Other reasons for high hba1c results

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Billy boy

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My wife recently fell ill and ended up on a high dependency unit at our infirmary on a covid ward where she spent 10 days with covid pneumonia, on steroids, morphine and antibiotics. On the day she went into hospital a blood test was done but the results were not given. About two weeks after her discharge she was requested to provide two ‘follow up’ blood tests, a fasted test and two days later another after eating. Over a week after what would have been the third test, we were contacted by our GP surgery and told that the first test, when she was admitted to hospital, was ‘high’ and that a reading of 67 for the fasted and 76 for the last test had been recorded. Long story short we are ‘in between‘ GP’s but my wife was asked to visit the diabetic nurse to discuss the issue, however that appointment was cancelled because on that day she was no longer on their patient list. My wife was told to collect a booklet on diabetes from the surgery and ‘oh by the way‘, a prescription for Metformin had been prescribed to be collected from our pharmacy.

Apart from the way my wife has been treated by the GP, my question is, bearing in mind my wife is 63, has had not one ‘typical’ diabetes symptom and wouldn’t have known her readings were high if she hadn’t been taken I’ll and ended up in hospital, is it possible that the high readings are as a result of her serious illness not two weeks prior to the last two blood tests as I have read that serious illnesses such as pneumonia can cause high blood glucose readings. I appreciate that the hba1c test results relate to the previous three months but she has just started taking the metformin with no GP or specialist input about diet, exercise etc. and we are concerned the hba1c results may not be a true reflection of her current status.

Many thanks
 
Has she been offered another HbA1C in a few months @Billy boy ? It’s possible her illness contributed but it’s also possible she had issues before that were only revealed by the blood test. Many Type 2s have no symptoms because the condition creeps up on them gradually.

If I was her, I’d get my own blood glucose meter so I could keep an eye on things at home. I’d also ask for another HbA1C in 3 months if possible. Anything above 48 is diabetes so her HbA1C is definitely into the diabetes zone whatever the cause.
 
We are in between doctors at the moment hoping to be registered with a new practice in the next week. Hopefully they will look into this and another hba1c test will be done within three months of the last test. We were just concerned that she has been given metformin with no medical input whatsoever and, IF she isn’t diabetic, that it cause her problems. BTW she only started taking one 500 mg tablet from last Thursday....
 
Hello @Billy boy and welcome to the forum.
I'm sorry to hear your wife has been so unwell, but hopefully on the mend now.

As I understand it people who have ended up on high doses of steroids due to covid do tend to develop diabetes. Fingers crossed with a controlled Carbohydrate diet your wife's numbers will go down. I would send in an email to your GP practice and basically say help as her after care leaves a lot to be desired and Covid is not really an excuse.
 
Steroids are known to raise BG.
But metformin isn't likely to cause any problems however, so until things settle down, as @Inka has said, simply keep an eye on it.
 
I've just been looking at the information leaflet that came with the tablets ( I know we should have read it earlier ) and it states the medication is for “the treatment of type 2 diabetes when diet and exercise changes alone for 3 to 6 months have not been enough to control blood glucose”

First point is, until she became ill which prompted the blood tests, (and I appreciate you can be diabetic and show no symptoms) she has had no symptoms whatsoever, and if she had not had the blood tests we would be none the wiser.

Secondly, the fact that even if she is diabetic (given the advice on the medication leaflet) she has not had the opportunity to try a diet and exercise regime initially (which to be fair we both need to address) to see if that has any effect due to none existent medical advice from a GP or specialist nurse.

We have discussed the situation and, subject to being registered with a new practice hopefully in the next week or so, as she has only taken 4 tablets so far, she is going to cease taking anymore until we can speak to a doctor and discuss her options.
 
No one on here would ever comment on medication or medical advice.
 
Billy boy said:
Secondly, the fact that even if she is diabetic (given the advice on the medication leaflet) she has not had the opportunity to try a diet and exercise regime initially (which to be fair we both need to address) to see if that has any effect due to none existent medical advice from a GP or specialist nurse.

We have discussed the situation and, subject to being registered with a new practice hopefully in the next week or so, as she has only taken 4 tablets so far, she is going to cease taking anymore until we can speak to a doctor and discuss her options.
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I would suspect the the Metformin was issued due to the last A1c being 76. Which equals an average of about 10.1 which is roughly double what it should be. So yes I can understand why it has been issued.
 
I think you really do need to get registered with a new GP and for your wife to have a repeat HbA1c ASAP. In the meantime you can help yourselves by addressing your diet and exercise. Many Type 2 benefit from reducing their carb intake - that's things like bread, potato, rice, pasta, pastries, cakes, sweets, some fruits etc. I suggest you read the orange tab Learning Zone for Type 2, particularly the sections for food and exercise.
I was ill for 4 months (not COVID but a very persistent infection) and it played havoc with my glucose levels. There are posts on the forum discussing the effect of illness on blood glucose as well.
Metformin can cause bowel issues, so if your wife is affected, she will wish to speak to someone about that - trying the diet exercise option, or a slow release version if medication is actually required. Best wishes
 
Pumper_Sue said:
I would suspect the the Metformin was issued due to the last A1c being 76. Which equals an average of about 10.1 which is roughly double what it should be. So yes I can understand why it has been issued.
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...but surely diet and exercise would have been a consideration before going straight on metformin without any consultation with a GP or nurse...
 
Felinia said:
I think you really do need to get registered with a new GP and for your wife to have a repeat HbA1c ASAP. In the meantime you can help yourselves by addressing your diet and exercise. Many Type 2 benefit from reducing their carb intake - that's things like bread, potato, rice, pasta, pastries, cakes, sweets, some fruits etc. I suggest you read the orange tab Learning Zone for Type 2, particularly the sections for food and exercise.
I was ill for 4 months (not COVID but a very persistent infection) and it played havoc with my glucose levels. There are posts on the forum discussing the effect of illness on blood glucose as well.
Metformin can cause bowel issues, so if your wife is affected, she will wish to speak to someone about that - trying the diet exercise option, or a slow release version if medication is actually required. Best wishes
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...I note that your hba1c levels shot up as a result, it would seem, of infection. As I said initially, my wife had a test on the day she was rushed into hospital with pneumonia having been ill for about a week prior to this and the two follow up tests were done within two weeks of discharge while recovering from the pneumonia...
 
Billy boy said:
...but surely diet and exercise would have been a consideration before going straight on metformin without any consultation with a GP or nurse...
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I think different healthcare professionals take a slightly different approach and some seem more likely to recommend medication earlier than others. However people also come to a diagnosis with diabetes at different stages - some only just over the threshold of 48, and some in 3 figures. So it is not uncommon for newcomers on the forum to have been offered medication straight away.
 
Billy boy said:
...I note that your hba1c levels shot up as a result, it would seem, of infection. As I said initially, my wife had a test on the day she was rushed into hospital with pneumonia having been ill for about a week prior to this and the two follow up tests were done within two weeks of discharge while recovering from the pneumonia...
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A couple of things to bear in mind
- HbA1C is an indication of blood sugar levels over the last 3 months so a high level due to pneumonia on the day of the test would have little impact unless your wife had been ill for a long time.
- Whilst illness causes a rise in blood sugars for someone with diabetes (or pre-diabetes), someone with a healthy pancreas would be able to manage the glucose dump from their liver by releasing the appropriate amount of insulin so would not see a significant rise in their blood sugar levels.

A diagnosis of diabetes is a shock but many people have taken it as the nudge they need to make improvements to their lifestyle. Disappointingly, doctors often do not have the time to work with all of their diabetic patients so dish out pills straight away. But that does not mean you and your wife cannot improve your lifestyle in parallel with the medication - I believe metformin has been found to have additional health benefits.
 
I was tested and then retested as apparently the gold standard for diagnosis is two tests over 48. Mind you, the doctor wrote out a script for metformin after the first test, I collected the meds after my second test and started them as soon as the second test results came back. I wanted to get my BG back to normal so happily took the drugs. Once back to normal I discussed with the GP and with the positive changes I had made in my life style he agreed I could stop taking them. I've been fine ever since. Exercise, lower carb intake and weight loss got my BG under control and made me fitter and healthier than I have been in years.
 
helli said:
A couple of things to bear in mind
- HbA1C is an indication of blood sugar levels over the last 3 months so a high level due to pneumonia on the day of the test would have little impact unless your wife had been ill for a long time.
- Whilst illness causes a rise in blood sugars for someone with diabetes (or pre-diabetes), someone with a healthy pancreas would be able to manage the glucose dump from their liver by releasing the appropriate amount of insulin so would not see a significant rise in their blood sugar levels.

A diagnosis of diabetes is a shock but many people have taken it as the nudge they need to make improvements to their lifestyle. Disappointingly, doctors often do not have the time to work with all of their diabetic patients so dish out pills straight away. But that does not mean you and your wife cannot improve your lifestyle in parallel with the medication - I believe metformin has been found to have additional health benefits.
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We bought a accu-Chek blood glucose meter today from boots. The wife had toast and cheese spread for breakfast, a sausage sandwich in Costa coffee about half past eleven, then a banana at half past one. We did a test at a quarter past three and the Reading was 6.5 mmol/l, she started on metformin last Thursday so has had four 500mg tabs...
 
The problem food for diabetics is carbohydrate. The body rapidly breaks down carbs into glucose. This includes bread, pasta, potatoes, rice etc. as well as the obvious sugary and sweet things. Tropical fruits also tend to be high in sugars. The trick to managing diabetes is to reduce the portions of carby things in the diet. From the menu you posted there was bread for breakfast, bread at costa, and carbs in the banana. Try testing before she eats and then again two hours afterwards. Ideally you are looking for a rise of no more than 2 mmol/l and a reading under 8.5 so the 6.5 two hours after the banana looks ok.
 
Billy boy said:
We bought a accu-Chek blood glucose meter today from boots. The wife had toast and cheese spread for breakfast, a sausage sandwich in Costa coffee about half past eleven, then a banana at half past one. We did a test at a quarter past three and the Reading was 6.5 mmol/l, she started on metformin last Thursday so has had four 500mg tabs...
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Just done another test at six o’clock, two hours after she ate a chicken breast, a portion of whole grain rice, a piece of garlic bread roll and a satsuma...it was 13.2!!!
 
Billy boy said:
Just done another test at six o’clock, two hours after she ate a chicken breast, a portion of whole grain rice, a piece of garlic bread roll and a satsuma...it was 13.2!!!
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Whilst that is a quite a carb heavy meal and it would push many Type 2 diabetics levels up that high, I would ensure her hands are very clean and retest. A trace of juice from the satsuma on her fingers could easily compromise the result.
 
rebrascora said:
Whilst that is a quite a carb heavy meal and it would push many Type 2 diabetics levels up that high, I would ensure her hands are very clean and retest. A trace of juice from the satsuma on her fingers could easily compromise the result.
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She did wash her hands prior to the test. Just wandering if anything else could have caused the leap. Is the two hour window after a meal always the best time to test?
 
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