Sudden jump in HBA1c/FBG

[VashtiB]

Hello and welcome,

I agree with Rachox that for me living in ignorance of my blood sugar levels would serverely lower my quality of life. I always want to be able to know the effect of different meals on my body. The frequent testing doesn't have to last that long but testing from time to time allows you to make changes immediately should the readings be higher than you would like.

My mother has also had type 2 for years and eats rubbish and is fine but I don't want to rely on that and end up having complications. I have decided it is my choice whether to either live in gin orange and hope for the best or find out as much information as possible and adjust quickly if needed. At the moment my choice is the second- maybe in 30 years time I might decide to opt for the second but I have about 10 years before I retire and then I want to do some living- complications would not help my life.

For me just finding out every three months is not an option- if my reading iwas too high it may have been high for over a month and if what I then did doesn't work it's 4 months down the track after the next three months.

That's just my own view though and I'm more than a bit of a control freak so as long as what you do works for you that's fine. I don't think it would hurt to have a meter and at least check from time to time.

 

[manxman66]

I've just been to see the diabetic nurse about these results, and she finds them as odd as I do. The sudden spike in HBA1c and FBG is particularly strange in that I'm slowly and steadily losing weight without dieting – my reading at the doctor's was 99.7kg in February 2018 and is now 95.4k (or might even have been 94.5kg – I forget which way round it was). Surely my blood sugar should be coming down along with my weight, not suddenly spiking?

The nurse agreed that the Atorvastatin could have contributed to the result, as could my doctor's request to eat more carbohydrates and less protein, but beyond that we're baffled. We've agreed to hold off on Metformin for now, and I'm going to attempt a 5/2 diet for three months to get some more weight off, before doing a full battery of blood tests.

Does anybody know what is going on here?

 

[EllieM]

Does anybody know what is going on here?

1) Honestly I suspect the issue is too many carbs. It doesn't matter if you're only eating once a day if you're eating more than your body can cope with. Maybe just ease up on the carbs in your one daily meal?
2) Or the statins, as they can be known to raise blood sugars.
3) Pretty unlikely, but I'll put it out there. If your diabetes is caused by a reduction of insulin production rather than an over abundance (T2s typically over produce insulin in a vain attempt to process the carbs that their bodies can't cope with) then weight loss and blood sugar rise would be the result, but I'd expect this to happen much more quickly than over 13 years.

But T2s can lose weight as a symptom if their levels get high enough, though I wouldn't expect an hba1c of 7 to be that high.

Good luck.

 

[manxman66]

3) Pretty unlikely, but I'll put it out there. If your diabetes is caused by a reduction of insulin production rather than an over abundance (T2s typically over produce insulin in a vain attempt to process the carbs that their bodies can't cope with) then weight loss and blood sugar rise would be the result, but I'd expect this to happen much more quickly than over 13 years.

This is the one that worries me. When I Googled weight loss and a sudden worsening of diabetic blood sugar control, several sites suggested that this can be an early indicator of pancreatic cancer. I already have a higher than normal predisposition towards the disease, as my father was an Ashkenazi Jew. Realistically, how likely is this? I'm asymptomatic at the moment (apart from the raised HBA1c and FBG), but it's a disease that doesn't generally present with symptoms until the end-stage.

I'm considering requesting a CA19-9 blood test and ultrasound to rule out a pancreatic tumour, but maybe I'm just jumping at shadows here. What does everyone else think?

I'm possibly being overly cautious, as there seems to have been a spate of cancers in the Isle of Man recently. Three of my friends died from cancer within two months of one another earlier this year, and one of them had pancreatic cancer.

My doctor said it was extremely unlikely that the raised HBA1c resulted from any kind of pancreatic failure, noting that "if your pancreas was giving out, I'd expect the figure to be nearer 12 than 7"; however, the diabetic nurse thought the sudden jump was very odd and noted that whilst diabetes is a progressive disease, it usually results in a much more gradual loss of control.

 

[Brunneria]

the diabetic nurse thought the sudden jump was very odd and noted that whilst diabetes is a progressive disease, it usually results in a much more gradual loss of control.

I would urge you not to take that as gospel. Is this the same person who told you to increase carbs?

The body is very good at coping and coping and coping right up until it doesn't any more, and things can go pear shaped very quickly after that.

From what you say, with bread, starter, main with carbs and a pud, every day, for years, you have been putting your body under a lot of pressure, for a long time, and sooner or later, there is a straw that breaks the camel's back.

I would urge you to have a good look around the www.bloodsugar101.com website
There is plenty of useful information on there about how T2 develops, and how fast, and in what ways, and when the evidence is actually examined (in a way that your nurse is very unlikely to have the time or the interest to do), you will see that different people develop T2 in different ways and at very different speeds.

Simply put: doing an occasional HbA1c may give the impression that things are worsening gradually, but sometimes the deterioration is in sharp steps downwards - sometimes very large steps downwards.

As for your unexplained weight loss... I am very surprised that your nurse if puzzled by this.
She should know that there is a point where the level of blood glucose triggers the body to filter glucose out through the kidneys - in an emergency attempt to get rid of the damaging glucose. The blood glucose level at which this happens is slightly variable from person to person, but is usually around 10-11mmol/l https://www.healthline.com/health/glucose-test-urine#diabetes

All it would take would be for your one, large, carby meal to raise your blood glucose above that level for a few hours, and you would be peeing glucose - which is effectively reducing the amount of energy you get from that meal - which may be causing the gradual weight loss. Of course, this isn't good. It places strain on the kidneys, and increases the chance of thrush and other urinary tract infections because some infections thrive on glucose. It is also a powerful sign that the body is under sufficient strain that it has fallen back on an emergency coping mechanism, because the usual methods are failing.

When you get your glucometer, be sure to eat one of your old style carby blowouts, and test every 15 mins for 3-4 hours. If the readings go over 10 at any point, then you have strong evidence of the peeing-out-glucose-weightloss theory.

 

[manxman66]

I would urge you not to take that as gospel. Is this the same person who told you to increase carbs?

No, that was my doctor.

The body is very good at coping and coping and coping right up until it doesn't any more, and things can go pear shaped very quickly after that.

This is precisely what my doctor said on the matter. She said that HBA1c can very easily go from 6.1 to 7.0 in three months – in fact, she said she's seen it go from 6.0 to 12.0 in that time. It was the nurse who thought it odd, as do I: my weight has been slowly coming down, as has my annual HBA1c reading (6.4 down to 6.1 over a couple of years), and then it's suddenly up to 7.0 even though I haven't put on any weight.

As for your unexplained weight loss... I am very surprised that your nurse if puzzled by this. She should know that there is a point where the level of blood glucose triggers the body to filter glucose out through the kidneys - in an emergency attempt to get rid of the damaging glucose. The blood glucose level at which this happens is slightly variable from person to person, but is usually around 10-11mmol/l

My weight was already coming down whilst my HBA1c was decreasing, yet the link between the two seems to have broken. That makes me wonder if this reflects some sort of damage to my pancreas, rather than the progression of Type 2, which in turn makes me concerned about the possibility of pancreatic cancer – hence my considering getting diagnostic tests just in case.

 

[EllieM]

Has your doctor or nurse done any spot blood sugar tests? While it's not a big increase in hba1c, the measurement is over the last 3 months, so a sudden big increase could be masked by the fact that the increase happened at the end of the three month period....

Personally, in your position I wouldn't wait to at least get a glucometer to find out what is happening to your blood sugars. The advice from the NHS for T2s and prediabetics to avoid blood tests is based on cost rather than science.... (If they tell you to do blood tests they have to pay for those strips.)

Good luck.

 

[maxjoe121]

I eat at restaurants once in a while, skip the bread at the start, ask for more veggies or a side salad in place of potatoes, I’ve never been refused and have the cheese, no biscuits for dessert, unless you can ask for berries and cream. That’ll dramatically reduce your carbs and improve your numbers. You can go for a low calorie approach as a temporary measure but once the weight is lost you need a follow up plan and in my opinion low carb is the way to go if you want to control your blood sugars. Having said that I went low carb and got my blood sugars under control while losing six stone at the same time.

Hi did you do low carb and high fat to lose weight?

 

[manxman66]

Has your doctor or nurse done any spot blood sugar tests?

We did a fasting blood glucose test a week after the HBA1c, and got a figure of 8.2. That seems high to me in conjunction with an HBA1c of 7.0, though a few years ago I simultaneously had FBG of 7.3 and an HBA1c of 6.3.

While it's not a big increase in hba1c, the measurement is over the last 3 months, so a sudden big increase could be masked by the fact that the increase happened at the end of the three month period....

Exactly what is concerning me. There are three conditions I can identify that can cause a sudden spike in blood glucose coupled with accelerating weight loss. From best to worst:

1) Hyperthyroidism (from which my mother suffered)
2) LADA (i.e. type 1.5 rather than type 2 diabetes)
3) Type 3c diabetes (i.e. pancreatic cancer)

How likely are these options? I'm tempted to get 1) and 3) thoroughly checked out whilst embarking on a 5:2 diet for the next three months, and then retesting my HBA1c.

 

[manxman66]

Sorry, just realised the question was directed to Rachox, not to me. My mistake.

 

[Rachox]

Hi did you do low carb and high fat to lose weight?

I did low carb but just didn’t go overboard with the fats, just ate enough to not feel hungry.

 

[EllieM]

How likely are these options? I'm tempted to get 1) and 3) thoroughly checked out whilst embarking on a 5:2 diet for the next three months, and then retesting my HBA1c.

Honestly, none of them sound very likely to me, but I am not a doctor and can't diagnose. I still think the most likely thing is that you've been having too many carbs for a T2 body.

But, if you're having blood tests done you might as well get a c-peptide, which would tell you how much insulin you are producing.... (high would probably rule out 2 and 3, though I don't know how pancreatic cancer works or if it can result in increased insulin production ???).

But honestly, plenty of T2s on here have to reduce their carb levels to keep their sugars down. You've already said you increased your carb intake at your doctor's advice. It's not rocket science to rule out T2 first.... .

 

[manxman66]

Honestly, none of them sound very likely to me, but I am not a doctor and can't diagnose.

In fairness, pancreatic cancer is probably not that likely, but it could account for the sudden increase in blood sugars after 13 years of consistent control, as well as the unexplained loss in weight. The lifetime risk of pancreatic cancer for a normal person is 1.6%, but I take Verapamil, a drug that is known to double the risk. Additionally, my father was an Ashkenazi Jew, and some Ashkenazis have a mutation of the gene BRCA2, which can multiply the risk tenfold; taken together, this would give me a lifetime risk of 32%. That said, only 1% of people with Ashkenazi heritage have the mutation, so it's highly probable that I do not.

But, if you're having blood tests done you might as well get a c-peptide, which would tell you how much insulin you are producing.... (high would probably rule out 2 and 3, though I don't know how pancreatic cancer works or if it can result in increased insulin production ???).

The c-peptide test would be very useful to rule out type 1.5. It doesn't really indicate anything with regard to pancreatic cancer: in a small study of pancreatic cancer patients, 26% had no c-peptide at all, 24% had reduced c-peptide, 29% had elevated c-peptide and 21% had normal levels. However, elevated non-fasting c-peptide (though not elevated fasting c-peptide) is seen as a potential marker for future pancreatic cancer. It's a tricky cancer to diagnose, but the best way would be an MRI scan or an endoscopic ultrasound. Both seem like overkill at this stage, since I am asymptomatic, but I may try to organise a CA19-9 (tumour marker) blood test and an external abdominal ultrasound.

But honestly, plenty of T2s on here have to reduce their carb levels to keep their sugars down. You've already said you increased your carb intake at your doctor's advice. It's not rocket science to rule out T2 first.... .

You're probably right: I'm letting my imagination run away with me here and thinking the worst. Nonetheless, I'm fairly cautious and like to rule out all the possibilities.

 

[EllieM]

have a mutation of the gene BRCA2

You could get tested for that gene???
As it stands though, given that only 1% have that gene, you've got 3.2% *.99 + 32% *.01 as your probability of pancreatic cancer, which is 3.5% (rounding up to one decimal place).

A loss of 4kg in 18 months doesn't seem that sudden to me, could you just be eating slightly less or exercising slightly more...?

Nonetheless, I'm fairly cautious and like to rule out all the possibilities.

No harm in that, as long as you're not having unnecessary invasive tests. If you have enough of them, the risk from the tests can be higher than the risk from the diseases you're testing for. (I think you're pretty safe giving out blood samples though, as a T1 I've lost count of the number of blood draws I've had. )

 

[manxman66]

You could get tested for that gene???

Yes, that is certainly a possibility. It would be very interesting to know.

As it stands though, given that only 1% have that gene, you've got 3.2% *.99 + 32% *.01 as your probability of pancreatic cancer, which is 3.5% (rounding up to one decimal place).

Agreed that it's fairly unlikely.

A loss of 4kg in 18 months doesn't seem that sudden to me, could you just be eating slightly less or exercising slightly more...?

Whilst I haven't made any conscious effort to lose weight (my HBA1c was gradually drifting down by itself until the last reading), it is entirely possible that my calorie consumption has dropped marginally. Since I eat out every day, I have no idea of the level of calories I consume and simply monitor my weight. One oddity is that when I weighed myself at home a few days ago, I got a reading of 14 stone 6 pounds. When I weighed myself yesterday (again at the same time of day, again naked, again using the same scales in the same spot) I was 14 stone exactly, which I found a little disconcerting.

Of course, weight can fluctuate from day to day, and I'm not entirely convinced of the accuracy of my scales, but my scales have nonetheless been consistent: for several years, I have weighed between 14½ and 15 stone, usually going up after Christmas and drifting down during the rest of the year. The 14 stone 6 reading was the first time I had gone under 14½ stone, so my chin hit the floor when I got the 14 stone 0 result.

No harm in that, as long as you're not having unnecessary invasive tests. If you have enough of them, the risk from the tests can be higher than the risk from the diseases you're testing for. (I think you're pretty safe giving out blood samples though, as a T1 I've lost count of the number of blood draws I've had. )

Agreed entirely, hence my reluctance at this stage to suggest an endoscopic ultrasound (which I think would be opposed anyway on cost grounds).

 

[EllieM]

Hmm, are your clothes looser? If that weight loss is real, I would be concerned, as 3kg in a week is a sudden drop.... If it's real, and continues, I'd strongly recommend returning for blood tests sooner rather than later.

 

[manxman66]

The drop was over a couple of days, rather than a week. I checked again yesterday, and there was no change: 14 stone exactly. Today I'm a couple of pounds down, but I'd expect that as I started my 5:2 diet yesterday and ate only 675 calories. As you suggest, I think I'll try to arrange some tests for this week, just in case.

 

[manxman66]

I'm now three months down the line, and things are back to normal.

The sudden drop of six pounds over a couple of days seems to have beenthe result of some oddness from my scales, rather than representing a real reduction. Strangely, after showing me at exactly 14 stone for a couple of days (no matter when I took the reading), my scales went back up to 14 stone 6 after that.

After discussions with my diabetic nurse. I went on a 5/2 diet for 11 weeks: 700 calories a day twice a week and eating normally (which for me means a restaurant meal once a day, comprising at least three courses) for the other five. This took approximately a stone off. My fasting blood glucose has come down from 8.2 in September to 5.4 and my HBA1C has decreased from 7.0% to 6.0%, taking it slightly below the level it was in June, before all this started.