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Second diagnosis of type 2 within 5 months !

Discussion in 'Newly Diagnosed' started by donnajv212, Jul 22, 2013.

  1. donnajv212

    donnajv212 Type 2 · Member

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    Hi everyone, this is driving me insane I saw my endocrinologist for another condition I have in Feb. He ordered a HBA1c and a OGTT. Didn't hear back so assumed everything ok I am not one to chase results. Then beginning of June get a letter which is a copy of the letter he sent to GP saying I should be started on Metformin and referred for retinal screening after my diabetes was confirmed by the OGTT in February. This was the first me or GP had heard about it. Anyway GP reluctant to start metformin and didn't agree I had diabetes as HBA1c was normal.So told me to go away and repeat OGTT in 4 weeks but she was pretty sure it would come back normal. This I did last week and went to see her today about something unrelated and she turns round and says you had a high reading after the OGTT but HBA1c still normal and looked completely baffled. Anyway she then said better start on metformin and made all the arrangements to be referred to dietician etc. I said does this mean I am diabetic she said well I put you down as a type 2 diabetic but results not adding up. So I said in that case I do not want the metformin she tried to get me to have it so we came to a compromise that if in October my bloods come back high even if HBA1c normal I will have to go on it. I am thoroughly confused she said just go read all the stuff as I've diagnosed you as type 2 has anyone else had this happen ? Thanks
     
  2. debs6566

    debs6566 · Active Member

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    How frustrating for you Donna - some health professionals need a kick up the jacksie. Sorry cant help but Im sure someone will know. Hope your feeling alright apart from totally confused :crazy: Take care
     
  3. EllisB

    EllisB · Well-Known Member

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    Donna,

    HbA1c is not always an accurate measure of someone's average blood glucose levels. There are a number of things that can interfere with the reading. For example, you may replace your red blood cells more frequently than most people. It might be worth discussing with your GP whether you are one of the rare cases where it is not a good measure.

    HTH

    Ellis
     
  4. Yorksman

    Yorksman Type 2 · Well-Known Member

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    HBA1c is often referred to as the 'Gold Standard' for diagnosis, but it not without its faults.

    The problem is that what causes diabetes, is being diagnosed by glucose levels but, there are several reasons why you may have high glucose levels. In most cases, this doesn't matter too much because it is the high levels of glucose that you need to avoid.

    You may have high levels because you don't produce enough insulin or because what you do produce is of poor quality. Or, after eating your insulin production may be slow to kick in. Or, you do produce enough of it but your muscle cells have become resistant.

    The glucose in your blood does not easily bind to your red blood cells. That's what makes HBA1c a good diagnostic test. Because it is difficult, if your HBA1c is raised it pretty much means that you have high levels of glucose in your blood all the time. However, if you only have high blood glucose levels some of the time, your HBA1c may remain nearer the normal range. But, the high level of glucose in your blood plasma can still cause some diabetic complications. It's best to be safe on this.

    I have taken the following from a paper entitled, The Pros and Cons of Diagnosing Diabetes With A1C
    http://care.diabetesjournals.org/conten ... l.pdf+html

    You don't have to understand them all but you will see that the difference between the various health professionals is one of interpretation of results. As far as I understand it, if it is showing up in your fasting blood plasma but not your HBA1c, it's probably going to be easier for you to control by watching what you eat and by taking some more exercise.


    Reasons to prefer A1C compared with plasma glucose determination for diagnosing diabetes:

    Chronic hyperglycemia is captured by A1C but not by FPG (even when repeated twice).
    Microangiopathic complications (retinopathy) are associated with A1C as strongly as with FPG.
    A1C is better related to cardiovascular disease than FPG.
    Fasting is not needed for A1C assessment.
    No acute perturbations (e.g., stress, diet, exercise, smoking) affect A1C.
    A1C has a greater pre-analytical stability than blood glucose.
    A1C has an analytical variability not inferior to blood glucose.
    Standardization of A1C assay is not inferior to blood glucose assay.
    Biological variability of A1C is lower than FPG and 2-h OGTT PG.
    Individual susceptibility to protein glycation might be caught by A1C.
    A1C can be used concomitantly for diagnosing and initiating diabetes monitoring.
    Diabetes assessment with A1C assay is not necessarily greater than with glucose assessment.

    Reasons not to prefer A1C compared with plasma glucose determination for diagnosing diabetes:

    Diabetes is clinically defined by high blood glucose and not by glycation of proteins.
    A1C is a poor marker of important pathophysiological abnormalities featuring diabetes.
    A1C has a poor sensitivity in diabetes diagnosis and would change the epidemiology of diabetes.
    2-h glucose level and IGT are stronger predictors of CVD than A1C.
    Fasting is not essential to identify perturbation in glucose metabolism.
    Standardization of A1C assay is poor, even in Western countries, and standardization of glucose
    assay would be easier to implement.
    In many subjects, A1C assay is unreliable and cannot be used.
    A1C has significant differences in various ethnic groups, which are poorly understood and characterized.
    Within-days biological variability of plasma glucose might unveil disturbance of glucose metabolism.
    Individual susceptibility to glycation of hemoglobin is not relevant to diabetes diagnosis.
    Using the same biomarker for diagnosing and monitoring diabetes might have negative effects.
    Cost of the assay: glucose is unquestionably cheaper than A1C, and A1C assay is not available on a large scale in most of the countries.
    A1C levels vary not only according to glycemia, but also to erythrocyte turnover rates (e.g., hemoglobinopathies, malaria, anemia, blood loss) as well as other factors.
    Correlation between A1C and FPG is ~0.85%, which means that as many as 30% of the variation in FPG is not explained by A1C and vice versa.
    Nothing is known about changes in A1C during the development of diabetes.
    A1C levels of 6.0 - 6.5% do not predict diabetes as effectively as FPG and 2-h PG (OGTT).
    Sensitivity of A1C to detect diabetes defined by the OGTT is, 50%; thus, the majority of diabetic individuals will remain undiagnosed if A1C is used.
    The levels of A1C predicting future retinopathy, nephropathy, etc., in the population is not well established (6.5%?).
    No diabetes prevention trials have selected their populations based on A1C.
    Using A1C will delay the diagnosis of diabetes in ~60% of incident cases
     
  5. donnajv212

    donnajv212 Type 2 · Member

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    Thank you all for your replies, and having done some research can see that HBA1c is affected by many things that have already been mentioned. I have a couple of auto immune problems pernicious Anaemia, adreanal insufficiency and was warned diabetes could follow. I just didn't want to add to the shed loads of meds I have already :cry: so I've really had to battle to be given a couple months grace. I am trying to lose weight not easy with the health conditions and different meds etc. But I'm trying with slimming world which doc said food plan was fine to continue. Hopefully by october it will be low enough not to need meds doc don't seem to think so but we will see. Thank you for taking the time to reply :)

    Sent from the Diabetes Forum App
     
  6. K1980

    K1980 · Newbie

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    I'm going through the exact same thing. Consultant says type 2 from fasting and hba1c coming back normal waiting on a call back from the diabetic nurses as we speak.......

    Just want to know what is going on with me so I can sort it out. Hope things become clearer for you soon :0)
     
  7. donnajv212

    donnajv212 Type 2 · Member

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    Hi its frustrating isn't it, but from what I've been reading you can be diabetic and still have a normal HBA1c. There are a few rare things that can make the test inaccurate, hopes this helps to lessen the confusion a bit. I hope things work out for you I really don't want to go on to metformin but have a feeling the fasting bloods in october will be no different. Hope things work out x

    Sent from the Diabetes Forum App
     
  8. viviennem

    viviennem Type 2 · Well-Known Member

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    Metformin is a well-tested drug and very many people settle on to it easily. Some do have gastric problems initially, which is why you start low and slowly increase the dose. If the problems are slow to settle you can always ask for the slow-release (SR) version, which suits most people. Very few can't tolerate it at all.

    It also gives some protection against CVD and strokes; I take it because I won't take statins. Also, recent research is suggesting that it gives some protection against many types of cancer. I'd fight to keep my Metformin!

    Having said that, I totally understand why you don't want to take too many meds, and it is completely your choice.

    Controlling your blood glucose by diet and exercise is a way many people take. It generally means controlling your carbohydrate intake. I'm rather extreme and try to eat only 30g of carb daily; in practice at the moment it's probably between 50g - 70g. Some people manage perfectly well on around 130g - 150g. Exercise needn't be terrifying either - you don't have to work out if you don't want to. Just try to make sure you walk every day - 20 mins exercise daily should be enough.

    Do you have a blood glucose metre and test strips? Ask you doctor to give you them on prescription so that you can test your blood sugar yourself and keep a record. It should help your GP too! I you can't get them on prescription (and many practices won't give them to Type 2s - it's worth getting your own. Quite often the metre is given away free if you approach the manufacturers, so all you have to buy is the test strips. These are expensive, but as you learn what you can eat and what you can't, you test less frequently.

    I'm no expert, but with this confusion in your results it seems likely that if you aren't Type 2 now you may well be in the future. Much better to take control now - it's not the end of the world :D

    There's lots of information on here about metres, how and when to test, and diets and recipes.

    Let us know how you get on.

    Viv 8)
     
  9. donnajv212

    donnajv212 Type 2 · Member

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    Thank you when they do routine bloods in october again if still high I have agreed to metformin. Its just I've started a healthy eating plan and just trying to avoid more meds if possible but if it means my health will suffer I will go on them. Thanks for the info :)

    Sent from the Diabetes Forum App
     
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