confused

[daxsmith05]

Hi I am type 2 and have a HbA1c of 45 but have sugar readings above 11.1 in the evenings mostly and verified in one case with a level of 12.0 and 11.9 on 2 seperate glucometers and another reading off 11.7 and thats inconsistent with my HbA1c as I suspect a reading of 10.8 may be also. I take many pills prescribed and a few supplements almost all affect blood sugar levels downward and one in particular is said to reduce the HbA1c level by 3 points, but the NHS definition of prediabetes is below 48 "without diabetes meds" but doesn't allow for other meds that cause such large differences. Is this another mistake on NHS website (have already found 4 others) So am I diabetic or prediabetic

 

[Leadinglights]

An Hba1C of 45 would be regarded as pre-diabetes or at risk but as it is a 3 month average of blood glucose any high or low levels will tend to even out so the high blood glucose levels you are seeing in the evenings are most likely to be the result of the meal you have eaten which is too high in carbohydrate for your body to cope with. In a test which is an average it will be compensated for by lower levels at other times of the day.
I would have a look at what you are having for those meals where you see blood glucose levels 2 hours after eating which are above 8.5mmol/l and are more than 2-3mmol/l more than your before meal reading.
Once diagnosed as diabetic then even a HbA1C in the prediabetic range would not mean you were not diabetic.

 

[daxsmith05]

My previous result was 54 and was diagnosed as diabetic. I only eat in the morning I believe its because the medication that reduces by 3 points is taken in the morning and has worn off. I usually take my blood reading at 6-9 am as I have multiple conditions (over 20) and one requires a test between 6 and 9 and is usually a lot lower

 

[Lucyr]

If your A1c of 45 is whilst taking medication for diabetes then you are diabetic. A prediabetic would sustain an a1c below 48 without any diabetes medications. What medication do you take?

 

[daxsmith05]

its not diabetic medication and a prediabetic maximum blood glucose is 11.0 my readings are above that so I am both diabetic and prediabetic depending on which you go by the A1c or the readings of blood glucose

 

[Drummer]

Once you are diagnosed as type two then that will remain your diagnosis, though if you can reduce your Hba1c and maintain the reduction in normal numbers then many people are then classed as in remission.

 

[daxsmith05]

normal numbers quoted as <48 but actually normal numbers are well below 48 like 41 or 38 depending on which country. Had the NHS accepted the numbers as below 39 as some do I would have known over 2yrs before diagnosis and could have started lifestyle changes which were delayed thus being diagnosed much later than should have been. Many countries say below 47 for prediabetes and below 39 as normal this is more accurate!

 

[rebrascora]

Curious to know what medication and supplements you feel are reducing your levels? Mostly we hear about things like steroids increasing it. And then there are a lot of potential "snake oil" purveyors making claims about natural remedies to lower levels and/or "cure" diabetes, which many are rightly skeptical of.

As has been said, once you get an HbA1c over 47 you are diabetic for life I believe. If you manage to reduce it again into prediabetic range or even below 42, into the normal range categorized here in the UK, then you have pushed it into remission but you are still considered diabetic. There are perceived advantages to that in that you continue to be monitored with the various health checks.

 

[Burylancs]

its not diabetic medication and a prediabetic maximum blood glucose is 11.0 my readings are above that so I am both diabetic and prediabetic depending on which you go by the A1c or the readings of blood glucose

You were diagnosed as T2 with 54 and that's for life. Your numbers will go up and down depending on control, the current 45 doesn't change the diagnosis. Forget talk of 'pre-diabetes' - it's irrelevant to you now.

 

[daxsmith05]

the UK range is rather high should be equal or above 47 and equal or above 39
I take turmeric, stable allicin, garlic, cinnamon and multi strain probiotic and medical evidence shows the first and last have a significant mpact and the meds all lower it total of 5 different meds (the others are quoted as having a minimal effect).
The damage from high glucose starts at a level of 39 and increases by a larger amount as your HbA1c goes up.
The prediabetic range goes upto 11.0 and readings above this are not in the prediabetic range therefore I believe the NHS statement is incorrect as I know of at least 2 meds one I am on that reduce it by 3 or more points therefore I believe they are wrong in their statement and the readings seem to prove it.

 

[rebrascora]

The damage from high glucose starts at a level of 39 and increases by a larger amount as your HbA1c goes up.

I don't think this is a reasonable statement.
I think there may be a very slightly increased risk of damage at 39 but probably a lot less than many other things were we happily accept risk, like crossing the road or driving a car.
As a Type 1 diabetic I am extremely unlikely to be able to manage my diabetes so strictly to get an HbA1c of 39 or less, otherwise I would be hypo a lot of the time. My consultant is extremely happy if I can manage to get an HbA1c of 52. I was 112 and 116 at diagnosis and it took me over a year to get down to these "good" levels. I am not worrying about what damage that may have caused. (Edited to add... but I think it is likely to be considerably higher than the extremely minimal risk of having an HbA1c of 39 for the rest of your life.) Most Type 1s and some Type 2s experience these very high levels and coming down slowly from them is actually safer than reducing them rapidly)
I have some amazing technology to help me improve my diabetes management which my uncle and his generation never had, but many of them survived well into old age despite occasional DKA comas and hypos. He survived and remained pretty fit for 60 years with it and died well into his 80s and still had both his feet and sight at that time.
HbA1c is the same for all of us regardless of Type of diabetes since it is an indication of our average BG levels over the course of the lifetime of our red blood cells.
I am not saying that it wouldn't be a good plan to aim to get your levels below 39 and maintain them there if you are able but to say that damage from high glucose starts at this level is an over exaggeration of the situation in my opinion and very negative.
The level at which pre-diabetes is considered to start and even diabetes itself is somewhat arbitrary and I certainly wouldn't get too hung up on a couple of mmols/mol either way as there is always a level of error involved in any testing
anyway.

I also wonder why, if turmeric is so effective at reducing levels, the Asian community has an increased risk of diabetes since their diet is usually rich in the spice. I think there is a lot of misinformation and some good marketing involved in many of these "natural" remedies/supplements and personally I am a sceptic. Pleased you feel it is working for you though.

 

[Docb]

Hi @daxsmith05 and welcome to the forum. Yes, it seems that you are confused! Not unusual with people who are newly diagnosed and most of us have been there.

In your first post you mention spot readings - blood glucose level measured on a meter from a drop of blood obtained by pricking your finger - and a HbA1c measurement. There are very different things and great care should be taken in comparing one with the other.

Spot readings vary a lot in anybody, whether they have a diabetes diagnosis or not. The biggest thing that affects that reading is what you have eaten and how long after you have eaten that you take the reading. I can think of circumstances when somebody without a diabetes diagnosis could get readings in double figures. So, it is possible that your readings are consistent with your HbA1c. I am not saying for certain that it is, but you need a lot more information to make a decision.

HbA1c smooths out the ups and downs that occur naturally, not by measuring how much glucose is floating around in your blood, but by how much is stuck to your haemoglobin. It tells you something about your average blood glucose over the last few months. The higher the number, the higher the average. The convention is that once it gets over 48, a formal diagnosis of diabetes is made. In reality what it means is that your average blood glucose has been at a level where the risk of causing damage is high enough to warrant taking remedial action. The urgency depends on the number. In the 50's you have time to take things at a sensible pace. At 150 you would probably be shunted off to hospital PDQ to get some fast action.

In my view worrying about whether the diagnosis level should be 47 or 48 is not helpful. I don't know what the reproducibility is but to all intents and purposes, they are effectively the same. You have to set a limit somewhere and 48 is what is used in the UK and to me that is fair enough. The idea of using the "at risk" category sort of reflects the imprecision in the number.

I suggest you have a hard look at the claims about the various supplements you are taking when it comes to their effect on blood glucose levels. Are any of them backed by evidence that stands scrutiny? Most of us who have looked hard at the claims find them unconvincing.

I know there is a lot to get your head round and sort out in the beginning, but I really do think that a better starting point is to accept the conventional wisdom and work from there. A lot of knowledgable people have spent a lot of time devising the NICE guidelines on which the NHS approach is based. You need a lot of hard evidence to challenge it effectively.

 

[daxsmith05]

I check with medical research so it is hard evidence I have 25 medical conditions and on several of them I know more than most Drs. I have only met one dr who knew more about diabetes than me and I have had to explain type 1.5 to a dr before. I have never met a dr. who knew more than me about PKU (Phenylketonuria) as I have been researching it for years now having been born with it and I taught a psychiatrist facts he didn't know about schizophrenia. I research thoroughly and the medication that lowers HbA1c by 3 points isn't a supplement but is more effective than a single dose of 500mg metformin but is for a different condition but there are others that reduce it by more (such as tramadol.).
This is (as most of my research) from medical research and also medical journals.
The prediabetic range is upto 11.0 so readings above are inconsistent with the HbA1c.
Incidentally its not the average of 2-3mths as 50% of the HbA1c is from 25-35 days previous and 80% from just over 2 months. Red Blood Cells live for approx. 120 days but are removed during this time so a proper average is not possible but its the best tool we have other than a CGM which are more expensive at over £50 for only 2 weeks worth of readings.

 

[daxsmith05]

I also have a diabetes diagnosis but want to ensure the Dr. doesn't remove me from eye checks etc.
I have my own podiatrist as thats not provided in our area

 

[daxsmith05]

Also the NHS guidance is often about saving money rather than clinical wisdom as I am sure most people will have noticed around 10% of the budget is spent on diabetes in some countries and I assume its similar here

 

[daxsmith05]

I am having HbA1c checked privately by a lab with reduced meds and no supplements for 8 weeks but a 4% weight loss

I should have results within a few days, I expect it to rise but don't know how much.

Incidentally I recommend Orlistat I tried it twice for a matter of weeks and the results were amazing!!

 

[daxsmith05]

Have had a result from a blood HbA1c meter that arrived in the post an is above 48 so I believe I have proven that the meds & supplements do alter the readings substantially. I assume the lab test will have a similar result and have restarted the supplements (but have not increased the medication back to original dose).