Levels

You can find the nice guidelines here. The target for diet controlled type 2 diabetics or those on drugs which do not cause hypoglycaemia is an HbA1c of 48.

The info in the nice guidelines seems to support your nurse suggesting medication, but as your recent HbA1c of 54 is just slightly above the medication threshold of HbA1c 53, and due to your reluctance to start medication, the nurse could be giving some leeway. Have you been given a target to aim for, @John 2 ? Also a date for another HbA1c test? Your levels need to be monitored.

It is not clear whether or not you brought the level down with or without medication. It would help to give more specific advice if you made that clear in your profile.

John 2 said:

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Level down without medication , next test prob 3 months but not stated , that is why I am asking , it’s all a bit hit and miss I think , I get the feeling it’s about pushing me onto meds , do they get a cash bonus fo doing it .

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Hi - bear in mind that normal HbA1c levels - where almost all non-diabetic people are - range from around 36 to 42.

GPs do not get a cash bonus simply for putting you on meds. They are rewarded for various things to do with type 2 , for example identifying anyone with an HbA1c of 48 or above. The new Quality and Outcpomes framework targets were published in the last couple of days and here's a link to them. The diabetes ones start "DM".

https://www.england.nhs.uk/wp-conte...ity-and-outcomes-framework-guidance-26-27.pdf

The QoF paper has links to the relevant NICE guidelines which go into more detail about the "target levels" for HbA1c. The targets are nowhere near normal BG levels.

@John 2 , I go with the concept that the higher your blood sugars go, the more likely you are to suffer the consequences of high blood sugars like damage to your vascular system , the nerve endings , your heart and kidneys. Obviously the closer one is to normal blood sugars the less likely damage may occur. And to complicate matters, not everyone suffers consequences the same. So some people can have symptom's associated with raised blood sugars at lower levels, even at prediabetic levels (rarely) and others may have no symptoms even when their blood sugars are high. Numbers are just numbers, they are used as means of addressing risk.

As for medications, some people choose medications over diet. They prefer to eat a diet with some carbohydrates , whilst others choose to control their blood sugars through diet, restricting their carbohydrate intake. One means is no better than the other. It’s just a choice. If you don’t want to take blood sugar lowering medications, choosing instead to use diet, then talk to your Dr.