Prediabetes

[dwnunder]

My last blood test at the GP came back as BG 5.7 HbA1c 5.5
For some years my fasting BG has been in the pre diabetic range when I get it tested at the GP and my HbA1c has always been in the normal range. I bought a Glucose monitor so that I can check it at home and my fasting finger prick test ranges from 4.4 to 4.8. I have also had a GTT and that too came back normal. Can anyone tell me what they think is going on? Am I prediabetic or is it just a liver dump as it’s usually 3 hours after getting out of bed until my blood is taken and I can be sat in the waiting room for over an hour. My GP told me that I am prediabetic.

 

[Melgar]

If I'm understanding you correctly @dwnunder you believe you are prediabetic or you were prediabetic? From your HbAc1 number 5.5 % that is in the normal range. So your Dr took a blood reading (fingerprick) and it came back at 5.7 mmol/ls that is also normal. Your fasting blood sugars are very good at 4.4 to 4.8 - great! If I'm reading you right, you want to know why your numbers have come down? Insulin resistance is usually the reason why one's blood sugars rise above 6.0% which in most countries (excluding the US which uses 5.7%) is the point at which you are classed as prediabetes. Insulin resistance means your body doesn't use insulin effectively causing blood sugars to stay in the blood stream instead of being utilized by your cells for energy. It may be because you have become more sensitive to insulin. Insulin resistance can rise and fall in both none diabetics and diabetics a like. Did you change your diet, or did you increase exercise ? In any event, congratulations!

Edited to add prediabetes

 

[dwnunder]

If I'm understanding you correctly @dwnunder you believe you are prediabetic or you were prediabetic? From your HbAc1 number 5.5 % that is in the normal range. So your Dr took a blood reading (fingerprick) and it came back at 5.7 mmol/ls that is also normal. Your fasting blood sugars are very good at 4.4 to 4.8 - great! If I'm reading you right, you want to know why your numbers have come down? Insulin resistance is usually the reason why one's blood sugars rise above 6.0% which in most countries (excluding the US which uses 5.7%) is the point at which you are classed as prediabetes. Insulin resistance means your body doesn't use insulin effectively causing blood sugars to stay in the blood stream instead of being utilized by your cells for energy. It may be because you have become more sensitive to insulin. Insulin resistance can rise and fall in both none diabetics and diabetics a like. Did you change your diet, or did you increase exercise ? In any event, congratulations!

Edited to add prediabetes

Thank you for answering my questions. I was more querying why my blood glucose goes up whilst fasting from say a 4.4 on waking and 3 hours later in a fasting state it always seems to go higher. It seems to be consistently 4.4 - 4.8 when I first get out of bed but by the time I get bloods taken and sent to pathology (not finger prick) it goes up so much, I have even had it go as high as 6.1 on blood tests from pathology. But my finger pricks at home seem to be in the normal range. Another question that I have if you can answer me from your knowledge is what test results do GP’s look at to say that you are pre diabetic. If HbA1c is in the normal range of 5.3-5.5% yet blood glucose is high in the pre diabetic range is that classed as pre diabetic? I thought that both had to be high but I might be wrong.

 

[Chris24Main]

It's all tremendously confusing....

Firstly - BG and HbA1c are both measures of the level of glucose in the bloodstream. The finger prick test is doing that directly, whereas the HbA1c test looks at the amount of glycation (the effect of glucose directly on red blood cells) - given the roughly three month life of a red blood cell, this becomes a better average test over about the previous three months - but if you take enough finger pricks over three months, they should average the same as an HbA1c.

As @Melgar is saying - your results are not concerning, but also it's a little confusing what pre-diabetic means; usually the diagnosis would hinge on two consecutive HbA1c tests (just to makes sure, and both being over whatever limit is set).

As for the amount of actual glucose in your blood at any given moment - well, your liver is a complex machine for doing a whole bunch of things, including storing about a day's worth of sugar-like stuff for turning back into glucose, and so your level will change even while fasting. These absolute changes are fairly small -

I just had a whole day fast - and after 24 hours my blood glucose level was slightly up on when I started - but that was because I'd just been paddleboarding, and my liver had provided the energy...

Hope that helps...

 

[KennyA]

My last blood test at the GP came back as BG 5.7 HbA1c 5.5
For some years my fasting BG has been in the pre diabetic range when I get it tested at the GP and my HbA1c has always been in the normal range. I bought a Glucose monitor so that I can check it at home and my fasting finger prick test ranges from 4.4 to 4.8. I have also had a GTT and that too came back normal. Can anyone tell me what they think is going on? Am I prediabetic or is it just a liver dump as it’s usually 3 hours after getting out of bed until my blood is taken and I can be sat in the waiting room for over an hour. My GP told me that I am prediabetic.

Hi, I can see why you're asking. Pre-diabetes isn't a diagnosis of anything. It's an invented term to cover the gap between someone's blood glucose levels going out of normal range (most non-diabetic people have a blood glucose level somewhere between 36 and 41 - see graph) and the backstop automatic HbA1c diagnosis level of 48. Unfortunately many health care systems teat the 48 as the only diagnostic criterion, although it is perfectly clear from all of the literature (see Bilous and Donnelly, Handbook of Diabetes) that a lot of damage can be done at much lower blood glucose levels. Bilous and Donnelly reckon that damage starts to occur at least 5-6 years before actual diagnosis.

That said, none of the values you're reporting appear to be problematic (I'm assuming your HbA1c is still in percentage form), although you say "my fasting BG has been in the pre diabetic range when I get it tested at the GP". I'm assuming this is fasted fingerprick test in a relatively stressed situation? Your liver might be really good at dumping glucose quickly, this is not a bad thing.

An OGTT is usually pretty conclusive one way or the other about showing an insulin response. So - the only reason you have to think that you are prediabetic is that a GP told you so on the basis of fingerprick testing and in the teeth of the HbA1c result? Seems to me that you might start with asking your GP exactly why s/he thinks you're prediabetic.

[Edited to attach graph]