8 years on

[Grogg1]

Hello. I was a member a very long time ago.

Anyway a bit about me age 60 type 2 diagnosed Nov 2016.

My readings at diagnosis.
Weight 80kg
BP 124/88
Hb1ac 117

Sept 2017

Weight 78kg
BP 120/70
Hb1ac 43
Col. 5.7 HDL 1.8 LDL 3.5 TG 0.8
Ratio 3.2
Creatinine 64

Jun 2022
Weight 81.8kg
BP 132/88
Hb1ac 55
Col. 4.8 HDL 1.3 LDL 3. TG 1.2
Ratio 3.7
Creatinine 64

This week
Weight 77kg
BP 120/60
Hb1ac 53
Col. 4.9 HDL 1.3 LDL 3 TG 1.3
Ratio 3.8
Creatine 71

I've been on 4 metformin tablets for years.

Every time I go she mentions statins but I always say they are ok aren't they and convo ends but now she tells me 4 is new guideline so I should consider. Is the 4 ratio or total ? I'm struggling to understand all my cholesterol, trig readings. Also creatine - what does this mean.

Thank you

 

[Leadinglights]

Hello. I was a member a very long time ago.

Anyway a bit about me age 60 type 2 diagnosed Nov 2016.

My readings at diagnosis.
Weight 80kg
BP 124/88
Hb1ac 117

Sept 2017

Weight 78kg
BP 120/70
Hb1ac 43
Col. 5.7 HDL 1.8 LDL 3.5 TG 0.8
Ratio 3.2
Creatinine 64

Jun 2022
Weight 81.8kg
BP 132/88
Hb1ac 55
Col. 4.8 HDL 1.3 LDL 3. TG 1.2
Ratio 3.7
Creatinine 64

This week
Weight 77kg
BP 120/60
Hb1ac 53
Col. 4.9 HDL 1.3 LDL 3 TG 1.3
Ratio 3.8
Creatine 71

I've been on 4 metformin tablets for years.

Every time I go she mentions statins but I always say they are ok aren't they and convo ends but now she tells me 4 is new guideline so I should consider. Is the 4 ratio or total ? I'm struggling to understand all my cholesterol, trig readings. Also creatine - what does this mean.

Thank you

For people in an at risk category of which diabetes is one then guidelines suggest total cholesterol should be below 4. The other parameters indicate the proportion of good cholesterol HDL and bad cholesterol non HDL (LDL). Good should be above 1, bad below 4. Ratio of Total to HDL should be 6 or below. Triglycerides (TG) Fasting 1.7 or below non fasting 2.3 or below. Info from British heart foundation web site where there is lots more info.
No sure about creatine.

 

[Maz2]

Creatinine is to do with kidney function but I am not an expert on anything renal. Would be best to discuss with GP.

 

[s'nic]

yup, your creatinine level is used to calculate your eGFR which reflects how well your kidneys are working.
It is good that your doctors tests are including creatinine. Since it has risen it would be worth having a chat to your doctor.

I have never been given specific advice with regard to my kidneys (and my appointments always had something more pressing to discuss).

I have however read that in order to help protect your kidneys it is best to avoid Non-steroidal anti-inflammatory drugs (NSAIDs). These include Ibuprofen and Aspirin. More general information on NSAIDs from the NHS

 

[Grogg1]

Thank you, Unusually for me as I had Covid in March I was taking ibuprofen, I usually get a print out of my results after appointment but this means it's hard asking questions then as she says results all ok & just focuses on cholesterol. My cholesterol been in steady decline for a good few months. February before I was unwell it was 4.6 so was surprised to see it up. My creatine was 64 then too, I also had my first hypo of 3.8 last week in morning. I retested and still low so I had a cup of tea and biscuit and came back up. I didn't think type 2 could go too low.

 

[s'nic]

From what I've been able to find out kidney results are routinely overlooked (my doctor actually admitted that to me when I told her of reading a post from a person who found out they had kidney disease 13 years after their surgery knew! They only found out as the nurse said, oh you're here for your blood test for your kidney disease - the patient was very shocked).

Please be aware that kidney problems can only be diagnosed after a series of tests as the results can vary.
The eGFR is calculated off the creatinine level ... in may 2021 apparently my eGFR was 55, but then in a test FOUR days later my eGFR was 77. Both of those tests were done in A&E, and neither result was discussed with me. My situation now is I do not know which of those results would be the baseline for my kidney function.
(note that low eGFR is bad / high creatinine is bad).

Anyhow, please do follow up on your creatinine result with your doctor. The first actual creatinine test result I was given was a creatinine level of 98 (last summer) but I was only diagnosed with ckd after I queried my results, raised my concerns, and got a final blood test where my creatinine was 106 (26 jan 2024).

 

[s'nic]

Oh, I forgot - apart from avoiding Non-steroidal anti-inflammatory drugs (NSAIDs), 2 other key things to protect your kidneys are control of blood sugar, and blood pressure

 

[Burylancs]

Hello. I was a member a very long time ago.

Anyway a bit about me age 60 type 2 diagnosed Nov 2016.

My readings at diagnosis.
Weight 80kg
BP 124/88
Hb1ac 117

Sept 2017

Weight 78kg
BP 120/70
Hb1ac 43
Col. 5.7 HDL 1.8 LDL 3.5 TG 0.8
Ratio 3.2
Creatinine 64

Jun 2022
Weight 81.8kg
BP 132/88
Hb1ac 55
Col. 4.8 HDL 1.3 LDL 3. TG 1.2
Ratio 3.7
Creatinine 64

This week
Weight 77kg
BP 120/60
Hb1ac 53
Col. 4.9 HDL 1.3 LDL 3 TG 1.3
Ratio 3.8
Creatine 71

I've been on 4 metformin tablets for years.

Every time I go she mentions statins but I always say they are ok aren't they and convo ends but now she tells me 4 is new guideline so I should consider. Is the 4 ratio or total ? I'm struggling to understand all my cholesterol, trig readings. Also creatine - what does this mean.

Thank you

Hi there, welcome back,

Biermann did the basic tests on cholesterol levels in the early 1990s. He found that the incidence of cardio/heart conditions advanced significantly in people with Total Cholesterol over 6. But for diabetics that tipping point came at TCs over 4. Naturally the standard recommendations became TC under 6 for ordinary folk and under 4 for diabetics. Of course lots of refinements were then added such as 'ratios' of HDL to Total Cholesterol. But ratios have recently been down graded and replaced as key measures by Total Cholesterol minus HDL ( to give a picture of all the 'bad' cholesterol) and the other new emphasis is on absolute level of LDL ( the little blighters that carry cholesterol through the pores in the artery walls and deposit it inside).

The NHS works on the Qrisk calculator. If a risk of more than 10% cardio in the next ten years is shown then a statin is suggested ( simply a preventive insurance measure). But putting Type 2 Diabetes in the Qrisk calculator usually results in more than 10% risk. 85% of T2s are said to die of cardio/ heart causes, and it's the main complication we are facing. So Statins are an important contributor in the management of the consequences of Type 2 ( in the present state of knowledge managing the consequences, one way or another, is the best we can hope for with Type 2).

Statins have become a mainstay in medicine and are credited, humourously, along with modern surgical techniques, with making Cancer the main killer in America and that's simply because big killer heart attacks have diminished markedly since the advent of Statins as a routine therapy. Being so important Statins have attracted Conspiracy Theories and the Pharmocophobes. The Daily Mail, probably predictably, has been most irresponsible in its Statin scaremongering over the years.

 

[Drummer]

The Atorvastatin and Metformin tablets I took for just 5 weeks had a devastating effect on my mental capacity and general situation.
If I was to be in that state and living longer I would not thank anyone for that extended period of existence in pain and misery. I had to put in a lot of effort to climb back from that low point.

 

[Grogg1]

Hi there, welcome back,

Biermann did the basic tests on cholesterol levels in the early 1990s. He found that the incidence of cardio/heart conditions advanced significantly in people with Total Cholesterol over 6. But for diabetics that tipping point came at TCs over 4. Naturally the standard recommendations became TC under 6 for ordinary folk and under 4 for diabetics. Of course lots of refinements were then added such as 'ratios' of HDL to Total Cholesterol. But ratios have recently been down graded and replaced as key measures by Total Cholesterol minus HDL ( to give a picture of all the 'bad' cholesterol) and the other new emphasis is on absolute level of LDL ( the little blighters that carry cholesterol through the pores in the artery walls and deposit it inside).

The NHS works on the Qrisk calculator. If a risk of more than 10% cardio in the next ten years is shown then a statin is suggested ( simply a preventive insurance measure). But putting Type 2 Diabetes in the Qrisk calculator usually results in more than 10% risk. 85% of T2s are said to die of cardio/ heart causes, and it's the main complication we are facing. So Statins are an important contributor in the management of the consequences of Type 2 ( in the present state of knowledge managing the consequences, one way or another, is the best we can hope for with Type 2).

Statins have become a mainstay in medicine and are credited, humourously, along with modern surgical techniques, with making Cancer the main killer in America and that's simply because big killer heart attacks have diminished markedly since the advent of Statins as a routine therapy. Being so important Statins have attracted Conspiracy Theories and the Pharmocophobes. The Daily Mail, probably predictably, has been most irresponsible in its Statin scaremongering over the years.

I don't wish to take them as studies show they can increase your BG ( even trigger diabetes in non diabetics) but thank you for the information on why they now say 4 as target level.

I'm happy taking metformin as I tolerate it well plus studies have shown it's can help prevent recurrence of breast cancer - I had BC in 2015.

 

[Grogg1]

The Atorvastatin and Metformin tablets I took for just 5 weeks had a devastating effect on my mental capacity and general situation.
If I was to be in that state and living longer I would not thank anyone for that extended period of existence in pain and misery. I had to put in a lot of effort to climb back from that low point.

So sorry to hear thi. Hope you feeling better .

 

[Burylancs]

I don't wish to take them as studies show they can increase your BG ( even trigger diabetes in non diabetics) but thank you for the information on why they now say 4 as target level.

I'm happy taking metformin as I tolerate it well plus studies have shown it's can help prevent recurrence of breast cancer - I had BC in 2015.

The NICE guidelines on cholesterol in diabetics is LDL under 2. Yours is 3.

 

[PerSpinasAdAstra]

As @Burylancs says - the targets and metrics have changed over the years and the NHS is a little behind the times.

The QRISK3 calculator (used by GPs) estimates the risk of having a heart attack or stroke in the next 10 years, and uses the ratio between total cholesterol and HDL cholesterol - Link

More recent and probably better metrics than the ratio are 'LDL' and 'Total minus HDL' (AKA Non-HDL cholesterol). This gives you a rough estimate of the concentration of particles in your blood which can cause atherosclerosis - the most common cause of cardiovascular problems. Finding recently-reviewed targets for these in the context of diabetes is not easy, though the American Diabetes Association recommend lowering 'LDL' below 2.59 mmol/L and 'Total minus HDL' below 3.36 mmol/L - Link (from 2008)

If triglyceride levels are high (above 2.3 mmol/L) the second metric is the one to aim for, because the standard LDL result on a blood test becomes unreliable when triglycerides are high.

By these metrics your 'LDL' (3 mmol/L) and 'Total minus HDL' (3.6 mmol/L) are a little on the high side, by 2008 standards specific to diabetics, but not by much. A low dose of a statin would probably do the trick and wouldn't raise your BG by very much (though experiences likely vary from person to person) - e.g. 10mg Atorvastatin might raise your HbA1c by around 2% - Link

Alternatively you could try to tackle it with diet changes - less saturated fats and more oily fish - and ask for another lipid panel in a few months to see if that change is enough to put you on the cholesterol happy place 😉

EDIT - I see a new post about NICE guidelines on LDL in diabetics - I can't find a reference to an LDL under 2 in the 2023 guidelines I can find, just a reference to QRISK3 - Link - though I'll take their word for it.

 

[Grogg1]

As @Burylancs says - the targets and metrics have changed over the years and the NHS is a little behind the times.

The QRISK3 calculator (used by GPs) estimates the risk of having a heart attack or stroke in the next 10 years, and uses the ratio between total cholesterol and HDL cholesterol - Link

More recent and probably better metrics than the ratio are 'LDL' and 'Total minus HDL' (AKA Non-HDL cholesterol). This gives you a rough estimate of the concentration of particles in your blood which can cause atherosclerosis - the most common cause of cardiovascular problems. Finding recently-reviewed targets for these in the context of diabetes is not easy, though the American Diabetes Association recommend lowering 'LDL' below 2.59 mmol/L and 'Total minus HDL' below 3.36 mmol/L - Link (from 2008)

If triglyceride levels are high (above 2.3 mmol/L) the second metric is the one to aim for, because the standard LDL result on a blood test becomes unreliable when triglycerides are high.

By these metrics your 'LDL' (3 mmol/L) and 'Total minus HDL' (3.6 mmol/L) are a little on the high side, by 2008 standards specific to diabetics, but not by much. A low dose of a statin would probably do the trick and wouldn't raise your BG by very much (though experiences likely vary from person to person) - e.g. 10mg Atorvastatin might raise your HbA1c by around 2% - Link

Alternatively you could try to tackle it with diet changes - less saturated fats and more oily fish - and ask for another lipid panel in a few months to see if that change is enough to put you on the cholesterol happy place 😉

EDIT - I see a new post about NICE guidelines on LDL in diabetics - I can't find a reference to an LDL under 2 in the 2023 guidelines I can find, just a reference to QRISK3 - Link - though I'll take their word for it.

Thanks. I don't eat fish and until diabetic vegetarian but as I had to reduce carbs I now eat chicken for protein with occasional butchers sausage. As my BG so high when diagnosed I'm wary of any meds that increase it as I work hard to keep it down, I was a heavy eater of carbs. My diet now consists of vegetables, chicken, eggs, beans, soya mince. Limit to 1 slice of bread with butter. I can tolerate jacket potatoes too according to my meter. If I'm out and had an ok meal if I have dessert I'll add full cream. I also have a treat size chocolate most days. Fruit I limit so will have 1/2 small banana, small pear. Hate berries ! 1 unit of alcohol a week, if that. Never drunk coffee. Tea with skim milk. Supplements - high dose vit D, low dose aspirin ( family history of bowel cancer), green tea extract, berberine and colon cleanse. Quite smoking 32 years ago. Try to keep active with walking & Pilates.

 

[Leadinglights]

Thanks. I don't eat fish and until diabetic vegetarian but as I had to reduce carbs I now eat chicken for protein with occasional butchers sausage. As my BG so high when diagnosed I'm wary of any meds that increase it as I work hard to keep it down, I was a heavy eater of carbs. My diet now consists of vegetables, chicken, eggs, beans, soya mince. Limit to 1 slice of bread with butter. I can tolerate jacket potatoes too according to my meter. If I'm out and had an ok meal if I have dessert I'll add full cream. I also have a treat size chocolate most days. Fruit I limit so will have 1/2 small banana, small pear. Hate berries ! 1 unit of alcohol a week, if that. Never drunk coffee. Tea with skim milk. Supplements - high dose vit D, low dose aspirin ( family history of bowel cancer), green tea extract, berberine and colon cleanse. Quite smoking 32 years ago. Try to keep active with walking & Pilates.

I would be careful of butchers sausages as they can be higher carb than the supermarket good quality sausages which are about 2g carb per sausage but they can vary depending if they are flavoured.
How about Tofu which is good in Stir fry with a mixture of veg.

 

[PerSpinasAdAstra]

Thanks. I don't eat fish and until diabetic vegetarian but as I had to reduce carbs I now eat chicken for protein with occasional butchers sausage. As my BG so high when diagnosed I'm wary of any meds that increase it as I work hard to keep it down, I was a heavy eater of carbs. My diet now consists of vegetables, chicken, eggs, beans, soya mince. Limit to 1 slice of bread with butter. I can tolerate jacket potatoes too according to my meter. If I'm out and had an ok meal if I have dessert I'll add full cream. I also have a treat size chocolate most days. Fruit I limit so will have 1/2 small banana, small pear. Hate berries ! 1 unit of alcohol a week, if that. Never drunk coffee. Tea with skim milk. Supplements - high dose vit D, low dose aspirin ( family history of bowel cancer), green tea extract, berberine and colon cleanse. Quite smoking 32 years ago. Try to keep active with walking & Pilates.

Seems like a fairly healthy diet to me. The eggs contain a lot of cholesterol but that isn't a problem for most people - some people are 'hyper absorbers' who are more susceptible to dietary cholesterol than the rest of us, but for the great majority of us eggs are entirely fine. The only things you could change or reduce to lower cholesterol would be the sausages, the butter, the chocolate and the cream. Even then it might not be that straightforward. There is decades of research linking saturated fat with higher cholesterol levels, but at the same time there is more recent research showing that some foods high in saturated fat, like cheese, do not appear to have this effect - Link

I'm of the opinion that the mountain of evidence going back decades can't be entirely wrong so my guess is that not all saturated fats are equally bad for raising cholesterol. Unfortunately there is insufficient hard evidence (so far) to tell us which saturated fats might be fine and which aren't. There is some research based on the idea that it's the molecular structure of the fat that counts, and if that proves true that would explain how seemingly conflicting research can be correct at the same time - Link - Link - but we'll be a while waiting before the answers are clear.

Until the mystery is resolved the only straightforward way to reduce cholesterol though diet changes is to eliminate trans fats (which you don't appear to eat much of, if any) and to swap saturated fats for monounsaturated and polyunsaturated fats. For example - instead of butter on your bread swap to a spread that is low in saturated fat. I use Bertolli Original - a spread with olive oil in it, which tastes fine. Flora Pro-Active is the best I've found for low saturated fat content which also tastes okay, but it's stupidly expensive due to the added plant sterols, which are a gimmick basically. I still eat a little real butter on potatoes, because that is of course essential and necessary 😉

 

[Grogg1]

I did ask my butcher about meat content if sausages and they were as good as best supermarket ones. My meter doesn't spike with them. I live with two vegans so tofu always an option but I just can't take to it. I'm a real sweet tooth person. Desserts better than savoury so I've added in a treat a day to diet. I'm currently sitting in hairdressers starving, just a scotch egg for breakfast as I had no time to cook !