Cholesterol

[What the..?]

Hello all, I went to have my three month HbA1c blood test yesterday - with a playful cocktail of excitement and trepidation coursing through my veins. Some of you may recall I've been following the low carb higher fat approach rather than taking the medication prescribed by the GP who diagnosed me (with a reading of 53, so I wanted to try to get it down with diet and exercise). Anyway, I've just got the cholesterol result back, and the nurse talked me through the figures over the phone. Apparently the total figure has gone up from 6.3 to 6.5 (yikes!) but triglycerides are down from 3.07 to 1.94 (whoop! - I think...) LDL is up from 3.9 to 4.2, and HDL is down from 1 to 0.92. Trying to really understand these figures is a bit like wading through treacle for me - if anyone can help with snippets of advice as to why some may have gone up I'd be grateful. The nurse wasn't able to suggest why my 'good' cholesterol has dropped, but was delighted about the triglyceride drop. Would it be wrong to assume the rises are related to the HF part of LCHF? Or I think I read somewhere that sometimes cholesterol goes up because it is, in effect, the bad stuff exiting via the blood stream...I am hoping that's true!
As for the HbA1c, which is what I am desperate to know about, the result came back as insufficient sample, so I have to have it taken again on Monday. It is always like getting blood out of a stone for me, and the person who took it at the clinic beat me black and blue trying to do it, so I'm going to the hospital to get it done. I just wish it was the cholesterol one that was insufficient. The cholesterol confusion wouldn't seem as bad if I knew my blood glucose levels had dropped. Feeling pretty fed up about it.

 

[Bruce Stephens]

You might be amused by Your results may vary: the imprecision of medical measurements (The BMJ)

(All of the results you report are within the expected error ranges so may not indicate any change at all. And the same interactive tool suggests that my HbA1c "increase" from 49 to 54 might also not mean anything.)

 

[What the..?]

Thanks so much Bruce - yes, that is a fantastic eye-opener! And yes, it has just amused me greatly.

 

[trophywench]

You know the figerprick blood glucose meters we use? Well assume the screen shows a reading of 5.0. The meters are allowed to be 10 - 15% out either way - so could really be anything between 4.2 and 5.8 ! Machines used in professional laboratories do tend to read more precisely - but how new is the machine and how long ago was it professionally checked?

I offered to take part in a quality assurance exercise when the UK changed over to reporting HbA1c results by the IFCC method, so we get that in whole numbers now whereas formerly it was quoted as a percentage - so instead of 54 mine would have been 7%. They did this by getting the blood donor centre to extract a pinta same as their normal whole blood collections, then the firm doing the QA whipped the pintas off to base in a coolbox where they divided them up into 300 different sample bottles, retaining 2 for themselves and sent the other 280 off to 280 different labs both here and abroad. They weren't actually interested at all in what the result was - only that they all matched what result they got at base using the first retained sample of the blood.

The blood service do not actually check anybody's BG when you turn up to donate - they still only check for anaemia! I was gobsmacked to discover this in 1972 cos I was diagnosed in the August and had last given blood in the April which I'd done for 4 years since I was 18. So that was the last pint I ever gave normally since T1s are not accepted at all (and T2s can only donate plasm) before this little project when I was over 65 !

 

[everydayupsanddowns]

Hope your HbA1c works next time @What the..?

Did you get another sample taken today? Or could they not do it because it’s Friday (my vampire won’t do bloods on a Friday because they sit around all weekend and spoil).

Great news about the Trigs drop. I gather that can be a proxy for the ‘bad’ gritty vLDL (not all LDL is unhelpful, the body makes at least some of it for important reasons!).

Let us know when your A1c comes through 🙂

 

[AndBreathe]

You might be amused by Your results may vary: the imprecision of medical measurements (The BMJ)

(All of the results you report are within the expected error ranges so may not indicate any change at all. And the same interactive tool suggests that my HbA1c "increase" from 49 to 54 might also not mean anything.)

Interesting find, Bruce.

A couple of months ago, I had 2 blood panels done on the same day; one for my GP's annual "look under the bonnet", relating to my thyroid challenges, and the second, largely different panel, for the metabolic bone clinic I was due to attend.

The blood draws were done by the same hospital phlebotomist, via the same giving set, with the vials filled within a minute or so, then sent to the same lab. The chances are they were processed one after the other. The results showed my Vitamin D levels were 158 - for my GP, and 148 for clinic. Oooooh. Awkward.

Naturally, I challenged the variance with both parties; which resulted in much wafflage, and "Trust me I'm a doctor"-speak from both.

The upshot was a reduction in Vitamin D for a couple of months, to allow both (!) numbers to dip a bit, but no adequate explanation.

Sometimes being an engaged patient is inconvenient (to the professionals). 😱)

 

[Bruce Stephens]

I should note that the first response on that page notes that things are a bit more complex than the tool suggests.

However, as a general principle it's worth being aware that these tests have a bit more normal variation than we'd all like. Sometimes a small change in these test results might not mean anything.

 

[Drummer]

I once had the task of checking micrometers in a factory making cardboard cartons. The whole reason for supervision in a factory making cartons was to get consistency - but half of them could not read a micrometer, half the micrometers were defective and no amount of adjustment could make them give consistent readings, and there were half a dozen men who insisted that I was not competent to even touch a micrometer in the first place. Yes, we did get whole shipments of cartons returned as not in spec.
I suspect that there are devices in laboratories everywhere which ought to have regular checks done on them but I can't really hold out much hope....

 

[What the..?]

Thanks everyone, that's a really interesting conversation - I shan't worry too much, as it's obviously not as accurate as it would like us all to believe. Of course that leaves me with a quandary if my HbA1c levels are 'down'...do I believe it? Hell yes I do, after all the extra exercise and low carb eating I have to have some glimmer of hope! On a more positive note I spoke to a different nurse yesterday (not the one I saw in person who was, shall we say, less than helpful) and she struck me as much more professional and tuned-in, so I'll definitely try to see/speak to her in the future if I have check-ups etc.

 

[What the..?]

Hope your HbA1c works next time @What the..?

Did you get another sample taken today? Or could they not do it because it’s Friday (my vampire won’t do bloods on a Friday because they sit around all weekend and spoil).

Great news about the Trigs drop. I gather that can be a proxy for the ‘bad’ gritty vLDL (not all LDL is unhelpful, the body makes at least some of it for important reasons!).

Let us know when your A1c comes through 🙂

Thanks Mike, I have to go to the hospital on Monday as I don't want to risk going back to the local clinic and having the same thing happen again. I think the longer it took the more rattled the phlebotomist became, thus the 'insufficient sample'. I know from previous experience that the bloods team at the hospital won't be beaten! The nurse who gave me the cholesterol results yesterday did seem pretty relaxed about the LDL rise, which makes me wonder if she knows herself how variable these things can be.