The story behind the decision beind the cutoff points is here
https://www.bloodsugar101.com/misdiagnosis-by-design
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.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.
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.
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.
@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.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.
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.
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.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.
Wouldn't you say that you are a member of the low carb family?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?
I've never heard that before so thanks! I shall use that at some point.......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.
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'.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
Suddenly 108mg/dl guide, changed on the website? to show it had lowered from 108mg/dl to now 100mg/dl.
- 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.
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.
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???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 toThank 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.
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.
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' !
We use cookies and similar technologies for the following purposes:
Do you accept cookies and these technologies?
We use cookies and similar technologies for the following purposes:
Do you accept cookies and these technologies?