary anxiety for the patient and significant insurance and employment issues as well as involve unwarranted costly medical procedures as regular retinal screening, seems they do 6 to 12 months screening in order not for anyone to be missed, re patients as I understand on reading information i may be wrong? based on NZ approach viewing order of the day is, caution, i.e. who are close to cut off point it would seem reasonable to offer first and foremost, interval lifestyle intervention before repeating the test and before giving a diagnosis of diabetes as a label of diabetes is currently a lifetime one with many downstream effects on general life to a large degree someway or another, perhaps a caution be 100% sure before giving that label is the right way to go???

For this, perhaps the diabetes world should take a leaf from this approach? on top of existing standards in place??

Your So right about the lab scientists explanations presented,I have queried this and been given he same explanation more or less. It is acknowledged over and above that yes, there are great variations worldwide on diagnosing procedures, hence, "it all depens where one is time of diagnosing", in my own case if I stay in Spain, I am classed as Diabetic, if I jump on a plane down to New Zealand, I fall under caution, retesting 6 12 months, change of lifestyle monitoring, Pre Diabetes.

Whether this is the right approach by NZ or others, who knows, we are in the hands of the so called experts? I am not a doctor, and these are only general comments,views only, differences, worldwide, indicate perhaps, this has to change, addressed and one strict criteria whatever that is, decided upon for the world to follow re diagnosing techniques, in the best interests of all those receiving results at the end of the day? Getting that message may be difficult.

on your point lowering cut offs, this is continued question of concern regards who benefits for this? such moves, hopefully in the best interests of the patients, always try to be positive, but perhaps there is some big business for many when the lowering of cuts offs are introduced,who knows again? Yes, getting the message out is of great importance,

Wishing you wonderful luck with the health issues in Adelaide, right behind you on this.

Good Luck and say Hello to beautiful and wonderful Australia, and how interesting also to note about the situation of Doctors getting fines regards diagnosing techniques, for pre prescribing a diabetes medication, this happened to myself here my doctor prescribed unnecessarily metformin, when I was normal readings, but was a precaution as I was high normal and explanation, medications given just in case approach, why give medications for something that may not happen was my concern wonderment, of course, I did not take those medications and have not todate.

I hope your input helps change some current concrete thinkings re diabetes Downunder and worldwide eventually.

Regards from Mallorca, Byron Bay Australia
 
P

pollensa

Guest
Thank you @pollensa, and please excuse my belated response. Whilst the lab scientists and doctors might explain the differing standards (figures) for diabetes diagnosis from time to time and country to country as due to continual researching of laboratory error range and new techniques of measurement, I tend to call this activity "changing the position of the goal posts'.
And I am cynical. In Australia the upper limit for safe mercury levels in tuna has increased as consumers become more aware of the risks and tuna sales have fallen. Political, food industry and other interests can be well served by these manipulations.
Lowering of some of the cut-off levels for diabetes /pre-diabetes in certain countries seems counter-intuitive in this regard yet the health professions, drug companies, diet and food industry benefit from an increase in numbers of newly diagnosed diabetics.
Where diagnostic levels have perhaps not budged much, the expense of newly diagnosed diabetics to Government-run health schemes is at least stabilised for the time being. Am I too cynical ??
I agree that NZ has at least clarified who is 'in' and who is 'out', rather than a person being left on the edge. And one can argue that an error range for the test could possibly place one person in and another out if the first argues for the upper error limit as the result to be used and the latter, argues for the lower extreme of the range.
Also who is to say that the test repeated the next week is not going to be different enough to change the diagnosis.?
Absolute figures, ranges, fancy predictions and statistics do not, cannot apply fully to human beings, only perhaps trends apply over time and other variables. Clinicians use a numbered scale to assess and person's level of pain. Pain is an experience which cannot be reduced to a linear scale yet concrete thinking rules the day!
There is not only the fear, worry about being diagnosed in or out of diabetes, there may be some financial benefits or disadvantages to health consumers and then the monitoring or diagnosis by HBA1C is still a crude measure. It is the best we have at the moment but again it has cut offs and by itself provides an average over 3 months, an average of BSLs and an average only on potential damage caused.
And we know that for some that diabetes is reversed, at least for a while. Do the health professions think this is a game of rounders, cricket etc? My premise is that trends, using whatever is the most effective, least interventive, and most economical form of assessment and use of a continuum paradigm better informs management of diabetes.(apologies for repetition of part of last post here).
Clinicians need to be trained to not think in absolutes, nor have Government try to enforce this. In Australia a GP can be fined for pre-emptively prescribing a diabetes medication to reduce insulin resistance for a person who under the guidelines (read cut-offs) is diagnosed as pre-diabetes rather than diabetes. Despite the fact that in one case a pre-diabetic women achieved pregnancy only by being prescribed such a medication before conception.
Health professional training from under-graduate upward needs to include health care consumers who can argue the case for modifying the 'cut off' paradigm. Sadly some doctors still think of healthcare consumers/patients as passive, unintelligent or too under-qualified to discuss things with. The exceptions amongst the profession are to be highly valued.
You have given me added umphh (so descriptive a word, and with no cut-offs attached) to add this to the Health Literacy projects I am working on with a Healthcare Consumer group here in Adelaide. If a change can occur through small group effort, anything is possible. If you see a future newspaper article on Adelaide showing protestors dressed in long trousers and slacks, holding banners labelled " Say NO to cut-offs", "Trends send the right message", "Managing diabetes is not cricket" I will be there.
Best Wishes - May the Trends always be in your favour, and those that appear not, May they be amendable always to change.
Thank you @pollensa, and please excuse my belated response. Whilst the lab scientists and doctors might explain the differing standards (figures) for diabetes diagnosis from time to time and country to country as due to continual researching of laboratory error range and new techniques of measurement, I tend to call this activity "changing the position of the goal posts'.
And I am cynical. In Australia the upper limit for safe mercury levels in tuna has increased as consumers become more aware of the risks and tuna sales have fallen. Political, food industry and other interests can be well served by these manipulations.
Lowering of some of the cut-off levels for diabetes /pre-diabetes in certain countries seems counter-intuitive in this regard yet the health professions, drug companies, diet and food industry benefit from an increase in numbers of newly diagnosed diabetics.
Where diagnostic levels have perhaps not budged much, the expense of newly diagnosed diabetics to Government-run health schemes is at least stabilised for the time being. Am I too cynical ??
I agree that NZ has at least clarified who is 'in' and who is 'out', rather than a person being left on the edge. And one can argue that an error range for the test could possibly place one person in and another out if the first argues for the upper error limit as the result to be used and the latter, argues for the lower extreme of the range.
Also who is to say that the test repeated the next week is not going to be different enough to change the diagnosis.?
Absolute figures, ranges, fancy predictions and statistics do not, cannot apply fully to human beings, only perhaps trends apply over time and other variables. Clinicians use a numbered scale to assess and person's level of pain. Pain is an experience which cannot be reduced to a linear scale yet concrete thinking rules the day!
There is not only the fear, worry about being diagnosed in or out of diabetes, there may be some financial benefits or disadvantages to health consumers and then the monitoring or diagnosis by HBA1C is still a crude measure. It is the best we have at the moment but again it has cut offs and by itself provides an average over 3 months, an average of BSLs and an average only on potential damage caused.
And we know that for some that diabetes is reversed, at least for a while. Do the health professions think this is a game of rounders, cricket etc? My premise is that trends, using whatever is the most effective, least interventive, and most economical form of assessment and use of a continuum paradigm better informs management of diabetes.(apologies for repetition of part of last post here).
Clinicians need to be trained to not think in absolutes, nor have Government try to enforce this. In Australia a GP can be fined for pre-emptively prescribing a diabetes medication to reduce insulin resistance for a person who under the guidelines (read cut-offs) is diagnosed as pre-diabetes rather than diabetes. Despite the fact that in one case a pre-diabetic women achieved pregnancy only by being prescribed such a medication before conception.
Health professional training from under-graduate upward needs to include health care consumers who can argue the case for modifying the 'cut off' paradigm. Sadly some doctors still think of healthcare consumers/patients as passive, unintelligent or too under-qualified to discuss things with. The exceptions amongst the profession are to be highly valued.
You have given me added umphh (so descriptive a word, and with no cut-offs attached) to add this to the Health Literacy projects I am working on with a Healthcare Consumer group here in Adelaide. If a change can occur through small group effort, anything is possible. If you see a future newspaper article on Adelaide showing protestors dressed in long trousers and slacks, holding banners labelled " Say NO to cut-offs", "Trends send the right message", "Managing diabetes is not cricket" I will be there.
Best Wishes - May the Trends always be in your favour, and those that appear not, May they be amendable always to change.
PS, I forgot to mention above all else, as there seems flaws on many areas re diabetes generally that need addressed, perhaps the first port of call to address one area to help all no matter where diagnosed in the world, is to ensure that those people who set the cut offs, the decision makers, for diagnosing purposes, ensure they do the same as New Zealand and that is to
clarify to all, more detailed information about the cut off number, its all very well, saying "if your below 6.5% your this, or if your above 6.5% you are that", what needs clarification is to also advise, "if your results are sitting on the cut off 6.5% you are viewed as........?"

This clarification is not been 100% explained to us all, and no one should be in a position as I see it, to have a result sitting on a cut off 6.5% and perhaps have the worry they are mis diagnosed because of this, if this happened to myself, I would look at my doctor and say, if you were the person sitting on the cut off would you diagnose yourself, as Pre Diabetic or Diabetic, I would be most interested to hear his reply on this?

Its a flaw area that needs addressed urgently in the best interest of the diabetic world, so thank you New Zealand for at least having the professionalism to ensure they clarify and make life easier for those receiving results, to be below or over, is not good enough information, we need to know what happens if sitting on the cut off? for surety and peace of mind purposes, Yes or no?
 
P

pollensa

Guest
You also have to throw insulin resistance into the mix. Even non Diabetics can have a measure of insulin resistance but do not develope Pre D or T2. It's not all about the glucose.

This is good valid point, i.e. as I understand may be wrong inform if I am, as I see it......the root cause of Diabetes which is a dietary disease yes or no? is what has to be focused and target re treatment, the sugars become a symptom of the root cause>

So as you say its not all about Glucose Sugars, I see it that way also.
 

kitedoc

Well-Known Member
Messages
4,783
Type of diabetes
Type 1
Treatment type
Pump
Dislikes
black jelly beans
Thank you @pollensa, I agree that over-diagnosing diabetes can be traumatic and expensive. A more gradual intervention approach which say, triggers lifestyle modification as a person approaches the cut-off level combined with other measures such a blood pressure elevation (preferably once 24 hour monitor testing can be more easily and cheaply done). The prescription of Blood pressure medication based on one reading in a doctor's surgery is almost criminal !!
What I have to wonder is does the degree of intervention between being 'nearly diabetic' and 'being nearly diabetic but with heart disease' differ ? Is actual aggressive anti-diabetes measures relevant in the latter case? - only well conducted trials are accepted as the arbiters of such decisions but do raise the question of how a series of factors might change the diagnostic 'description' and treatment protocol.
Except for eye problems which are developing quickly, routine eye examinations for diabetics tend to be every 2 hours in Australia. Hopefully routine eye examinations by optometrists and eye specialists for those requiring spectacles will find others who require testing for diabetes. We are ruled by statistics, results-orientated evaluations and finances when it comes to screening of common and/or serious health conditions.
And yes, standardised diabetes diagnoses world-wide is the ideal. And less expensive ways to do interval testing. Trying to get a menace of medics to agree on something is a tall order !! We can but try!!
Even the question of screening for diabetes vs other situations is in need of improvement. From what I can gather the authorities do not seem to bat an eyelid when a doctor orders say a fasting serum glucose test for a person and a simple stated reason an HBA1C seems to cause no stir. As might be expected as the cost of tests increases such as ordering of a Glucose Tolerance Test (GTT) the 'resistance' even from the pathology laboratory increases (according to GPs I have consulted anyway). There is still some arbitrariness about what tests doctors can order here in Australia (but based on my very, very restricted survey)!!
Yet in another area, that of antenatal screening, a specific and standardised test for diabetes is performed at 28 weeks of pregnancy is in GTT form. Is this because Obstetrics is less advanced or progressive in its thinking about diabetes or more due to prudent science-based reasons.? Cut-offs of course apply here too.
To press the point about screening in general terms, not related to diabetes specifically, antenatal testing for thyroid conditions is recommended only case by case, i.e. is one or more of a series of questions (listed by Australian Obstetric College guidelines) relevant?- if so, the thyroid test is ordered. (as opposed to routinely screening everyone in early antenatal stages). But the list of afore-mentioned questions has fewer discrete questions ( and thus range) than the guidelines set down by the Thyroid Association of USA. What is the doctor to do ? Will he/she be cautioned for following the latter rather than the former?
Difference about recommendations arises also n Low Carb diets for diabetics (i.e. Treatment as opposed to Diagnostics). Searching " Jennifer Elliott vs Dietitians Association of Australia 2015" describes the de-registration of a NSW-based dietitian who recommended Low Carbohydrate diets for T2D patients which at the time was recommended by the American Diabetes Association, but not apparently by the DAA. Yes, there are challenges ahead !!
Best Wishes to you in your lovely part of the country!! I shall send updates on progress in the 'fullness of time' !
 
P

pollensa

Guest
Thank you @pollensa, I agree that over-diagnosing diabetes can be traumatic and expensive. A more gradual intervention approach which say, triggers lifestyle modification as a person approaches the cut-off level combined with other measures such a blood pressure elevation (preferably once 24 hour monitor testing can be more easily and cheaply done). The prescription of Blood pressure medication based on one reading in a doctor's surgery is almost criminal !!
What I have to wonder is does the degree of intervention between being 'nearly diabetic' and 'being nearly diabetic but with heart disease' differ ? Is actual aggressive anti-diabetes measures relevant in the latter case? - only well conducted trials are accepted as the arbiters of such decisions but do raise the question of how a series of factors might change the diagnostic 'description' and treatment protocol.
Except for eye problems which are developing quickly, routine eye examinations for diabetics tend to be every 2 hours in Australia. Hopefully routine eye examinations by optometrists and eye specialists for those requiring spectacles will find others who require testing for diabetes. We are ruled by statistics, results-orientated evaluations and finances when it comes to screening of common and/or serious health conditions.
And yes, standardised diabetes diagnoses world-wide is the ideal. And less expensive ways to do interval testing. Trying to get a menace of medics to agree on something is a tall order !! We can but try!!
Even the question of screening for diabetes vs other situations is in need of improvement. From what I can gather the authorities do not seem to bat an eyelid when a doctor orders say a fasting serum glucose test for a person and a simple stated reason an HBA1C seems to cause no stir. As might be expected as the cost of tests increases such as ordering of a Glucose Tolerance Test (GTT) the 'resistance' even from the pathology laboratory increases (according to GPs I have consulted anyway). There is still some arbitrariness about what tests doctors can order here in Australia (but based on my very, very restricted survey)!!
Yet in another area, that of antenatal screening, a specific and standardised test for diabetes is performed at 28 weeks of pregnancy is in GTT form. Is this because Obstetrics is less advanced or progressive in its thinking about diabetes or more due to prudent science-based reasons.? Cut-offs of course apply here too.
To press the point about screening in general terms, not related to diabetes specifically, antenatal testing for thyroid conditions is recommended only case by case, i.e. is one or more of a series of questions (listed by Australian Obstetric College guidelines) relevant?- if so, the thyroid test is ordered. (as opposed to routinely screening everyone in early antenatal stages). But the list of afore-mentioned questions has fewer discrete questions ( and thus range) than the guidelines set down by the Thyroid Association of USA. What is the doctor to do ? Will he/she be cautioned for following the latter rather than the former?
Difference about recommendations arises also n Low Carb diets for diabetics (i.e. Treatment as opposed to Diagnostics). Searching " Jennifer Elliott vs Dietitians Association of Australia 2015" describes the de-registration of a NSW-based dietitian who recommended Low Carbohydrate diets for T2D patients which at the time was recommended by the American Diabetes Association, but not apparently by the DAA. Yes, there are challenges ahead !!
Best Wishes to you in your lovely part of the country!! I shall send updates on progress in the 'fullness of time' !

That would be so wonderful as the diabetes world needs more people like yourself who is putting energy and taking interest to approach health cares and others with suggestion box ideas,

I watch this space for updates accordingly

off to the beach now in 29 degrees for a surf, thats summer in Mallorca, ah, and no sharks by the way, an added bonus.
Say G.day to Oz, one of the best countries on this planet along with Mallorca.