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Just diagnosed as Type 2, am confused

R

RachelG.

Active Member
Messages
33
Type of diabetes
Type 2
Treatment type
Diet only
Hi all,

Since I had a bunch of bloods done in January after a chest infection, I've had some high Hba1c results, a couple prediabetic, one 51 mmol/mol and another 53. I have really low ferritin which is being addressed through Tranexamic acid for heavy periods and iron supplementation - in Jan it was below 10 ug/L, it went up to slightly over 20 in June, then I had a stomach bug for ages and it's back down below 10. A diabetes specialist GP at my surgery saw me as she has coded me as diabetic based on my Hba1c scores, I was very surprised as I have no symptoms (I think), never been overweight, very active, good diet etc. There's no diabetes in my family.

I asked if we could try a fasting plasma glucose test which came back 5.9 mmol/L so just within normal (6.0 is prediabetic cut off). She now says she think I am diabetic despite the fasting plasma glucose result as she 'doesn't like to use two different kinds of tests as it's confusing', is insisting that as my haemoglobin levels are within normal the iron isn't affecting the Hba1C and trying to offer me 'healthy lifestyle education' which I have said I think I don't need. I'm not against assuming I am diabetic if it's unclear to be on the safe side but she said I need to 'change my diet' and she will redo the Hba1c in 3 months to look for improvement, otherwise I will need medication of some sort. She doesn't seem to think the chronically low ferritin is important. She insists there's no point testing for antibodies as she 'is sure I'm not Type 1'.

I suppose I'm questioning how ignoring the normal fasting blood glucose result makes sense and also wondering how I have diabetes as I don't seem to fit the profile (as I understood it) for Type 2. Does anyone else here have a similar story? Does it seem like I am getting sensible medical care and if not, how do I find someone better? I am concerned that she won't test for antibodies for Type 1. On the other hand, she is a diabetes specialist so presumably knows what she's talking about?

Thanks for your help,
Rachel
 
Hi @RachelG. and welcome to the forum.
If you are in the UK then the accepted test for Diabetes is HbA1C rather than Fasting Blood Glucose.

It is estimated that around 10% of Type 2 diabetics are (and always have been) normal weight or below. I was a slim T2D but in mt 50's and 60's started to carry a little extra around my belly. This is known as TOFI (Thin Outside, Fat Inside). Dr Michael Mosely (of Trust Me I'm a Doctor TV program in the UK) was probably the most famous of this type of T2 diabetic- though I think he managed to catch it at the pre-diabetes stage.

Many people on this forum (and I, will tell you that it was 'healthy eating' i.e. EatWell Plate and 5 A Day (= Low Fat High Carb) which caused them to develop T2D and they have done just the reverse - Low Carb High Protein High(er) Fat way of eating to control it or even get into remission. I have been in remission (i.e. Normal non-diabetic HbA1C) for over 4yrs so far.
Being Fit only tends to delay T2D rather than prevent it. Prof Tim Noakes became T2D after he stopped competing in marathons and endurance races, even though he was still fit. He discovered that all that carb loading as an athlete had done him no favours and so had to re-write a key chapter of his famous book 'The Lore of Running'.
 
Hi, I have no direct experience of this myself, but I had a quick look in my copy of Bilous and Donnelly's Handbook of Diabetes - 5th edition.

One of the issues they mention with HbA1c tests is that it can give "spurious results in patients with anaemia (iron deficiency)" as well as a few other categories (chapter 3 page 10). Screenshot attached.

You say you've been taking iron supplements because your iron is low. It is perhaps possible that "spurious results" thing might apply to you. If I were you I'd want to discuss that with my GP.
 

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If you think that you have a slightly strange blood condition that might affect your hba1c you coyld always ask for a fructosamine test , usually given to pregnant women because it reflects your bg for the lasr 2 to 3 weeks.
 
EllieM said:
If you think that you have a slightly strange blood condition that might affect your hba1c you coyld always ask for a fructosamine test , usually given to pregnant women because it reflects your bg for the lasr 2 to 3 weeks.
Click to expand...

Ah yes, thanks, that was why I asked for the fasting glucose test but this doctor seems to want to ignore the normal result so I assume she would ignore anything that isn't Hba1c.


Thanks, very interesting to hear about the marathon runner. I am very active and eat quite large portions to fuel myself so have probably ingested a lot of (mostly wholewheat) carbs over my lifetime.
 

Thanks, my surgery seem to point me in the direction of this GP as she is a diabetes specialist and she is insisting that if my haemoglobin is normal then the low ferritin can't be skewing the Hba1c result. Not completely convinced of that from what I've read but that seems to be their line.
 
@rachelg I’m fit and lean. BMI of 19 . I kind of mimic @ianf0ster ’s example of the runner Prof Tim Noakes. I don’t have insulin resistance, being insulin sensitive, so my raised blood sugars are down to my pancreas not producing enough insulin. Why that is, is another question.

I’m going to grab that book ,’ The Lore of Running’.
 
I’ve also had chronically low ferritin for years (decades?) but within range haemoglobin. I’ve dug deep and have found plenty of papers talking about iron deficiency anemia causing inaccurate results but nothing that relates to iron deficiency without anemia. Most papers and drs seem to pretty much ignore the latter frustratingly. I’ve managed to get a couple of infusions in the last year or so having sent my dr a lot of links to how IDWA is far more important than most drs are taught it is. I haven’t noticed much change in my hba1c and the glucose tests I take do more or less correspond to my hba1c.

One issue with the fasting test is that it is a single moment in time whereas the hba1c looks at a period of time. Even before the widespread use of the hba1c it wasn’t a fasting glucose test but the oral glucose tolerance test. obviously I can’t say if your results are affected but if you feel you want it reconfirmed try explaining the literature says little one way or the other about low ferritin and can you have the fructosamine test before embarking on a life long diagnosis. Regardless it seems you’re likely sailing in that direction at the least so the same lifestyle changes would still apply to turn things around.
 
Thanks that's very interesting, guess my ferritin may not be related then. I ordered a free 2 week libre 2 sensor and it does seem to show that my average levels are in the 6s and 7s with dips below 4 and above 10 sometimes so it seems more likely to me now that I do have diabetes. Will ask for the fructosamine test, if nothing else then it should give more up to date info than the hba1c.
 
Even non diabetics dip briefly and slightly below 4 occasionally. Our bodies are designed to self correct by the liver putting out glucose unless there’s something blocking that action, most commonly something like injected insulin or a diabetic drug like gliclazide. Lows are not a sign of diabetes, more so of the effects of the treatment of it.

As to the above 10 again sometimes non diabetics will reach these levels and higher but it would be after a more carby meal and not take too long to go back down. So the timing of the level in relation to meals (and activity sometimes) is very relevant

The hba1c covers the lifespan of the red blood cells (average 12 weeks). This means the more recent weeks are weighted more heavily but the longer since changes were made has passed the more reflective of the current situation it becomes.

You are not alone is fighting against diagnosis - I very much did blaming all sorts of events. They may indeed have had an effect but the end result was the same however I got here. Occasionally there is good cause for doubt, but sadly for many of us it’s a stage of acceptance and hopefully action

edit: added missing word to make it make sense
 
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Just a quick one, iron is an essential component in the hemoglobin that the HbA1c is looking at, so it would be kind of surprising if ferritin (protein most responsible for regulating iron) did not have an effect - I'm not saying what effect though...
 
To my understanding ferritin is the stored iron that is not being utilised in haemoglobin. It’s perfectly possible to have a normal HB whilst being almost totally deficient in ferritin. I know as I’ve been that way for years and have spoken with many others the same. .
 
I can see it being described that way - and I don't want to challenge your personal experience, but strictly ferritin is a protein.. I'll back off; but it's not a million miles away from the whole LDL thing - LDL is described as cholesterol, but really its a protein molecule for carrying things, including cholesterol - same kind of thing.

Point being that ferritin is likely to be influential in the amount of iron available to be turned into Haemoglobin - that doesn't conflict with what you are saying and experiencing. And again, I'm not at all saying that I know what the effect may be.
 
Totally agree it makes a difference to what iron is available for haemoglobin. I’m not disagreeing about it being a protein concerning iron storage either. It is, I was just being simplistic about it.

From my reading (and personal experience) it might well be that haemoglobin and iron levels can be maintained in some people so long as there is any ferritin left, but potentially at the expense of other biological processes (low ferritin even without anaemia can still have a huge number of symptoms, some quite serious and unpleasant). Other people seem to suffer with a lack of iron for haemoglobin (and become anaemic) well before their ferritin runs out. Like lots of things the effect of a deficiency can be variable person to person.
 
The Hba1c gives a 3 month reading so is probably more accurate to the Doctor.

The trouble with diabetes is that not only food and medicines can affect your blood readings, if you are ill or stressed it can affect them too. Sometimes, there is just no logical reason why you have dropped low or rocketed up high, so it is quite frustrating to manage.

Oh well, you've come to the right place for advice. Good luck

Edited by Mods to comply with forum rules
 
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Thanks all, for the moment I’m taking 200mg iron a day and also managing my diet as if I have diabetes to cover all bases. Totally agree, low ferritin isn’t good for all kinds of bodily processes so I need to get on top of that.

I was on holiday last week with a friend and his brother who is a doctor and the brother suggested that for him, one great aunt with diabetes coupled with an aunt with gestational and then prediabetes and the fact all babies in my generation of the family were born with low blood sugar suggested a ‘strong family history’. It surprised me a bit but could explain my situation if he’s right. I just feel a bit depressed about it all and kind of let down by the universe! But I’m sure loads of people on here can relate to that.
 
bensonamandaw said:
I am Also Confused.. My Hba1c 10%.. Don't Know How to Improve
Click to expand...
Hi @bensonamandaw , what about starting your own thread with your questions?
You're reacting to a thread by someone who has just been diagnosed and not on any medication, a completely different situation from you being on insulin and a gliptin, and having been diabetic for a while.
 
Hello and welcome @bensonamandaw

Completely agree with @Antje77 . There are some suggestions which may help but you are likely to get more responses if you start your own thread. I would suggest you include information about your diet, and medication and your HbA1C and any other information that ay be relevant.

I am continually impressed by the level of knowledge in this forum and the willingness of people here to provide help and advice.
 
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