Bit of a shock

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So talking details from the print out the GP gave me...

Blood Glucose level
March 2012 5.2 mmol/L
Feb 2016 5.67
Aug 2017 5.9

HbA1c
Nov 2019 8.8

Cholesterol
Ratio Nov 2019 4.2

March 2012
Overall 6.3
HDL 1.08
LDL 4.0

Feb 2016
Overall 5.93
HDL 0.99
LDL ??

Aug 2017
Overall 6.1
HDL 1.16
LDL 3.76

May 2019
Overall 6.1
HDL 1.22
LDL 3.76

Nov 2019
Overall 5.9
HDL 1.4
LDL ??

You can see the two attached files (if I’ve done it right) so if anyone can unpick the key data and let me know what to watch out for or what to question with the nurse and/or GP when I see him on the 10th I’d be very grateful.
46BD7503-2964-4110-9326-81E96CB4AD43

46BD7503-2964-4110-9326-81E96CB4AD43

  • Media owner ColinUK
  • Date added
28/01/2020
6607158C-FE17-4E2A-A449-6CB91EF95CAD

6607158C-FE17-4E2A-A449-6CB91EF95CAD

  • Media owner ColinUK
  • Date added
  • Comments 1
28/01/2020 2
 
BP is inching down and I’m getting more readings in the normal range than I used to. Majority are low end of “high normal” but of expect that to change for the better as I drop weight.
 
And meds have been switch from standard metformin @ 2 x 500 mg twice daily to the slow release version but the dosage has been halved. So that’s 2x500mg one daily.
 
Hi
I used a blood sugar converter to input your results from 2012 to all be on the same basis of mmols/mol which is the modern measuring system.

RECOMMENDED HBA1C RANGES The recommended HbA1c range for most with diabetes is to keep the value under 48 mmols/mol (under 6.5% in the old percentage units).

Mar 2012: 30
Aug 2017: 50
May 2019: 50
Nov 2019: 73

As you can see, you were very good in 2012, just in the diabetic level in 2017, maintained for 21 months, then shot up in 6 months. At a level of 73 I believe Metformin is usually prescribed straight away. The good news is that with diet and exercise, many people can bring down their levels, but you really need to be re-measured after 3 months to see whether the medication and lifestyle measures are working.

Like you, mine shot up in just 6 months, but with hindsight, my diet had slipped, and 2 accidents with fractures meant I was not exercising for almost 20 weeks and had gained weight. Once I addressed the diet and exercise issues I reduced from 57 to 48 in 3 months.

I expect you will need to ask to be re-tested within 3 months of starting the medication. If you think back over the period May-Nov, can you identify issues which may have caused the jump - stress being another major factor? If not already suggested you should ask to go on a Training Course. Others may have additional suggestions.

Your total cholesterol is high but has been fairly consistent. Diabetics are usually advised to get the level below 4. I can't recall if you are on statins - if not you may be recommended to take them.
Best wishes
 
Felinia said:
Hi
I used a blood sugar converter to input your results from 2012 to all be on the same basis of mmols/mol which is the modern measuring system.

RECOMMENDED HBA1C RANGES The recommended HbA1c range for most with diabetes is to keep the value under 48 mmols/mol (under 6.5% in the old percentage units).

Mar 2012: 30
Aug 2017: 50
May 2019: 50
Nov 2019: 73

As you can see, you were very good in 2012, just in the diabetic level in 2017, maintained for 21 months, then shot up in 6 months. At a level of 73 I believe Metformin is usually prescribed straight away. The good news is that with diet and exercise, many people can bring down their levels, but you really need to be re-measured after 3 months to see whether the medication and lifestyle measures are working.

Like you, mine shot up in just 6 months, but with hindsight, my diet had slipped, and 2 accidents with fractures meant I was not exercising for almost 20 weeks and had gained weight. Once I addressed the diet and exercise issues I reduced from 57 to 48 in 3 months.

I expect you will need to ask to be re-tested within 3 months of starting the medication. If you think back over the period May-Nov, can you identify issues which may have caused the jump - stress being another major factor? If not already suggested you should ask to go on a Training Course. Others may have additional suggestions.

Your total cholesterol is high but has been fairly consistent. Diabetics are usually advised to get the level below 4. I can't recall if you are on statins - if not you may be recommended to take them.
Best wishes
Click to expand...
Thanks for doing that for me.
Yes I can pin point something(s) that cause huge amounts of stress. I changed jobs and moved to a role and a company that I just don’t enjoy. Also there were a spate of deaths in very quick succession - family members and also friends. It all became too much and I had a bit of a breakdown.
 
Well you've got a lot of information there.
The second image shows your HbA1c in both old and new scales. Some people are still using the old scale (including professionals it appears), while others use the new scale (bigger numbers). So having both can be useful.
Can be confusing though. And they've split the old numbers, with a line showing newer between.
So, you're HbA1c was (new scale):
50; 50; 73 (big jump)
HbA1c (old scale):
6.7; 6.7; 8.8

48 (6.5) is the point at which they diagnose you as diabetic. (Even if you go below this, you're still down as diabetic).

I can never remember which one mmol/L is. I'm guessing the "blood glucose level" is from a finger prick test (I suggest you ask). Although the numbers look similar to the old scale HbA1c, it is telling you something different.
HbA1c is an average covering the last 12 weeks. Finger prick is your level at that moment.
Do you remember having your finger pricked, and a drop of blood being put on a machine?
20200130_193237.jpg
 
ColinUK said:
Thanks for doing that for me.
Yes I can pin point something(s) that cause huge amounts of stress. I changed jobs and moved to a role and a company that I just don’t enjoy. Also there were a spate of deaths in very quick succession - family members and also friends. It all became too much and I had a bit of a breakdown.
Click to expand...
Sorry to hear that Colin
 
ColinUK said:
Thanks for doing that for me.
Yes I can pin point something(s) that cause huge amounts of stress. I changed jobs and moved to a role and a company that I just don’t enjoy. Also there were a spate of deaths in very quick succession - family members and also friends. It all became too much and I had a bit of a breakdown.
Click to expand...
Sorry to hear of your problems. Stress really does affect your diabetes, so I hope you can find some resolution with your work issues. But it's a hard world out there. My cousin's partner was made redundant at 59 from the company he had worked for since he left school, where he was a manager (Management buy-out). He found work driving a food delivery van on minimum wage but was much happier. He made a few suggestions and after a year, they offered him a better job which he also enjoys - that and the staff perks of getting free food samples!!
 
What a jumble that lab report is - categories mixed together etc. And no reference ranges given for the various metrics. It's not designed for patients and probably a lot of docs would find it less useful than it could be, unless eg the carry the normal reference range for calcium etc etc in their heads.

Anyway, a bunch of the numbers are electrolytes/liver function tests. This is very useful for digging into things: https://labtestsonline.org.uk/ Unfortunately, the UK version doesn't give standard reference ranges, saying that they can vary between labs. Here in Oz things seem to be more standardised, and the local version does give reference ranges https://www.labtestsonline.org.au/ Probably broadly applicable to UK results.

I guess one approach for things other than the cholesterol, blood glucose, HbA1c results might be to check yr various numbers against the Oz ranges, and get your doctor to discuss with you anything which looks iffy. Given past performance, I wouldn't be inclined to trust that you would necessarily have been told if anything was out of line.

For cholesterol: as before, nobody here can tell you whether yr numbers are OK or not. This is the tool which HCP's in the UK are supposed to use for assessing CV risk: https://qrisk.org/2017/ (There's a later version: https://qrisk.org/three/ but last I looked NICE hasn't gotten around to adopting it yet.) I'd suggest running it on yrself to get a feel for risk levels.

There isn't, or shouldn't be, a magic risk level which marks a statin/no-statin divide - should come down to clinical judgement by the HCP, informed by the risk calculation, and in discussion with the patient about risks vs benefits and also in the context of potential lifestyle changes. But generally I think statins would become part of the discussion when the qrisk score is >= 7.5%.

A caveat is if you already have significant atherosclerosis or other CV conditions - in which case statins are usually indicated regardless of the risk score.
 
So sorry to hear this news, its shameful how these things can happen.... I had a similar experience after i suffered a kidney stone, where my scan results got lost in the ether and never made it back to my doctor to review, hence i didnt get a follow up/all clear and I thought, stupidly, no news is good news and it was only a co-incidence some months later (when I was taking my late mother to her stone clinic) that her consultant there had a quick look at my scans out of curiosity. He found i had been left with a 90 degree bend in one of my tubes!!! ...you can imagine my shock (But its all fixed now btw! Since then, I always ask the receptionist at my GP surgery for a copy of any blood tests, scans etc etc ive had done. It may be helpful in future that anytime you have bloods done or any other monitoring, get a copy of the results for your own info and peace of mind. It pays to be pro-active in these areas of life.
 
Eddy Edson said:
What a jumble that lab report is - categories mixed together etc. And no reference ranges given for the various metrics. It's not designed for patients and probably a lot of docs would find it less useful than it could be, unless eg the carry the normal reference range for calcium etc etc in their heads.

Anyway, a bunch of the numbers are electrolytes/liver function tests. This is very useful for digging into things: https://labtestsonline.org.uk/ Unfortunately, the UK version doesn't give standard reference ranges, saying that they can vary between labs. Here in Oz things seem to be more standardised, and the local version does give reference ranges https://www.labtestsonline.org.au/ Probably broadly applicable to UK results.

I guess one approach for things other than the cholesterol, blood glucose, HbA1c results might be to check yr various numbers against the Oz ranges, and get your doctor to discuss with you anything which looks iffy. Given past performance, I wouldn't be inclined to trust that you would necessarily have been told if anything was out of line.

For cholesterol: as before, nobody here can tell you whether yr numbers are OK or not. This is the tool which HCP's in the UK are supposed to use for assessing CV risk: https://qrisk.org/2017/ (There's a later version: https://qrisk.org/three/ but last I looked NICE hasn't gotten around to adopting it yet.) I'd suggest running it on yrself to get a feel for risk levels.

There isn't, or shouldn't be, a magic risk level which marks a statin/no-statin divide - should come down to clinical judgement by the HCP, informed by the risk calculation, and in discussion with the patient about risks vs benefits and also in the context of potential lifestyle changes. But generally I think statins would become part of the discussion when the qrisk score is >= 7.5%.

A caveat is if you already have significant atherosclerosis or other CV conditions - in which case statins are usually indicated regardless of the risk score.
Click to expand...

These are the NICE guidelines for cholesterol modification, statins etc: https://www.nice.org.uk/guidance/cg181/chapter/1-Recommendations

However, bear in mind that they seem to be overdue for an update. The NICE surveillance committee made a bunch of update/amendment recommendations in January 2018 which have not been acted upon, for some reason.

https://www.nice.org.uk/guidance/cg...73/chapter/Surveillance-decision?tab=evidence

- Replace the QRISK2 tool with QRISK3.

- "NHS Choices" shouldn't be used as an authoritative recommendation source. (That would include the < 30% of calories from fats, which I don't think any credible international expert group recommends any more; rather, no upper limit on fats in general, but restrict saturated fats.)

- No lower limit to LDL cholesterol for CV benefits - the lower, the better.

- Other stuff.

These changes would bring NICE more into line with latest US guidance, which is what I follow - frankly, it's more detailed and nuanced, and supported by a richer evidence base and analyses.

But a lot of this is really secondary detail, with the risk analysis being much more important, along with the discussion of risk reduction potential vs potential harms.

Another important thing to note is that risk calculation tools all have just a yes/no switch for diabetes: nothing about duration, HbA1c, meds etc. This is pretty clearly inadequate. Diabetes does increase atherosclerosis risk and progression, and it is thought that some of this persists even if the diabetes is excellently controlled. But there will surely be a big risk difference between well-controlled and out-of-control diabetes. And some recent research suggests that if all your markers are in a good range - LDL, BP, BG etc - then in fact a diabetic doesn't necessarily have greater risks. But it's an active research area at the moment.
 
Eddy Edson said:
- No lower limit to LDL cholesterol for CV benefits - the lower, the better.
Click to expand...
I agree, but only because no LDL = death, and you can't have a heart attack if you're already dead.
LDL is essential for life !
 
Diagnosis: Jan 2020 73
Feb 2020: 63

First appointment with the diabetes nurse and she was really pleased. GP said “Your HbA1C is really high” no acknowledgment of the improvement since diagnosis a month ago just criticism - I said it’s come down a long way in a month and he just shrugged. The lifestyle changes I’ve made run counter to his advice too. He again said it was pointless to track my BG levels and that my BP monitor “won’t be accurate because it’s not for doctors”.

The diabetes nurse thought it great that I was tracking BG, BP and weight. She found the tracked results useful. All of my readings were very close to those she got using her equipment.

All he wanted was to double my metformin. I won’t be seeing him again but will make sure I see a GP with a better bedside manner.
 
Forgot to say the nurse did the feet test and was happy. She commented on the softness of my skin and asked what moisturiser I used on my feet!

She’s referring my to one of the training courses - not sure which one. And she’s also referred for the eye tests.
 
Given the HbA1c is an average over three months and your January one was 73 - that will be still affecting your current HbA1c and skewing the result to show a higher reading than if it showed your real situation at the moment.

Keep going as you are going and in a couple of months you will be getting readings in the 40s and maybe even 30s from the readings you are seeing on your BG monitor.

I think the tricky part for people like us who get a massive motivation as soon as we get our diagnosis to change our lifestyles/dietary habits is that we find a way to move forward that isn't just a response to a bad diagnosis but is actually a change we enjoy and want to keep going with because we prefer it to how we were living before.

My nurses ( I don't see the GP for this any more although mine has been mostly helpful) and I've changed them twice because of staffing changes - were at first worried that my excellent control would slip because they see people who treat it like a slimming club and start off very gung ho and then go back to their old ways. But I know and I think my nurse now knows it too - that this isn't going to happen with me because my old ways make me shudder and I so much prefer keto food I would be very upset if I had to go back to eating stuff like milk and sugar and rice and potatoes and pastry and such like. I'm much happier on psyllium husk and cheese and salami and konjac and olives and fatty cuts of meat and green veg etc.

My only 'slips' are introducing crispbread and chocologic chocolate back into my repertoire and I still stay within my 20 - 40g of carb a day limit even on a 'naughty' day.
 
ColinUK said:
Diagnosis: Jan 2020 73
Feb 2020: 63

I won’t be seeing him again but will make sure I see a GP with a better bedside manner.
Click to expand...

What a twit. That's a big HbA1c improvement in a month; not encouraging you to monitor yr own BP is just dumb and goes against all the guidelines I've seen; and showing no interest in yr preferred brand of moisture is just insensitive 🙂

Ditch him and get a better one.
 
There are three GP’s at the practice and I’m going to avoid him going forward.
 
I just did some sums.

Assuming two months at 73 (two months of the previous blood test's 3 months) and one month at 42 (this month since you've been making all the changes)
Thats 73 + 73 + 42 = 188
Divide that by 3 to get a three month average 188/3 = 62.66 which rounds up to 63 !!

So that means it is likely you have got your levels down to 42 as I suspected from the readings you've been sharing here.
And that is an average of 42 over the last month - which means you may be even doing better than that now you've got the hang of how things work.

Doubling the Metformin on those results would be craziness!!
 
NotWorriedAtAll said:
I just did some sums.

Assuming two months at 73 (two months of the previous blood test's 3 months) and one month at 42 (this month since you've been making all the changes)
Thats 73 + 73 + 42 = 188
Divide that by 3 to get a three month average 188/3 = 62.66 which rounds up to 63 !!

So that means it is likely you have got your levels down to 42 as I suspected from the readings you've been sharing here.
And that is an average of 42 over the last month - which means you may be even doing better than that now you've got the hang of how things work.

Doubling the Metformin on those results would be craziness!!
Click to expand...

Pretty much what I said to the doctor, who of course just shrugged.

Repeat bloods in three months.
 
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