Diagnosis of Type 2

[MJP]

During a recent medical my husband was found to have glucose in his urine. The GP organised a fasting blood test that showed a result of 8.6. The GP said that they wouldn't make a diagnosis based on a single blood test so organised another one. The result of the second test was also 8.6. The GP has still not said that he is diabetic only that the results are "borderline". Can someone tell me at what level of result you are considered to be officially diabetic?

 

[mcdonagh47]

During a recent medical my husband was found to have glucose in his urine. The GP organised a fasting blood test that showed a result of 8.6. The GP said that they wouldn't make a diagnosis based on a single blood test so organised another one. The result of the second test was also 8.6. The GP has still not said that he is diabetic only that the results are "borderline". Can someone tell me at what level of result you are considered to be officially diabetic?

It all depends what kind of blood tests they were - fingerpricks with a meter, Oral Glucose Tolerance Test or HbA1c.

The diagnostic criterion for Type 2 Diabetes are ...

- Two fasting bg tests over 7 ( with a basic meter).
- any random Bg test with a meter over 11.1
- an HbA1c over 6.5
- a score of 11.1 at the two hour mark of an OGTT ( Oral Glucose Tolerance Test)

If it was two fingerprick tests with a meter, 2 fasting results over 7 are enough for dx of Type 2 Diabetes.
If the results were HbA1c test your husband is diabetic ( Over 6.5 on an HbA1c is diabetes).
If the results were from OGTTs then your husband is IGT ( Impaired Glucose Tolerance ). Not diabetic but with serious problems of glucose control.

Can you clarify what kind of tests they were ? Did your husband have other symptoms as well, such peeing a lot and drinking a lot recently ?

Your GP should not mention the word "borderline" in relation to Type 2 Diabetes - the diagnostic criterion are designed to be definitive. It is like saying someone is "borderline pregnant".

 

[MJP]

Thanks for the info.

I think it must have been the HbA1c test. He had to fast for 12hrs and the blood was taken from his arm for both tests. He has had other symptoms (gets out of bed to go to the loo at least two or three times and extreme thirst).
I am concerned because he has also been recently diagnosed with high blood pressure. Despite being in the range of severe hypertension the GP has taken over a month to put him on any medication and then didn't suggest any follow up to see if it was working.
He has got an appt. with the dietician but that is for the hypertension not diabetes. The dietician's appt. is not until 2nd April (10wks after he had been told he had high blood pressure). There just doesn't seem to be any urgency to treat him. There is also a family history of fatal strokes.

If they don't give an official diagnosis of diabetes then there will be no advice or treatment. It is like banging your head against a brick wall trying to get them to do something.😡

 

[Caroline]

MJP your doctor sounds as helpful as mine. I had been going backwards and fowards to my doctor for ages before anything got done. It was only because of something I took part in at work that he relented and did any proper tests and I got a diagnosis. I hope you get some proper help soon.

Although it is not within range 8.6 is not hugely high. My father was told by the specialist that 8 was OK, every time he went for tests he was always round the 8 mark.

When you see the dietician she may be able to advise on a low carb diet that will help.

 

[SimplesL]

Hi MJP

Sounds similar to the blood tests I had. My GP told me as fasting test over 7 on 2 occasions (12.5 & 9) I was a type 2. HBA1c also done on second test came in at 8.9.

I went straight on to meds (metformin & a low-dose statin) Cholesterol was normal but not the right ratio of good & bad stufff. Statin has balanced it out.

Hope you have some progress soon.

 

[mcdonagh47]

Thanks for the info.

I think it must have been the HbA1c test. He had to fast for 12hrs and the blood was taken from his arm for both tests. He has had other symptoms (gets out of bed to go to the loo at least two or three times and extreme thirst).
I am concerned because he has also been recently diagnosed with high blood pressure. Despite being in the range of severe hypertension the GP has taken over a month to put him on any medication and then didn't suggest any follow up to see if it was working.
He has got an appt. with the dietician but that is for the hypertension not diabetes. The dietician's appt. is not until 2nd April (10wks after he had been told he had high blood pressure). There just doesn't seem to be any urgency to treat him. There is also a family history of fatal strokes.

If they don't give an official diagnosis of diabetes then there will be no advice or treatment. It is like banging your head against a brick wall trying to get them to do something.😡

Hello again,

Its not uncommon to have hypertension and Type 2 Diabetes. Four conditions go together (Obesity/overweight, Type 2 Diabetes, Hypertension and high cholesterol). This combination is called the Metabolic Syndrome and an underlying cause is thought to behind all of them.
It is considered best to treat any manifestations of the Metabolic Syndrome in an aggressive manner and get the numbers for each one in range - that might mean looking for a new GP.
What your OH can do ,if he is overweight , is start loosing some pounds - even a 10% reduction in bodyweight improves Insulin Resistance and thus bgs considerably.
And don't be too hopeful - even an Official diagnosis might well bring some treatment but probably precious little advice.

 

[Northerner]

During a recent medical my husband was found to have glucose in his urine. The GP organised a fasting blood test that showed a result of 8.6. The GP said that they wouldn't make a diagnosis based on a single blood test so organised another one. The result of the second test was also 8.6. The GP has still not said that he is diabetic only that the results are "borderline". Can someone tell me at what level of result you are considered to be officially diabetic?

Hi MJP, welcome to the forum 🙂 As has been said earlier, two fasting tests of 8.6 (or HbA1c, if that's what they were, but I think unlikely as they measure a sort of average blood glucose level over the previous 6-12 weeks, and there would be little point in having two such tests close together) suggest a firm diagnosis of diabetes - not 'borderline', as there is no such thing and a poor use of terminology. Some doctors will also talk of 'mild' or 'severe' diabetes, which is also wrong - diabetes is diabetes!

I think that the best approach would be to consider your OH as having had a firm diagnosis and to begin making the changes to diet and lifestyle that that would bring with it in order to improve his blood sugar control. It would be worth getting a copy of Type 2 Diabetes: The First Year by Gretchen Becker - highly recommended by many of our members as the best introduction to understanding diabetes and what it entails. Regular exercise, whatever he enjoys and can manage, will help enormously. I'd also recommend getting a blood glucose meter so that you can monitor the effects of different foods on his levels - an explanation of how to do this is explained in Test,Review, Adjust by Alan S and you can get a free meter by going to http://www.abbottdiabetescare.co.uk/free-meter-signup (but be warned that the test strips are not cheap). You'll find lots of other good information in our 'Useful Links' thread, so have a browse, and please ask us any questions you may have and we'll do our best to help out!

 

[pippaandben]

When I was first diagnosed I felt I was getting little or no help from GP so took myself to the Diabetic Clinic at the hospital - "just to get as much information as I could". Told them the test results - which they could also access directly on their computer system. The result was they gave me an urgent appt despite officially needing to be referred to them by the GP. They also wrote to my GP asking for an official referral and told him he should be treating my cholesterol (7.6) as a matter of urgency as well and not wait from BG to get under control . So after only 6 weeks on statins now 3.9!! Might be another avenue for you to explore

 

[RachelT]

My mum's in a similar situation, she went for a "free" check up (am confused since all check ups are free arn't they?) because she's over a certain age, and then kept having to go back for blood tests and blood pressure tests only to be told that she's on the diabetic "list" and is now entitled to free eye tests and has to go for the review and have retinopathy scans but not to worry too much about actually being diabetic, just try and get more exercise. It doesn't bother her much, they asked her if there was a history of diabetes in her family and she said "yeah, my mother, grandmother (or possibly great grandmother, i forget) and daughter have it.". She's on ramipril for high blood pressure but nothing for diabetes. It's just kind of frustrating that nobody seems prepared to commit themselves either way on the subject of her health.
Unlike muggins here who was simply asked "how long have you been diabetic for?" when the answer was "eeek! i didn't know i was!" and prompt put on metformin.

 

[Ellie Jones]

Doc is right it does take more than one set of bloods tests to really determine whether somebody is T2 or not, because an infection or unusual levels of stress can temporary raise blood glucose, so any underlying infections and/or stress need to be ruled out and second lot of bloods done..

8.6 is not good either for an HbA1c or a fasting finger break blood glucose test...

It might be wise if he speaks to another doctor in his practice and discuss his concerns and get them to explain what tests they did and the results etc...

Borderline diabetes or sometimes referred to pre-diabetes is a bit of a smoke screen for insurance companies... When Who was determining at what point somebody was classed as diabetic... Part of the discussion was the effect it would have on somebody's medical, life insurance etc... As soon as somebody is diagnosed with diabetes this has impacts on their insurances a major problem if you'll American etc.. So it was decided that they would raise the bar a little for a definite diagnoses, and fudge the lines with borderline/pre-diabetes...

Another good thing about this fudge line... It can encourage those who problems is based around weight issues to change their lifestyles to keep their diabetes at bay and within a lower long term healthier area...

 

[Vicsetter]

Not that I'm a GP but an HBA1c of 8.6 is equivalent to 11.1 blood glucose finger reading. with 2 of those (not one Ellie) and the symptoms of thirst and bedtime pees I have no doubt he should be on metformin now.
I would also be worried that seeing a dietician for high blood pressure (you don't say how high, MJP) without reference to glucose levels will and up with the wrong diet. I should ask for a second opinion.

 

[snow-white]

Not that I'm a GP but an HBA1c of 8.6 is equivalent to 11.1 blood glucose finger reading. with 2 of those (not one Ellie) and the symptoms of thirst and bedtime pees I have no doubt he should be on metformin now.
I would also be worried that seeing a dietician for high blood pressure (you don't say how high, MJP) without reference to glucose levels will and up with the wrong diet. I should ask for a second opinion.

Hi Vicsetter, I'm interested in what you are saying about "an HBA1c of 8.6 is equivalent to 11.1 blood glucose finger reading" - I didn't know this. I am recently diagnosed also, and my average daily readings are about 9-9.5 - what would this roughly equate to in HBA1C?

Snow-white

 

[novorapidboi26]

my average daily readings are about 9-9.5 - what would this roughly equate to in HBA1C?

7.5% maybe, depends when you have tested............😉

 

[everydayupsanddowns]

There are a number of A1c estimation formulae (take your pick!). Essentially they are only as accurate as the spread of results and the variation of the meter. If you have a good range of premeal and postmeal readings (ie you are catching most of your high and low readings as well as all your 'best ones') they can give a reasonable guesstimate, but they are never to be relied upon.

The one I tend to use is:

Estimated HbA1c = (AvgBG+2.52)/1.583

Which has worked well some times, and not so well other times (I think my new Contour meter is a little 'kinder' in that it tends to read a bit lower for me than my old Expert).

Using that conversion yours would be around 7.3% - 7.6%

 

[snow-white]

Thanks!

I test before every meal and 2 hours after every meal using an Accu-check meter and I do get the high and low readings (unfortunately )

My HBA1C 3 weeks ago was 9.5 and I'm not on any meds yet - doc wants me to try controlling it with diet for 3 months, so it looks like I might be heading in the right direction.

Thanks for the advice!

Snow-White

 

[Vicsetter]

I used : http://www.diabeteschart.org/intlbgchart.html but does seem a bit high, my GP used to say 6.5% equates to average of 8mmol so everydays formula Estimated HbA1c = (AvgBG+2.52)/1.583 is roughly correct, although I don't look at the average on my meter, just do a rough guess on fasting lows and 1 hour highs, sort of.

What diet have you been recommended snow-white? Interesting approach as I thought GPs were keen to give out metformin as soon as diagnosed.

 

[snow-white]

I used : http://www.diabeteschart.org/intlbgchart.html but does seem a bit high, my GP used to say 6.5% equates to average of 8mmol so everydays formula Estimated HbA1c = (AvgBG+2.52)/1.583 is roughly correct, although I don't look at the average on my meter, just do a rough guess on fasting lows and 1 hour highs, sort of.

What diet have you been recommended snow-white? Interesting approach as I thought GPs were keen to give out metformin as soon as diagnosed.

I've not been recommended any diet Vicsetter. A friend at work was diagnosed T2 last year and he has given me a lot of advice and I've looked on the net also.

I bought a meter before I was diagnosed (my friend done a few tests using his meter on me and they were 12-15 each time) and my readings initially were about 11-13 - one night it was 17. I started keeping a diary of what I was eating and showed my GP when I was diagnosed - I think this is what made her decide on trying the diet route first.

I am basically just doing a low-carb diet - it's difficult though when I don't really like salad and veg!

My cholestoral is high too (7.5) and BP also. Strangely enough I am not much overweight (only 6 or 7 lbs).

This is all very new to me and all the information I am getting is much appreciated.

Thanks

 

[MJP]

Thank you all for the info and suggestions and making me feel immediately welcome.
My husband has a BMI of 12.8 so is not considered overweight. As he has already seen 4 of the 6? doctors at the practice I don't think a second, third or even fourth opinion has helped much. Despite them all having access to his records via their computer system every appt. seems like the first again. None of them seem to realize what the previous doctor has already done or not done. His BP seems to be coming down now after he asked for a change of medication last week. When he went today another doctor suggested increasing the dose again until he told her that that had only been done a week ago. Also last Thursday he was told they wanted to do a 24hr ambulatory BP test and the nurse would phone him to arrange it in a couple of days. Nobody called. Today a different doctor suggested a 24hr test as if it had never been mentioned before. The earliest they can do it is May 10th! I am worried that the dietician will suggest a diet relating only to his BP and not his (unofficial) diabetes.
Unfortunately my husband believes that they must know what they're doing because they are the "experts". He won't let me go with him because he thinks I will embarass him by making a fuss. If it was me they were supposedly treating I would have made an official complaint to the practice manager by now.
Anyway rant over for the day and thank you all again for your help. I expect i'll be back with more questions in the coming weeks.

 

[Mark T]

...BMI of 12.8 so is not considered overweight...

Was that a typo? 12.8 would be classed as dangerously underweight!

 

[MJP]

Sorry, don't know where that came from😱. His BMI is 24.8.