test strip results and HbA1c results

[david252]

Yes defren is correct. I apologise. I didn't really mean that the way it sounded. But it really isn't a case of "lowly T2's". Diabetes type pulls no rank either!! .

It's partly about quality of life (why stab yourself 3-4 times/day and get fingertip scarring when you don't have to and for no real benefit in any medical sense of the word) and partly about beneficial use of finite resources (yes unfortunately medical economics does come into it - but really only minimally).

Anyway, back to the original point of the post before I opened this can of worms! :***: I really wouldn't worry too much about an HbA1c of 7.2% though. The target keeps changing. A few years back the target HbA1c in general (ie no complications etc) was 7.5%. They (NICE) then reduced it to 7% and were about to reduce it to 6.5% until a study showed that statistically the mortality rate was higher with an Hba1c of 6.5% compared to 7% (no-one really knew why - various postulations about more hypo's in elderly populations being dangerous etc) and so they kept it at 7%.

HbA1c is not an absolute target and there are various reasons why some people may want or need to have a higher target.

In any case 7.2% is really pretty good and statistically will have very little difference to morbidity/mortality compared with 7%.

Remember that HbA1c is an AVERAGE - over the last 3 months and 7.2% is roughly equivalent to a continuous home reading of about 9.5mmol/l. Your fasting blood sugars may be in the 5-6mmol/l range but I bet they aren't at this level after a meal (nobody's is - not even non diabetics). After a meal they could rise to as high as 15mmol/l or more, for example, depending on the type and amount of carbohydrate eaten (I've blathered on enough about GI so won't bore you a;; again).

 

[Pneu]

Snip..

Isn't it an odd thing however that all of the type II's on this forum who are active in their diabetes management by TESTING their blood sugars report good HbA1c's yet what was it on the last NHS diabetes audit something like 60%+ of type II's failing to meet an HbA1c targets using the NHS's don't test and eat starchy carbohydrate approach..

I do not think that anyone would argue that type II's need to test as regularly as type I... however experience of 100's of type II's on this forum shows us that blood glucose testing allows individuals to better manage their own condition by understanding how carbohydrates effect their blood glucose..

Perhaps we would do better with type II diabetic control if the NHS actually started to recommend that type II's reduced they carbohydrate intake.. shock they may have to eat some fat... this country is years behind in its treatment of the disease and its a problem that's only getting worse.. backwards attitudes and saying 'what we have got works' simply doesn't cut it.

 

[Pneu]

I really wouldn't worry too much about an HbA1c of 7.2% though. The target keeps changing. A few years back the target HbA1c in general (ie no complications etc) was 7.5%. They (NICE) then reduced it to 7% and were about to reduce it to 6.5% until a study showed that statistically the mortality rate was higher with an Hba1c of 6.5% compared to 7% (no-one really knew why - various postulations about more hypo's in elderly populations being dangerous etc) and so they kept it at 7%.

You might want to read this:

They found no evidence that hypos were a problem.
http://www.medicalnewstoday.com/articles/153578.php

Morevover, (as mentioned in the article linked by Catherine) they have very recently published a paper with very different findings. There were more deaths in the intensive arm, but this was in people who were unable to lower their HbA1cs in spite of the intensive medication.

Various characteristics of the participants and the study sites at baseline had significant associations with the risk of mortality. Before and after adjustment for these covariates, a higher average on-treatment A1C was a stronger predictor of mortality than the A1C for the last interval of follow-up or the decrease of A1C in the first year. Higher average A1C was associated with greater risk of death. The risk of death with the intensive strategy increased approximately linearly from 6–9% A1C and appeared to be greater with the intensive than with the standard strategy only when average A1C was >7%.

CONCLUSIONS These analyses implicate factors associated with persisting higher A1C levels, rather than low A1C per se, as likely contributors to the increased mortality risk associated with the intensive glycemic treatment strategy in ACCORD
Diabetes Care May 2010

 

[Squire Fulwood]

your GP should have access to a local primary care based type 2 DM specialised education group, usually led by dieticians, that he/she can refer you to for this type of advanced patient education

Is all that contained in the two diet sheets I was given. One of them was written by the British Hypertension Society and the other claimed to reduce cholesterol. Nothing on diabetes.

The dietitian told me about doggies and bunnies racing round a track.

Do you think we all live on the same planet?

 

[ladybird64]

Thanks Pneu for your understanding and support of what so may of us are trying to achieve.

David, with the greatest respect, you are wrong in summising that many of us are continually pulling high figures after meals. Yes, of course there are some but from what I have seen on this forum many are not far away from non diabetic numbers. Some have achieved this through portion control but I believe I am correct in saying that the vast majority of us have achieved it through a marked reduction in carbs and by regular self monitoring. I am also sorry to say that if we had listened to the current NHS advice given out by many specialist deititians and DN's, we would be looking complications in the eye. (Pardon the unintended pun)

Here we have one thing in common, to reduce our levels as much as we can to prevent complications. There is a long long road to morbidity and mortality and it is a road paved with these complications. There are many here who do have these complications and are desperate for help and guidance, in that respect I'm afraid the NHS is failing many of us.

There will always be those who choose to ignore their diabetes and carry on as before. But there are a heck of a lot of us who have improved our a1c's by ourselves. The point is David, if the current advice is working then why are the numbers of Diabetics with complications rising? Non-compliance? Some, but just as many who follow the advice given to the letter. they get sicker and sicker, feel worse and worse and are often practically accused of not following the sacred advice.
Please have a good look around the forum. at the signatures under peoples names. They tell their own story, of how many people arrive here with really high figures and manage to get them down.

They also (not all, but many) tell some awful stories of what they have encountered with diabetes services as they stand at present. Please take time if you can to read them. .

 

[david252]

I really wouldn't worry too much about an HbA1c of 7.2% though. The target keeps changing. A few years back the target HbA1c in general (ie no complications etc) was 7.5%. They (NICE) then reduced it to 7% and were about to reduce it to 6.5% until a study showed that statistically the mortality rate was higher with an Hba1c of 6.5% compared to 7% (no-one really knew why - various postulations about more hypo's in elderly populations being dangerous etc) and so they kept it at 7%.

You might want to read this:

They found no evidence that hypos were a problem.
http://www.medicalnewstoday.com/articles/153578.php

Morevover, (as mentioned in the article linked by Catherine) they have very recently published a paper with very different findings. There were more deaths in the intensive arm, but this was in people who were unable to lower their HbA1cs in spite of the intensive medication.

Various characteristics of the participants and the study sites at baseline had significant associations with the risk of mortality. Before and after adjustment for these covariates, a higher average on-treatment A1C was a stronger predictor of mortality than the A1C for the last interval of follow-up or the decrease of A1C in the first year. Higher average A1C was associated with greater risk of death. The risk of death with the intensive strategy increased approximately linearly from 6–9% A1C and appeared to be greater with the intensive than with the standard strategy only when average A1C was >7%.

CONCLUSIONS These analyses implicate factors associated with persisting higher A1C levels, rather than low A1C per se, as likely contributors to the increased mortality risk associated with the intensive glycemic treatment strategy in ACCORD
Diabetes Care May 2010

No. What this says is what I was trying to say - no-one really knows why it occurred - the more frequent hypo hypothesis was just that - a hypothesis. It's basically not known and it's also very difficult to find proven causative associations from trials. Nevertheless, there was a higher mortality rate from the intensive treatment arm of this study. Hence the NICE guidance remains at 7% (or even higher in certain individual circumstances,

As far as advanced patient education is concerned; unfortunately like all everything else in the NHS, it is a bit of a postcode lottery and probably not all NHS trusts/soon to be abandoned PCTs will provide the service. And No it's not just 2 bits of paper!

 

[david252]

OMG! Sorry Drippihippi, I seem to have succeeded in both hijacking your thread and opening up a can of worms. I'm not saying that your blood sugars ARE going up to 15mmol/l. I'm just giving this as an example of how your blood sugars may vary during the day and HbA1c is AN AVERAGE. Your fasting blood sugars of 5-6mmol/l are NOT representative of what they are throughout the rest of the day.

Try checking them at different times out of interest, especially after meals and you will probably find that they will be significantly higher than 5 0r 6mmol/l. You have type 2 diabetes for crying out loud - that's what it does! That's how it's diagnosed!! A person without diabetes will have a rise in post prandial blood sugars let alone a type 2 diabetic.

 

[Pneu]

I test 2/3 times daily with strips and on average I am mostly in the mid 5's 2 hours after meals, sometimes in the 6's and sometimes in the 4's after exercise [cycling twice daily] I have checked that the meters are accurate.

My strip results have been in the above ranges for the last 5/6 months yet my HbA1c is 7.2, I would have expected it to be lower given my daily blood test strip results, I don't eat sugar, junk food, rice, pasta, potatoes, cereal, and only 2 slices of Granary bread a day, maybe I'm expecting too much too soon but surely there is a correlation between strip results and the HbA1c figure?

Drippihippy just to get this back on track... I would ask your GP for a re-test of the HbA1c..

If you bloods are mostly 5's post meal and you have checked the meters then something doesn't stack up.. if your morning readings are 5 or 6 mmol/l as well then it is unlikely you are running high overnight.. it might just be worth doing a couple of 2am checks to rule that out..

Hopefully your GP will be open-minded enough to at least review your meter readings and take note of your diet before automatically making an assumption.

 

[xyzzy]

Anyway, I really wouldn't worry too much about an HbA1c of 7.2% though. The target keeps changing. A few years back the target HbA1c in general (ie no complications etc) was 7.5%. They (NICE) then reduced it to 7% and were about to reduce it to 6.5% until a study showed that statistically the mortality rate was higher with an Hba1c of 6.5% compared to 7% (no-one really knew why - various postulations about more hypo's in elderly populations being dangerous etc) and so they kept it at 7%.

I take it you mean this research http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61969-3/fulltext
You are incorrect about there not being later studies that investigated the reason why going under 7% seemed to be more risky. It came down to the data set the original researchers selected being rubbish and the research was later discounted by other leading health services most notably the Swedes in for example this 2011 doc. http://www.healthcare-bulletin.com/...ascular_Disease__in_Diabetes_Care_-_2011_.pdf

It appears the UK study included far too many insulin dependent overweight diabetics who had the non surprising tendency to die from CVD events rather than for any HBA1c related reason.

A recent observational UK General Practice Research Database (GPRD) study has reported increased risk of total mortality with lower HbA1c with lowest risk for HbA1c 7.5%, and also a 49% higher risk of total mortality with insulin treatment versus oral agents. However, this was not verified in the NDR study, showing no J-shaped risk curve for total mortality in patients treated with insulin or oral agents, and that the increased risk of total mortality with insulin was due almost exclusively to an increased risk of non-CVD mortality, and that HbA1c was not at all associated with non-CVD mortality

I would ask you to consider the following very carefully.

How many newly diagnosed T2 patients have you treated who like myself then regularly tested their blood sugars and adopted a low carbohydrate high fat diet regime, reduced their HBA1c from 11.3% to 4.9%, lost 4 stone in weight and now has a BMI of 23, has normalized their cholesterol levels and come off Simvastatin with their GP's blessing and normalized their BP from being on average 160/90 to 115/75 within SIX MONTHS OF DIAGNOSIS and all by specifically NOT doing what the NHS recommends.

Perhaps instead of coming on this forum and lecturing us all that you know best and "pulling rank" it would do you and loads of other HCP's the power of good to actually ask people like me and countless others on this forum over the years it has run how we achieved what we have and how best YOU and others can learn from our experiences.

There are T2 members of this forum who have maintained sub 6% hBA1c's for years using a pure diet no meds approach and have suffered no further progression in the disease. They will all tell you they are still T2 but they like me know if we consume the 50% carbohydrate rubbish advice that the NHS dishes out our hBA1c's would soon rise again and we have the meters and knowledge to prove it to ourselves.

My own GP is likewise a diabetes specialist and he wholly supports my way of controlling the condition and is actively encouraging me as I believe does Defren's GP. Perhaps you should go and read how diabetes is treated in other world leading health services notably the Swedes and even the Americans advocate a far more up to date approach.

I own my own IT business and have to constantly retrain to keep up to date I suggest you do likewise.

 

[Pneu]

Try checking them at different times out of interest, especially after meals and you will probably find that they will be significantly higher than 5 0r 6mmol/l. You have type 2 diabetes for crying out loud - that's what it does! That's how it's diagnosed!! A person without diabetes will have a rise in post prandial blood sugars let alone a type 2 diabetic.

Again you make such sweeping statements about type II diabetics! perhaps your assumption is correct if the individual is eating the standard eat a load of carbohydrate diet; but the OP is eating very little carbohydrate I should imaging they have very little postprandial movement in blood glucose.. I think they are right to question the result of the test...

As to what is 'normal' this: http://care.diabetesjournals.org/conten ... 7.abstract is a very interesting study of a group of non-diabetics.. nearly 95% of non-diabetics over 25 did not record a glucose reading of about 7.7 mmol/l on the CGM monitored trail.. and I am pretty certain from memory that around 75% of those people we below 5.5 mmol/l @ +2 hours.. to suggest normal people regularly leap in the the 8's/9's/10's+ mmol/l is not right.. and to suggest that its not damaging to health is criminal!

 

[david252]

My intention was not to antagonise everybody. This is going to be my last post as I've had enough of this. I tried to do a quick post but it didn't seem to work, so I appologise if this comes through twice.

Drippihippy, the bottom line is this:

1. Medicine is not an exact science and it is possible (but unlikely) that your HbA1c result is inaccurate. Much more likely that your home BGs are inaccurate as home meters are not going to give you lab certified accuracy, just a guide.

2. Don't get too caught up in the numbers, whichever way you look at it - your home measurements are EXCELLENT. Your HbA1c is EXTREMELY GOOD. Well done and keep up the good work.

 

[Defren]

Try checking them at different times out of interest, especially after meals and you will probably find that they will be significantly higher than 5 0r 6mmol/l. You have type 2 diabetes for crying out loud - that's what it does!

Sorry, I have to say this, but you are talking out of your hat!! My readings pre and post prandial are never higher than 5.5. I can test any time of the day (don't do night testing) and they are always around the same. I have worked damned hard to achieve the levels I have now, and I don't appreciate you - a 'so called ex GP' telling me my meter, my readings, my hard won gains and a 4.9 Hba1c is not true. Perhaps YOUR diabetes was so badly controlled that YOU got figures of higher than 5 or 6 mmol/l + but please don't tar us all as not proactive in our own condition!!!!

 

[xyzzy]

Try checking them at different times out of interest, especially after meals and you will probably find that they will be significantly higher than 5 0r 6mmol/l. You have type 2 diabetes for crying out loud - that's what it does!

Sorry, I have to say this, but you are talking out of your hat!! My readings pre and post prandial are never higher than 5.5. I can test any time of the day (don't do night testing) and they are always around the same. I have worked damned hard to achieve the levels I have now, and I don't appreciate you - a 'so called ex GP' telling me my meter, my readings, my hard won gains and a 4.9 Hba1c is not true. Perhaps YOUR diabetes was so badly controlled that YOU got figures of higher than 5 or 6 mmol/l + but please don't tar us all as not proactive in our own condition!!!!

Snap.

I was diagnosed with a BG reading of over 20. I swapped to a low carb diet pretty much immediately. Over the next 8 weeks I tested my BG's before and 2 hours eating every meal. I saw them gradually reduce to non diabetic values. I will PM you my spreadsheet of my readings if you so desire. It runs from December 8th 2011 to May 26th 2012 and religiously recorded by BG readings. It is the same spreadsheet that I show my own GP who does support me. Today I have an hBA1c of 4.9% my fasting level is on average around 4.8. My 2 hour readings hardly ever exceed 5.5. There are countless others on this forum who will tell you the same story. Are we all lying? I still have T2. If I go and eat a load of sugar or more than around 50 g of rice, pasta or other starchy carb my BG's go through the roof. You are simply showing many of us what is wrong with T2 treatment in this country. Like I said go read about low carbohydrate regimes as recommended by the Swedes or the Americans (ADA) and by an increasing number of GP's in this country.

 

[Pneu]

My intention was not to antagonise everybody. This is going to be my last post as I've had enough of this. I tried to do a quick post but it didn't seem to work, so I appologise if this comes through twice.

Drippihippy, the bottom line is this:

1. Medicine is not an exact science and it is possible (but unlikely) that your HbA1c result is inaccurate. Much more likely that your home BGs are inaccurate as home meters are not going to give you lab certified accuracy, just a guide.

2. Don't get too caught up in the numbers, whichever way you look at it - your home measurements are EXCELLENT. Your HbA1c is EXTREMELY GOOD. Well done and keep up the good work.

David.. you have antagonised people because you have not read the original post properly.. the OP clearly stated his readings were +2 hour post meal.. he stated he had checked the meter(S) for accuracy.. one can assume this is with control solution.. the difference between his average reading on the meter and the lab HbA1c is VAST around 4 mmol/l average.. I suspect he probably has the wrong persons lab results.. you then go on to make sweeping generalisations about type II diabetics and show frankly the sort 'I know best' attitude the infuriates members on this forum... the sort of thing they here week in week out... the NHS approach is the only approach despite the fact that it is years behind the rest of the world..

We welcome all contributors here but you are going to get pretty short shift unless you can defend what most would see as an antagonistic starting position...

To be blunt it comes across as "your type II your going to get bad readings because that's what you have to expect"

 

[smidge]

Hey guys!

Please try to keep this on topic and avoid personal comments. I know it is a very emotive thread, but getting personal does nobody any good and doesn't help answer the OP's question.

Drippihippi - do you have the print outs of your test results? If your surgery is able to get your colestorol reading mixed up with your HbA1c and give you the wrong result, Heaven knows what else they've mixed up. Ask them for a print out of your last 3 blood test results. If your HbA1c really is 7.2 (?) and it is not a mistake, then you must be getting some hidden highs that you don't know about. Maybe do a couple of night time tests and a couple of 1 hour post-prandial tests to see what your BG is doing at those different time? Your testing is really valuable - otherwise you would have no idea what is going on with your BG. Keep it up and don't lose heart!

Smidge

 

[ladybird64]

Oh gawd..can we start over please?

David, I am assuming you joined this forum because you are a diabetic, not because you had any particular desire to give NHS advice here. I note that you are a type 1 using a pump. i would not deem to give you advice on any of that, not just because I am not medically trained but because I have no PERSONAL experience of it.
You may well be an ex-GP but the experience you have is with your own patients, not us so please do not try and categorise us in any particular fashion because we live with our diabetes and know what we are talking about from EXPERIENCE. I am sorry that you feel that"you have had enough of this" and at the same time I believe that you did not intend to set out to antagonise but if you continually choose not to see what is in front of you how do you expect to see people react?

Please do not be blinkered, that's all I ask. Read what has been said with open eyes. not closed ones. If you still disagree that is entirely up to you. If you feel you speak here as a gp, then quote from those guidelines perhaps you would be prepared to counter the arguments that are bring put forward? We are not all anti-NHS and some of us have very supportive GP's..if you have a look through the newly diagnosed section you will see that this is not often the case.

I think we do have a right to question why things are happening with our body. It's called being pro-active. I certainly hope Drippi gets some answers as he/she is obviously a pro-active patient. In between all the to-ing and fro-ing there has been understanding and good advice Drippi..please don't get downhearted.

 

[borofergie]

Anyway, back to the original point of the post before I opened this can of worms! :***: I really wouldn't worry too much about an HbA1c of 7.2% though. The target keeps changing. A few years back the target HbA1c in general (ie no complications etc) was 7.5%. They (NICE) then reduced it to 7% and were about to reduce it to 6.5% until a study showed that statistically the mortality rate was higher with an Hba1c of 6.5% compared to 7% (no-one really knew why - various postulations about more hypo's in elderly populations being dangerous etc) and so they kept it at 7%.

HbA1c is not an absolute target and there are various reasons why some people may want or need to have a higher target.

In any case 7.2% is really pretty good and statistically will have very little difference to morbidity/mortality compared with 7%.

Remember that HbA1c is an AVERAGE - over the last 3 months and 7.2% is roughly equivalent to a continuous home reading of about 9.5mmol/l. Your fasting blood sugars may be in the 5-6mmol/l range but I bet they aren't at this level after a meal (nobody's is - not even non diabetics). After a meal they could rise to as high as 15mmol/l or more, for example, depending on the type and amount of carbohydrate eaten (I've blathered on enough about GI so won't bore you a;; again).

:shock:

1. You are suggesting that an average BG of 9.5 mmol/l is somehow acceptable? I'd define it as "uncontrolled diabetes"
2. You don't seem to understand the concept of averaging - a spike of 15mmol/l in the first 2 hours postprandial will not give you an average of 9mmol/l over a 24 hour period.
3. I'd be horrified if my BG went over 10 mmol/l at any time. I usually try and keep it below 6mmol/l even after eating
4. What possible reasons could there be for a T2 on diet and/or metformin to have a HbA1c > 7%?
5. The difference between 7.2% and 7.5% is relatively small. The difference between risk of complications between >7% and <6% is large.

I'm shocked and appauled. It's no wonder that T2 diabetics get a rough deal if this is the quality of advice getting handed out by GPs.

Stephen (HbA1c=4.9% no-meds)

 

[Grazer]

Been a bit busy recently, and only just seen this thread. Dr David, we are educated diabetics here, and do things the correct way, not the NHS way. Suggest you look at some of our results before thinking your "specialist knowledge" makes you right. Testing is essential for all type 2s, particularly in the early days, and HbA1cs in the 7s AREN'T great.

 

[david252]

Look, please everybody, let's play nicely. I've apologised for acting high and mighty and yes I deserve the comebacks and yes I've generalised. I haven't picked on anyone and their individual management/levels of control etc. I accept that some people want to intensively look at controlling their diabetes. As a health care professional looking after hundreds of type 2 diabetics, I know this is certainly not usually the case and many of my points are generalisations based on populations not any particular individual, so please don't take all of this personally, I'm not criticising, I am just trying to help Drippihippy understand why his home blood sugars do not match his HbA1c reading.

I'm just trying to point out that everybodys blood glucose varies during the day to a greater or lesser extent and that an HbA1c is just an average. I'm afraid blood glucose machines will not be as accurate as a laboratory venous sample, no matter how you calibrate them, whether you want to believe me or not. They use a capillary blood sample which usually lags behind venous sampling by about 15 minutes and will usually have an error margin by up to 2mmol/l. That's not to say any particular individuals machine is giving that error margin, just that it may

 

[borofergie]

...and an average BG of 9mmol/l is somehow acceptable and nothing to worry about.

What's your position on low-carbing for T2 diabetics David?