Advice for 1st annual review

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Clairsey

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Type 2
Hi all, I have my first annual review with my DN next week. I have my blood results back and wanted advice re what questions to ask. I was diagnosed T2 last Nov. My HbA1C has gone from 78 to 47 and I've had 8 tests done in the last 2 weeks.

Serum cholestrol is a bit high at 7, HDL quite low at 1.2 but LDL is high at 4.5. Triglycerides also quite high at 3.1. White blood cell count quite high at 11.5 and high neutrophil count at 8.25. Urine albumin: creatinine ratio high at 8.8.

I understand high white blood cells count and neutrophil are related to stress of the body fighting infection. This is true as I had a chest infection after suffering with a throat infection/sinus issue for a couple of weeks when I had my blood tests done which I put down to that and since I've no other earlier tests on them to compare with.

Serum cholestrol has come down only slightly by 0.8 with HDL/LDL about the same as the first test. Triglycerides are up 0.5.

Urine albumin: creatinine ratio is up quite a lot by 3.2. This is a bit of a worry as I understand that to be linked to kidney disease

Everything else tested came back normal.

Sorry for info overload here What I have found out above is all internet research and I wanted to ask what questions should I be asking my DN at my appointment as she was less than useless on my initial diagnosis so I know from that I will have to steer the conversation. At the very least I want a referral to a dietician which was not offered in my initial meeting. Should I ask to see a GP if she doesn't let me know what all the results mean for me? That's a laugh as I can't ever get a GP appointment!
 
I think it may well depend on who you see at your appointment and hopefully if she can't answer your questions about your results then she should refer you to see the GP.
Usually your results will be given against reference ranges so they can tell which and by how much they may be adrift.
Certainly you have done really well with your HbA1C reduction so they and you should be pleased with that. It puts you at a level that if it is maintained for another test would be considered in remission if you are taking no medication. I suspect they will be a bit concerned about your cholesterol so may want you to take statins or if you are already on them to increase the dose but that would be your decision. As you say the white cell count is a bit high but likely because of your chest infection.
There may be some notes from the GP as they usually review the results before they are given to you.
Make a list of the things that concern you and if you are not happy with the outcome then do ask to see the GP.
 
Thank you Leadinglights. You are always so kind and helpful with your advice.
 
Have you been losing weight during the past few months? That can sometimes inflate your cholesterol results and particularly LDL I believe.
Are you currently on statins? Much as I am not a fan of the blanket prescribing of statins, I think in your situation at those levels, I might be tempted to try them.
Many congratulations on your HbA1c reduction though. That is excellent work. Well done!
 
Hi Barbara, thank you for your reply. I have lost 2 stone since my diagnosis last Nov which I think must be what has brought my HbA1C down and thank you for your praise, still a long way to go but I've been working with a fantastic PT instructor who is really encouraging and every session he tries different targeted exercises which is certainly making me stronger. I can't believe I'm still sticking to it and actually always looking forward to our sessions after 7 months!

I didn't know weight loss could inflate cholesterol so that's an interesting point to raise with my DN. I thought all exercise leading to weight loss would reduce it.

I am not currently on statins. I think it was mentioned on my initial meeting as a possibility but I think she wanted to see how I would get on with the metformin and ramipril (for high bp) first. I will ask if I can try some and see if that improves things. Much like you, I don't like blanket prescriptions either and prefer not to take painkillers etc before trying something else first but perhaps a small dose will help.

Many thanks.
 
I believe the inflated cholesterol can be a temporary thing during weight loss as the fat is burned, so you might want to consider holding off on statins if you are still actively losing weight or for a few months after you reach your target weight, to see if it settles down but if your cholesterol levels were high before you started the weight loss and are still high then it may be a genetic thing and you may be best starting statins now, if your nurse/GP feels that it would be beneficial.

I am currently refusing statins because my results have been consistently mid 4s since diagnosis and whilst they would like them below 4 because I am diabetic, I don't see mid 4s as a problem as my diabetes is well managed, but if I was in the 7s I would probably reconsider my stance. Everyone has to make up their own mind based on their own circumstances.
 
Thank you Barbara, that is certainly a point worth considering. A lot of my conditions are genetic I believe and I was actually just discussing that with my PT instructor this evening funnily enough as we can't understand my results when I'm not eating much and eating reasonably healthy.

I think I will ask the DN if she thinks I'd be best to try a small dose of statins and she how my next blood tests go.

In your own situation yes I agree with your stance to hold off taking them as you are managing it very well.

Thank you for the further advice. Have a nice evening.
 
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